bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical decison making and knee arthroscopy
Authors: Derrett Sarah , Walley Gayle , Bridgman Stephen , Richards Paula , Maffulli Nicola
Published: January 2011

Objectives

This study aimed to identify decisions made by orthopaedic surgeons about whether patients on a waiting list should proceed to arthroscopy, and to describe surgeons' decisions.

Methods

Surgeons were asked to think aloud as they made their decisions as the clinical management for patients from a previous randomised controlled trial (RCT) looking at the use of MRI for patients on a waiting list for knee arthroscopy. Audiotapes of the decision making were transcribed for analysis.

Results

Surgeons agreed about proceeding with arthroscopy for five patients, although reasoning differed. In no cases did surgeons agree about not proceeding to arthroscopy. However, more súrgenos decided not to proceed to arthroscopy than to proceed. Patients with clinically diagnosed with osteoartritis were less likely to be cosen to have arhtroscopy than those with meniscal abnormalities for which the general consensus was to proceed with arthroscopy..

Conclusions

There tended to be disagreement between súrgeons about proceeding with arthorscopy when osteoarthritis was diagnosed clinically. Surgeons decisions did not reflect the decision making as reflected in the original RCT. Surgeons' decisions were influenced by patient wishes. For some patients, the decision to proceed with arthroscopy was based solely on clinical diagnosis; MRI may not be advantageous in these instances. This study has implications for decision making in the current NHS patient choice environment. Patients may choose a treatment provider from a list of available providers at time of original clinical assessment and diagnosis. However, the treating surgeon does not necessarily re-examine the patient until the day of surgery. Given the variation between surgeons about the merits of proceeding with arthroscopy, surgeons may end up in the invidious position of providing surgery to patients whom they do not believe will benefit from arthroscopy.
The use of epcs (endothelial progenitor cells) for the regeneration of the musculoskeletal system and the spine
Authors: Keramaris N C , Tsiridis E , Malliaropoulos N , Kostakos A , Topkas A , Pnevmatikos S , Papagellopoulos P J , Sapkas G
Published: January 2011

Introduction

Endothelial progenitor cells (EPCs) are cells that can differentiate into endothelial cells in vitro. Their importance lies on the fact that vasculature has a cornerstone role in the healing process after injury of the musculoskeletal system and of the spine. The main target of this review is to clarify whether EPCs could be a viable alternative of mesenchymal stem cells for musculoskeletal regeneration.

Methods

The literature search was performed via the internet using the Medline, Scopus and Cochrane database. The key words which were searched in the abstracts were the terms ‘EPCs’, ‘bone’, ‘spine cord’, ‘cartilage’, ‘menisci’, ‘ligament’, ‘tendon’ and ‘healing’.

Results

Three papers reported that EPCs can differentiate into osteoblasts in vitro. In a fourth paper, EPCs were used in an in vivo model in order to enhance the fracture healing in a non-union animal model. A fifth paper implies that fracture may induce mobilisation of EPCs and recruitment of the mobilised EPCs into fracture sites. Another two papers showed that local transplantation of EPCs with atelocollagen scaffold is a feasible strategy for therapeutic vasculogenesis and osteogenesis needed for fracture and ligament healing. Another paper suggested that co-transplantation of hematopoietic and mesenchymal stem/progenitor cells may improve the regeneration of vascular dependent tissues such as bone, adipose, muscle and dermal grafts. Two papers reported stimulating results for the use of EPCs for spine cord regeneration.

Discussion

The importance of EPCs for the healing of both musculoskeletal tissue and spine is based on the advantages of this cell population for regeneration purposes: (1) relative abundance, (2) isolation by the circulation, (3) new insight revealing new mechanisms
Small leucine rich proteoglycans (SLRP's) expression in skin, tendons and capsules of athletic population after shoulder dislocation and ACL injuries
Authors: Akhtar M A , Ingman T G , Robinson C M , Keating J F , Muir A Y , Simpson H , Salter D
Published: January 2011

Introduction

Cruciate ligament ruptures and shoulder dislocations are often caused by trauma, but predisposing intrinsic factors might also influence the risk. Decorin and biglycan are members of the small leucine rich proteoglycans (SLRP's) family which are important constituents of interstitial extracellular matrices (ECM) and play important roles in the regulation of collagen fibrillogenesis. Their deficiency could influence wound healing and integrity of skin and muscle. The aim of this study was to localise Decorin and Biglycan in skin, hamstring tendons and shoulder capsules.

Patients and methods

Localisation of decorin and biglycan was studied by immunohistochemical staining of paraffin embedded sections of skin, tendons and capsules of the patients attending for shoulder stabilisation or anterior cruciate ligament (ACL) reconstruction between November 2008 and July 2009.

Results

40 patients were studied, 25 undergoing primary ACL reconstruction and 15 undergoing shoulder stabilisation. The mean age of patients was 26 years. 34 patients (85%) were male and 6 female (15%). Most common sport played was football in 13 patients (32%) followed by rugby in 10 (25%) and skiing in 5 (12%).

Skin epidermis, blood vessels, sweat glands, sebaceous glands and arrector pilli stained negative but dermis stained positive to varying degrees for decorin. Synovial surface of the capsule, blood vessels and skeletal muscles stained negative but ECM was positive to varying degrees for decorin. Tendon sheath and collagen fibres in ECM stained positive to varying degrees but skeletal muscle stained negative for decorin.

Skin epidermis, blood vessels, sweat glands, sebaceous glands and arrector pilli and dermis stained positive for biglycan to varying degrees. Synovial surface of the capsule, blood vessels and ECM stained positive for biglycan to varying degrees. Tendon sheath stained negative but collagen fibres, blood vessels and skeletal muscles stained positive for biglycan to varying degrees.

Discussion

We looked at the expression and distribution of decorin and biglycan in skin, tendons and capsules of patients undergoing shoulder stabilisation or ACL reconstruction following sports injuries. There may be a link in the distribution of these SLRP's and strength of tissues, which can predispose individuals to injuries while playing sports and can also affect healing process. Further studies are needed to study this link.
Physiotherapy for prevention of lower back injuries in wrestling
Authors: Dimitrova E , Stanev S
Published: January 2011

Introduction

About 10% of all sport injuries in wrestling occur in lower back area.1 The purpose of this report is to summarise the incidence of lower back injuries in wrestling and the mechanisms involved, and to represent our experience in physiotherapy (PT) for prevention of these injuries.

Methods

From a sample of 95 wrestlers (males), 11 lower back injuries were found (11.6%). Problems such as muscle and joint injuries and dysfunctions occur quite frequently. Treatment of dysfunctions begins with PT program, that emphasises analytical stretching2 and strengthening of the back and abdominal musculature. We allow a return to sport when the athlete has regained at least 70% of his viability and pain-free full range of motion.

Results

Lower back injureis can be due to numerous factors: extensions, combined with twisting in take-downs (5 out of 11 wrestlers −45.5 %), extensions against resistance as in lifting an opponent off the mat (6 out of 11 wrestlers −54.5 %). Reduction in low back injuries was found as a result of a physiotherapy program. 8 out of 11 wrestlers who were treated from low back injuries returned to high-level competitions. In three cases the condition was not treated on time and it became chronic. As a result of our study, many changes have been made to the strength and conditioning training.

Conclusion

In cases of low back injuries an early diagnosis is essential, so that treatment can be commenced as soon as possible. Preventive physiotherapy program is essential and should be included in every training program as an integral part of the warm-up and recovery.
Physical testing prior to returning to normal sports activity for elite athletes following ACL injury
Authors: Ziogas Georgios G
Published: January 2011

Anterior cruciate ligament (ACL) injury is among the most frequent sports-related injuries especially in contact sports such as football, basketball, soccer and skiing. In professional sports, ACL injury has a significant financial impact on both athlete and team, since several months are required before full return to professional sport activity. At the end of the rehab program an overall assessment is taking place which traditionally includes isokinetic testing, functional tests and stability clinical assessment prior to the final approval for returning to normal professional sports activity. However, these tests do not examine whether running economy has been altered following ACL injury and rehabilitation. Deterioration in running economy will increase the physical load on the injured knee and may increase the risk for injury in the future. In addition, the traditional tests do not assess whether muscle fatigue at given submaximal and maximal loads has returned to preinjury levels although most researchers agree that fatigue appears to have a central role in non-contact ACL injuries, since it affects most of the modifiable risk factors which are related to ACL tear such as hamstring recruitment, proprioception, lateral trunk motion, tibial rotation, knee abduction, dynamic foot pronation, ground reaction, hip abduction, balance and flexibility. In addition, fatigue can cause alterations in landing and cutting mechanics similar to the ones proposed to increase the risk of ACL tear. Based on preliminary data from our lab, these tests may be very useful for a safe return of the injured athlete to normal sports activity and for the evaluation of the rehabilitation process. These tests may include running economy assessment at low, medium and high intensities, lactate curve analysis at all intensities, lactate removal rate and cardiovascular endurance assessment.
The effect of resveratrol on the inflammatory response and delayed onset muscle soreness after a marathon in male athletes: a randomised, double-blind, placebo-controlled pilot study
Authors: Laupheimer Markus W
Published: January 2011

Objectives

Resveratrol, a natural polyphenolic flavonoid antioxidant is known to have numerous health benefits and to act as a potent anti-inflammatory substance. This study was undertaken to investigate the inflammatory responses and delayed onset of muscle soreness after the London Marathon, and whether it is altered by Resveratrol.

Design and setting

Double placebo-controlled randomised trial conducted at the London Marathon, 2010.

Methods

Seven healthy male athletes were recruited for the study. Participants were randomised to either Resveratrol or placebo. The Resveratrol group was treated with 600 mg Resveratrol daily for 7 days immediately before the marathon. Blood was taken 48 h before the marathon and 18–32 h after the marathon. Samples were analysed for white blood cell count (WBC) and C reactive protein (CRP). To assess delayed onset muscle soreness a visual analogue scale (VAS) score was taken at the same times as the blood samples. The prepost changes were compared between the groups using the Mann–Whitney U test.

Results

There was no significant difference between the two groups in terms of changes occurring between pre and post-tests for WBC, CRP or VAS (p=0.857, 0.629 and 0.70 respectively).

Conclusion

This pilot study could not find a difference in immune response or delayed onset of muscle soreness between Resveratrol and placebo after the London Marathon 2010. Further investigations are needed with longer treatment time and higher doses, analysing additional parameters like interleukins for a possible effect of Resveratrol on the inflammatory response due to extensive exercise.
Patient pain drawing in diagnosing the cause of exercise-induced leg pain
Authors: Rennerfelt K , Zhang Q , Hamilton L , Styf J
Published: January 2011

Introduction

Classifying symptoms by patient pain drawing (PPD) may be helpful in diagnosing chronic anterior compartment syndrome (CACS). We have investigated the sensitivity and interobserver reliability of the PPD to diagnose CACS among patients with exercise-induced leg pain (EILP).

Methods

This study included 88 consecutive patients (48 men, 40 women; mean age 33, range 13–66, years). Two observers independently diagnosed the causes of leg pain based solely on PPD. The causes of leg pain in patients were diagnosed into seven categories (CACS, chronic lateral compartment syndrome, chronic posterior compartment syndrome, medial tibial syndrome, peroneal tunnel syndrome, muscle rupture and miscellaneous). The true diagnosis was based on a complete clinical examination including laboratory measurements of intramuscular pressure and intramuscular oxygenation by near-infrared spectroscopy during and after an exercise test that elicited the symptoms.

Results

The sensitivity of PPD to diagnose CACS was 69%. The positive predictive value was 53%. The interobserver reliability based solely on PPD in diagnosis of CACS was 92% (κ=0.81). Based on PPD, the causes of EILP were correctly diagnosed into the seven categories in 69% of all cases. The interobserver reliability in diagnosis of EILP reached 88%. Multiple pain locations on PPD were observed in 4% of patients with CACS and 24% of patients without CACS. No patient had chronic compartment syndrome in the lateral or posterior compartments.

Conclusions

This study indicates that PPD is a reliable tool to make accurate predictions in diagnosing CACS and other causes of EILP. Patients with CACS reported significantly less co-morbidity compared to patients with other causes of EILP. PPD should be combined with patient's history, clinical findings during an exercise test that elicits the symptoms and signs, as well as with the results from laboratory tests.
Shoulder laxity and traumatic shoulder instability in professional rugby players
Authors: Sivardeen Ziali , Cheng Shih Chung , Buchanan Donald , Hulse David , Fairbairn K Julia , Kemp Simon Patrick Thomas , Brooks John Huw Meirion , Wallace William Angus
Published: January 2011

Objective

This study aimed to see whether the risk of shoulder dislocation is associated with innate shoulder laxity, in professional rugby players.

Methodology

We performed a pilot study where we validated techniques we used in the study and subsequently gained ethics committee approval. We visited all the premiership rugby clubs in England and assessed 169 professional rugby players with no history of shoulder instability and 46 players with clinical instability symptoms in one shoulder. We assessed shoulder laxity by means of clinical evaluation, questionnaires and ultrasound. Previous studies have shown no difference in shoulder laxity in left and right shoulders in normal individuals. We therefore compared the laxity in the uninjured shoulder of players with a previous history of dislocation, with the shoulders of players with no history of shoulder injury. Data was analysed by unpaired t tests.

Results

The results showed there was no significant difference between the left and right shoulders in players with no history of instability (p>0.05). Players with a history of instability had a significantly higher shoulder translation in their normal shoulder than uninjured players (p<0.05). Players with an anterior laxity of at least 4 mm had a 50% chance of sustaining a dislocation. There was no correlation between, the age of the player, dominant hand or position played and the incidence of increased laxity.

Conclusions

This is the first study looking at laxity and the risk of shoulder dislocations in sportsmen involved in a high contact sport. These results support the hypothesis that rugby players with ‘lax’ shoulders are more likely to sustain a dislocation or subluxation injury to one of these lax shoulders in their sport. We believe preseason screening and targeted training may play a role in identifying those at risk and may decrease the incidence of dislocations.
Leg length discrepancies in elite track and field athletes with stress fractures
Authors: Kostopoulos Markos , Malliaropoulos Nikolaos , Papalada Agapi
Published: January 2011

Introduction

The purpose of this study is to analyse the presence of leg length discrepancies in track and field athletes with stress fractures.

Material-Methods

During 1990–2007 we studied 88 track and field athletes (43 male 45 female) with lower limp stress fractures.The age of the athletes ranged from 18 to 30 years old. We estimated the anatomic leg length of each athlete and evaluated the connection between the injured leg and the asymmetry in lower limb length.

Results

From the total of 88 athletes 72 (82%) had anisomelia, 22 (31%) had R-leg anisomelia and 50 (69%) had L-leg anisomelia. Male were 43(49%) athletes and 45 athletes were female (51%). The 34 male athletes (79%) had anisomelia, 12 (35%) R-leg anisomelia and 22 (65%) L-leg anisomelia. The 84% (38 female athletes) had anisomelia, the 10 (26%) had R-leg anisomelia and the 28 (74%) had L-leg anisomelia.

From the 72(82%), anisomelic athletes 23 (32%) had L-leg anisomelia and (L) stress fracture, 12 (17%) R-leg anisomelia and (R) stress fracture, 9 athletes (12%) L-leg anisomelia and (R) stress fracture and 23 (32%) had R-leg anisomelia and (L) stress fracture.

From the 34 anisomelic male athletes (79%), 12 (35%) had L-leg anisomelia and (L) stress fracture, 8 (24%) R-leg anisomelia and (R) stress fracture, 3 athletes (9%) L-leg anisomelia and (R) stress fracture and 8 (29%) had R-leg anisomelia and (L) stress fracture.

From the 38(84%) anisomelic female athletes, 11 (29%) had L-leg anisomelia and (L) stress fracture, 4 (10%) R-leg anisomelia and (R) stress fracture, 6 athletes (16%) L-leg anisomelia and (R) stress fracture and 13 (34%) had R-leg anisomelia and (L) stress fracture.

Finally, from the 16 isomelic athletes (18%), 7 (43%) had (L) stress fracture and 9 (57%) had (R) stress fracture.

From the nine isomelic male athletes (21%), two (22%) had (L) stress fracture and six (78%) had (R) stress fracture.

From the 7 isomelic female athletes (16%), 5 (71%) had (L) stress fracture and 2 (29%) had (R) stress fracture.

Conclusions

Leg length anisomelia in athletes seems to increase the possibility of stress fractures.

Sex%AnisomeliaIsomeliaAthletes8872 (82%)16 (18%)Male43 (49%)34 (79%)9 (21%)Female45 (51%)38 (84%)7 (16%)
The additional effects of swiss ball use during the wall squat exercise on lowerlimb muscle activity
Authors: Hinds E
Published: January 2011

Objective

To investigate whether the addition of a swiss ball to a wall squat exercise has any effect on the levels of lower limb muscle activity at varying angles of knee flexion.

Design

An observational study with repeated measures design.

Methods

Measures were made of both legs of 14 healthy subjects (3 female, 11 male) mean height, age and weight were 31 years, 175 cm, 73 kg respectively. Each subject performed the wall squat exercise to 60°, 90° and 110° of knee flexion, with and without a swiss ball. Electromyographical (EMG) muscle activity was collected from vastus medialis, vastus lateralis, rectus femoris, semitendinosus, bicep femoris, internal oblique, gluteus maximus and gluteus medius. A pelvis and lower limb motion capture protocol was used to enable the EMG to be referenced to position. The EMG data was rectified and smoothed using a root mean square method. Analysis was made of the EMG data to determine whether the addition of the swiss ball resulted in any significant changes in muscle activity and also to identify whether there was a significant difference in muscle activity between the three angles of knee flexion used during the test.

Results

The addition of the swiss ball to the wall squat exercise resulted in a significant increase in muscle activity of vastus medialis at 60° and 90° of knee flexion (Z=−4.053 and 3.643 respectively, p<0.002), vastus lateralis at 60°, 90° and 110° of knee flexion (Z=−3.142, −3.142, −3.142 respectively, p=0.002), semitendinosus at 60°, 90° and 110° of knee flexion(Z=−3.388, −3.075, −4.213, p=0.002) and internal oblique at 90°of knee flexion (Z=−3.074, p=0.002).

Conclusion

The addition of the swiss ball to the wall squat exercise does increase muscle activity of the some of the lower limb muscles. However, the effects appear to be dependant on the muscles investigated and the angle of knee flexion to which the exercise is performed. The swiss ball cannot be generalised as a means of increasing lower limb muscle activity during the wall squat but the study indicates that it does play a role in increasing the muscle activity of specific muscles.
Foot and ankle injuries during the athens 2004 olympic games
Authors: Takvorian M , Evangelou E , Badekas T
Published: January 2011

The Athens Olympic Games in 2004 represented a significant sporting and medical challenge. Major, rare and complex incidents can occur at any mass gathering sporting festival and team medical staff should be appropriately prepared for these. During the 2004 Olympic Games, injuries in all sport tournaments (men's and women) were analysed. A total of 624 injuries (520 soft tissue injuries and 99 bony injuries) were reported. The most prevalent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (68%) versus female athletes (32%) were recorded. The incidence, diagnosis, and causes of injuries differed substantially between the team sports.

This study concerns an epidemiologic analysis to determine the incidence rate of foot and ankle injuries as also the treatment options of these lesions in the field and in short term during the time frame of the Games. Also analyse the function modalities of the Foot and Ankle Clinic, the necessity of the establishment of a well organised Foot and Ankle department. and the co operation of the different medical specialities that dealing with foot and Ankle Sport Injuries.
Anti-doping programme and physicians
Authors: Petrou Michael
Published: January 2011

Lecture 1

The role of physicians in supporting athletes dates from the ancient times. Since the 18th century, it can be documented the role of physicians in the ‘doping’ of athletes with banned drugs. Today, even though governments, sport authorities and organised medicine abandon doping, a significant minority of physicians seem to continue playing a role in the doping of athletes. Several studies have shown that physicians are consulted by athletes and officials for advice on doping and the majority indicated not willing to prescribe doping substances without medical indication. Recent studies showed that the knowledge of the majority of physicians about doping agents and doping in general remains poor. Under the World Anti-Doping Program, the revised definition of doping includes physicians in the group of persons who can fulfil the elements of a doping offence. The Prohibited List clearly specifies the substances and methods prohibited in-, and out-of-competition while the International Standard for Therapeutic Use Exemption indicates the criteria for athletes who need, for therapeutic purposes, to use prohibited substances or methods. Through their unique relation with the athletes, physicians have an important role in discouraging doping in sport. For physicians, as with athletes, it is important to closely follow the changes on anti-doping regulations.
Achilles tendon pathology, present and future
Authors: Maffulli N
Published: January 2011

Lecture 18

Introduction

The recent progress in molecular biology, could make possible to identify the factors which influence the metabolism of the tenocytes and promote their natural healing process. The role of growth factors in the healing of tendons, for example, is still unclear, although basic fibroblast growth factor can stimulate healing by promoting cell proliferation and synthesis of the matrix. Gene transfer for the targeted delivery of growth factors has been used successfully in animal studies. Excessive repetitive overload of tendons is regarded as the main pathological stimulus which leads to tendinopathy. The aetiology of this pathologic condition remains unclear. Tendinopathies have been linked to overuse, poor vascularity, lack of flexibility, genetic make-up, gender, endocrine or metabolic factors. Excessive loading of the tendon during vigorous physical training is regarded as the main pathological stimulus. The tendon may respond to repetitive overload beyond physiological threshold by either inflammation of its sheath or degeneration of its body, or by a combination of both. Damage to the tendon can occur even if it is stressed within its physiological limits since frequent cumulative microtrauma may not leave enough time for repair. Microtrauma can result from non-uniform stress within tendons producing abnormal concentrations of load within the tendon, frictional forces between the fibrils, and localised damage to fibres. Tendinopathy has been attributed to a variety of intrinsic and extrinsic factors. Vascularity, dysfunction of the gastrocnemius-soleus, age, gender, bodyweight and height, are considered to be common intrinsic factors. Changes in training pattern, poor technique, previous injuries are common extrinsic factors which may predispose the athlete to tendinopathy. The aetiology of pain in tendinopathies is still unclear. Management of tendinopathy can be conservative or surgical, but this is recommended after exhausting periods of conservative management, often lasting for at least 6 months. Conservative management is unsuccessful in 24–45.5% of patients with tendinopathy of Achilles tendon. Failure of conservative management after 6 months is an indication for surgery. Surgery may range from percutaneous longitudinal tenotomy to various open procedures. Long-standing tendinopathy, however is associated with poor results after operation, with a greater rate of reoperation before an acceptable outcome is obtained.
Carbohydrate requirements of elite athletes
Authors: Hassapidou Maria
Published: January 2011

Lecture 23

It is well documented that exercise performance is greatly influenced by nutrition. The key factor in coping with the heavy demands of exercise faced by elite athletes seems to be carbohydrate intake. Carbohydrate recommendations range from 6–10 g/kg of bodyweight depending on gender and physical fitness level of the individual, total training load, energy expenditure, type of physical activity and environment.

Although carbohydrate rich diets were recommended in the past, specific recommendations in percentages should be used with caution. For example, in a 5000 kcal diet, a 50% of energy in carbohydrates will provide 7–8 g/kg of bodyweight for a 70 kg athlete. On the contrary, a 60% in carbohydrates diet will provide only 4–5 g/kg of bodyweight for a 60 kg athlete.

The proportional increase in carbohydrate requirement increases accordingly the proportional need in number of servings for carbohydrate-based food groups. Thus, many athletes should exceed the upper range of servings for these food groups, that is: (A) bread-cereals-legumes: more than 10 servings/day, (B) vegetables: more than 5 servings/day, (C) fruits: more than 4 servings/day, (D) milk-alternatives: more than 3 servings/day. Athletes with lower energy needs of small body shape are advised to select nutrient-dense foods in order to obtain adequate carbohydrates.

Athletes seem to benefit from 200 to 300 g of carbohydrates consumed 3–4 h before the athletic event. Pregame meal targets to prepare the athlete for the upcoming event, providing him with carbohydrates, electrolytes and water. Carbohydrates are essential to maintain blood glucose levels and maximise glycogen stores. There is a dispute whether glycaemic index of carbohydrates influences performance.

During exercise athletes should consume 30–60 g carbohydrates per hour (or 0.7 g/kg of body weight) in order to maintain blood glucose levels. This is of extreme importance when the event lasts more than an hour and it takes place in extreme environmental conditions (cold, heat or high altitude).

After exercise athletes should consume 1.0–1.5 g/kg of bodyweight during the first half hour and again every 2 h for 4–6 h in order to replace liver and muscle glycogen stores.

Carbohydrate intake can enhance training capacity and may consist the trigger point for winning an event and achieving the best possible performance.
Addressing biochemical deficiencies in athletes for performance enhancement
Authors: Pettersen S
Published: January 2011

Lecture 24

Introduction

In order for an athlete to achieve the highest level of performance, every cell of their organism must be functioning efficiently. Nutrient deficiencies limit metabolic function of their respective biochemical pathways and possibly any subsequent reactions. Optimal biochemical regulation will determine performance whether an athlete is attempting to set a record or heal from an injury. Because every athlete has unique biochemistry, diet analysis cannot predict nutrient status even among athletes of the same sport. Every sport has different nutrient requirements and every athlete in that sport will have distinctive needs based on age, medical history, nutrient absorption, metabolism, genetic predisposition and medications. Even high-performing athletes who appear healthy can have deficiencies that make them prone to injury or poor recovery.

Methods

Laboratory testing reveals the health status of an athlete without bias or judgement allowing for accurate supplementation. Urine and blood analysis are performed to determine direct and indirect measures of specific nutrients. Genetic testing can be performed from the DNA through blood or saliva.

Conclusion

Identifying and correcting biochemical imbalances is the fastest way to balance the athlete and allows them to reach their maximal genetic potential.
Development of sports and exercise medicine in Ireland and future challenges
Authors: Carolan Philip E
Published: January 2011

Lecture 25

The Faculty of Sports and Exercise Medicine was set up in September 2001 and is a joint Faculty of the Royal College of Physicians and Royal College of Surgeons in Ireland.

The Medical Council gave the Speciality, Specialist recognition in May 2004 and to date there are 25 doctors on the Register of Medical Specialists in the Division of Sports and Exercise Medicine. The Faculty has developed a curriculum for Higher Specialist Training; this is a 4-year training programme which includes a number of core specialities that trainees must complete (ie, A&E, Cardiology/Resp Medicine, etc). All trainees will have completed a BST programme and should have completed some Postgraduate course such as an MSc in Sports and Exercise Medicine (SEM). Our curriculum is very similar to FSEM (UK) HST training programme and both Faculties have collaborated over the curriculum development. Unfortunately we have not secured funding for a programme and trainees need to apply prospectively to the Faculty to outline there training programme rotations for accreditation. This has become more difficult for trainees with changes to the Irish Medical Council Register where trainees need to be in approved training numbered posts. We continue to work with the Medical Council, Health Service Executive and the Forum of Postgraduate Training Bodies. Part 11 of the Medical Practitioner Act 2007 was commenced in May 2010, bringing Competence Assurance into law, this will drive the need for a training programme and developing CPD programmes. Going forward, further development of Postgraduate programmes in SEM for doctors with a special interest in SEM is very important at either MSc or Diploma Level. The Faculty continue to work on developing continuous education programmes with a new Diploma course in conjunction with the Irish College of General Practice. E-learning programme development in conjunction with the NUI colleges should be explored. For development of the Speciality, UEMS recognition is a must with an agreed Specialist Training programme curriculum that can be delivered throughout Europe. I believe that both Faculties from Ireland and UK can collaborate on having a greater input on such developments.
Medicine for football: football for health
Authors: D'Hooghe M
Published: January 2011

Lecture 7

Football has developed enormously over the last 25 years but there is no doubt that over the same period the world around football has developed even further.

The medical world around football has been no exception to this.

In the first part of the conference I will explain how the Medical Commission of FIFA and UEFA try to answer the challenge: medicine for football.

It started with the four classical themes of sports medicine: traumatology, physiology, psychology and pharmacology. We should add that important aspects of nutrition, hydration and hygiene have been gradually joining this leading quartet.

Quite rightly too, another major focus has been the prevention of injuries. Over the last years, especially due to the many cases of sudden death, the importance of emergency medicine was largely emphasised.

Even more specific fields have also joined the list: for example, youth football, women's football, medical care in relation to refereeing, specific traumatology of the goalkeeper.

The globalisation of football has created new problems in the medical sector:

▶

What are the criteria for adaptation to jetlag?

▶

What medical preparation and care is needed for a team playing matches and tournaments at high altitude?

▶

What measures should be taken for matches played in extremely hot conditions with an obvious risk of serious dehydration?

We must also highlight the problem of the fight against doping in football. We test the presence of amphetamines, narcotics and anabolic steroids, diuretics, and peptide hormones, particularly erythropoietin and growth hormone. We are confronted with excessive use of β2-agonists and corticosteroids.

Looking into the future we can already detect the advent of genetic doping whereby athletes will be genetically prepared to improve artificially all former sport performances.

Our philosophy is there are three important reasons for refusing any form of doping:

▶

The use of doping is opposed to the ethics of sport. In a world of sports where ethical arguments are defeated every day by commercial considerations the medical world should stand firm as the first guardian of ethics.

▶

Doping is prejudicial to the integrity of our competitions. We must not collaborate in the organisation of football games where artificial medications take the place of natural values such as talent, training, skill, character and endurance.

▶

Above all we must respect the health of the athletes.

We will discuss the importance of football for health: studies have proven that weekly practice of football is superior to many other exercises in the care for health. The importance of physical exercise, particularly by football, will be underlined as an important preventive factor in the health of people of all ages.
Development of hybrid aeolian dunes: the William River dune field, northwest Saskatchewan, Canada
Authors: Carson M. A. , MacLean P. A.
Published: January 2011

Observations have been made on the structure, morphology, and pattern of sand movement on large-scale, roughly elongate, northwest–southeast-aligned aeolian sand dunes in a desert area of northern Saskatchewan, Canada. Transverse profiles show steeper northeast flanks, the lower parts of which are covered with psammophilous grasses. Dune structure is dominated by northeast-dipping accretion laminae, and 14C dates of organic material trapped between such exposed laminae on the southwest flank indicate migration to the northeast at about 0.5 m/year in the last few centuries. On the other hand, there is a progressive increase in height, bulk, symmetry, and peakedness of the dunes from northwest to southeast, suggestive of substantial along-dune sand movement. The present-day wind regime shows a potential resultant sand-transport vector to the southeast, virtually parallel to the dune axis; winds from the north-northeast and northeast dominate the first 6 months of the year, followed by winds from the west-southwest in the latter half. Field evidence of airflow and sand-movement patterns upon the surfaces of two dunes also indicates a strong along-dune component. The dunes are interpreted as hybrid landforms reflecting both transverse and longitudinal processes acting at the present time. Of particular sedimentological significance is the discordance between dune stratigraphy and the wind regime. Dune structure is controlled by a southwest–northeast imbalance in sand movement assumed to result from an asymmetric distribution of sand-trapping vegetation and from a seasonal contrast in sand mobility that partly correlates with seasonality in the wind regime. Both factors promote northeast migration normal to the potential resultant of effective winds.
PROBING CP VIOLATION IN THE NEUTRINO SECTOR WITH MAGIC BASELINE EXPERIMENTS
Authors: MOHANTA RUKMANI , JOHN DAUGHTY
Published: January 2011

We investigate the effect of CP violation in the leptonic sector. Due to the tiny neutrino masses its value is predicted to be very small and it is far beyond the experimental reach of the current experiments. Recently, the magic baseline experiment from CERN to INO (Indian Neutrino Observatory) with L = 7152 km has been proposed to get a sensitive limit on sin θ13. We show that due to such magic baseline neutrino beam, it is possible to observe CP violation in the neutrino sector upto several percent for the beam energy between 1–10 GeV.
A LOW DROPOUT REGULATOR WITH LOW QUIESCENT CURRENT AND HIGH POWER SUPPLY REJECTION OVER WIDE RANGE OF FREQUENCY FOR SOC
Authors: ZHAN CHENCHANG , KI WING-HUNG
Published: January 2011

A CMOS low quiescent current low dropout regulator (LDR) with high power supply rejection (PSR) and without large output capacitor is proposed for system-on-chip (SoC) power management applications. By cascoding a power NMOS with the PMOS pass transistor, high PSR over a wide frequency range is achieved. The gate-drive of the cascode NMOS is controlled by an auxiliary LDR that draws only 1 μA from a small charge pump, thus helping in reducing the quiescent current. Adaptive biasing is employed for the multi-stage error amplifier of the core LDR to achieve high loop gain hence high PSR at low frequency, low quiescent current at light load and high bandwidth at heavy load. A prototype of the proposed high-PSR LDR is fabricated using a standard 0.35 μm CMOS process, occupying an active area of 0.066 mm2. The lowest supply voltage is 1.6 V and the preset output voltage is 1.2 V. The maximum load current is 10 mA. The measured worst-case PSR at full load without using large output capacitor is -22.7 dB up to 60 MHz. The line and load regulations are 0.25 mV/V and 0.32 mV/mA, respectively.
A SURVEY OF LOW-VOLTAGE LOW-POWER TECHNIQUES AND CHALLENGES FOR CMOS DIGITAL CIRCUITS
Authors: HUNG YU-CHERNG , SHIEH SHAO-HUI , TUNG CHIOU-KOU
Published: January 2011

Low-power design is an important research in recent years. A huge amount of papers in the open literature until now were proposed to deal with various low-power issues, including technology innovation, circuit/logic design techniques, algorithm realization, and architecture/system selection. Due to the high-energy electron effect and reliability consideration, it is necessary to further reduce the supply voltage of integrated circuit in CMOS sub-micro technologies. However, it is hard to get a whole view for various low-power low-voltage techniques in a short time. In this paper, the motivations and challenges of CMOS low-voltage low-power circuit are addressed. Various design methodologies are surveyed and summarized in whole. The paper attempts to quickly give readers a full-view conception in low-voltage low-power CMOS system design.
LOW-LEAKAGE FLIP-FLOPS BASED ON DUAL-THRESHOLD AND MULTIPLE LEAKAGE REDUCTION TECHNIQUES
Authors: ZHANG WEIQIANG , SU LI , ZHANG YU , LI LINFENG , HU JIANPING
Published: January 2011

The scaling of transistor sizes has resulted in dramatic increase of leakage currents. The sub-threshold and gate leakages have now become a major contributor to total power dissipations. This paper presents two flip-flops based on dual-threshold CMOS and multiple leakage reduction techniques to reduce their leakage dissipations. In the DT-TG FF (Dual-Threshold Transmission Gate Flip-Flop), some transistors on non-critical paths use high-threshold devices to reduce their leakage currents, while the other transistors on critical paths use low-threshold devices to maintain performance. The MLRT FF (Multiple Leakage Reduction Technique Flip-Flop) uses P-type CMOS techniques, MTCMOS (Multi-Threshold CMOS) power-gating and dual-threshold technique to reduce both sub-threshold and gate leakage dissipations. Taken as an example, a practical sequential system realized with the two low-leakage flip-flops is demonstrated using a mode-5 × 5 × 5 counter. The simulation results show that the two flip-flops achieve considerable leakage reductions.
TOPOLOGICAL ANALYSIS OF CHAOTIC SOLUTION OF A THREE-ELEMENT MEMRISTIVE CIRCUIT
Authors: GINOUX JEAN-MARC , LETELLIER CHRISTOPHE , CHUA LEON O.
Published: January 2011

The simplest electronic circuit with a memristor was recently proposed. Chaotic attractors solution to this memristive circuit are topologically characterized and compared to Rössler-like attractors.
THE DYNAMICS OF THE LUO–RUDY MODEL
Authors: WEI HSIU-CHUAN
Published: January 2011

Computer simulation of mathematical models of mammalian ventricular myocytes has become a very promising tool for understanding the underlying mechanisms of cardiac arrhythmias and may provide useful predictions of treatment in order to prevent fatal arrhythmias. In this paper, we employ the Luo–Rudy (LR) model of membrane action potential of the mammalian ventricular cell. Simulation is performed with the aid of a direct method for locating the equilibria and by an adaptive grid method for constructing bifurcation diagrams. Two-parameter bifurcation diagrams are constructed to show the parameter sets in which (a) spontaneous oscillations exist, (b) the equilibrium corresponding to the resting potential is stable, or (c) the equilibrium with the most depolarized potential is stable. Multiple attractors are detected near the boundary of these parameter sets. The generation of normal and abnormal pacemaking activities is elucidated via bifurcation analysis. Spontaneous oscillations appear and disappear via saddle-node homoclinic bifurcations, Hopf bifurcations, homoclinic bifurcations, or fold bifurcations of limit cycles. Limit cycles may become chaotic via period-adding cascades as the extracellular potassium concentration [K]o decreases. Pacemaking activities may also be generated when the time-independent potassium current is blocked.
ON COMPONENT DEPENDENCIES IN COMPOUND SOFTWARE
Authors: KRISTIANSEN MONICA , WINTHER RUNE , NATVIG BENT
Published: January 2011

Predicting the reliability of software systems based on a component approach is inherently difficult, in particular due to failure dependencies between the software components. Since it is practically difficult to include all component dependencies in a system's reliability calculation, a more viable approach would be to include only those dependencies that have a significant impact on the assessed system reliability. This paper starts out by defining two new concepts: data-serial and data-parallel components. Then, this paper illustrates how the components' marginal reliabilities put direct restrictions on the components' conditional probabilities, and proves that the degrees of freedom are much fewer than first anticipated when it comes to conditional probabilities. At last, a test system, consisting of five components, is investigated to identify possible rules for selecting the most important component dependencies. To do this, three different techniques are applied: (1) direct calculation, (2) Birnbaum's measure and (3) Principal Component Analysis (PCA). The results from the analyses clearly show that including partial dependency information may give substantial improvements in the reliability predictions, compared to assuming independence between all software components. The analyses also indicate that including only dependencies between data-parallel components may give predictions close to the system's true failure probability, as long as the dependency between the most unreliable components is included. Including only dependencies between data-serial components may however result in predictions even worse than by assuming independence between all software components.
ANALYTIC REGULARITY AND POLYNOMIAL APPROXIMATION OF PARAMETRIC AND STOCHASTIC ELLIPTIC PDE'S
Authors: COHEN ALBERT , DEVORE RONALD , SCHWAB CHRISTOPH
Published: January 2011

Parametric partial differential equations are commonly used to model physical systems. They also arise when Wiener chaos expansions are used as an alternative to Monte Carlo when solving stochastic elliptic problems. This paper considers a model class of second order, linear, parametric, elliptic PDE's in a bounded domain D with coefficients depending on possibly countably many parameters. It shows that the dependence of the solution on the parameters in the diffusion coefficient is analytically smooth. This analyticity is then exploited to prove that under very weak assumptions on the diffusion coefficients, the entire family of solutions to such equations can be simultaneously approximated by multivariate polynomials (in the parameters) with coefficients taking values in the Hilbert space [Formula: see text] of weak solutions of the elliptic problem with a controlled number of terms N. The convergence rate in terms of N does not depend on the number of parameters in V which may be countable, therefore breaking the curse of dimensionality. The discretization of the coefficients from a family of continuous, piecewise linear finite element functions in D is shown to yield finite dimensional approximations whose convergence rate in terms of the overall number N dof of degrees of freedom is the minimum of the convergence rates afforded by the best N-term sequence approximations in the parameter space and the rate of finite element approximations in D for a single instance of the parametric problem.