Common neuromusculoskeletal injuries amongst rock climbers in the Western Cape

BACKGROUND: Rock climbing is an extreme sport that is fast gaining interest in the Western Cape. Due to the physical nature of the sport, climbers often suffer neuromusculoskeletal (NMS) injuries. Physiotherapists are first-line practitioners who diagnose and treat NMS injuries, but no previous study has been conducted regarding common NMS injuries amongst rock climbers in the Western Cape. OBJECTIVE: To determine the common NMS injuries amongst rock climbers, and the relationships between independent variables and injury. METHOD: A Quantitative, cross-sectional, retrospective descriptive study design utilised a self developed survey based on the literature. This was completed by rock climbers from an indoor climbing gym in Cape Town and two outdoor crags in the Western Cape. Out of the total population of 650 climbers, 247 were conveniently sampled to complete the self-administered SURVEY, making the results generalisable to the climbing population. RESULTS: Finger flexor tendon pulley injuries were the most commonly diagnosed NMS injury. Injury to the fingers, hand and elbow regions were the most common self-reported injury by area. The risk of suffering climbing-related injuries was significantly correlated to gender, setting, grade and type of climbing, but not to frequency of climbing. CONCLUSION: The results of this study could assist physiotherapists to assess and manage the common NMS injuries that occur in this group of extreme athletes, as well as to raise awareness amongst rock climbers in the Western Cape about potential risk of injury.Web of Scienc

Prevalence of concussion and adherence to return-to-play guidelines amongst male secondary school rugby and hockey players

Concussion injuries are common in contact sports. Young players can suffer lifethreatening complications if concussion is not recognised and managed.To determine the prevalence of concussion amongst secondary school rugby and hockey players and describe players’ knowledge and adherence to return-to-play guidelines.A mixed-method approach included Phase A, which utilised a questionnaire completed by 221 players (n = 139 rugby; n = 82 hockey) between 13 and 18 years of age, and Phase B, which utilised three focus group discussions of 15 participants who had suffered a concussion

Outcomes, infectiousness, and transmission dynamics of patients with extensively drug-resistant tuberculosis and home-discharged patients with programmatically incurable tuberculosis: a prospective cohort study.

BACKGROUND: The emergence of programmatically incurable tuberculosis threatens to destabilise control efforts. The aim of this study was to collect prospective patient-level data to inform treatment and containment strategies. METHODS: In a prospective cohort study, 273 South African patients with extensively drug-resistant tuberculosis, or resistance beyond extensively drug-resistant tuberculosis, were followed up over a period of 6 years. Transmission dynamics, infectiousness, and drug susceptibility were analysed in a subset of patients from the Western Cape using whole-genome sequencing (WGS; n=149), a cough aerosol sampling system (CASS; n=26), and phenotypic testing for 18 drugs (n=179). FINDINGS: Between Oct 1, 2008, and Oct 31, 2012, we enrolled and followed up 273 patients for a median of 20·3 months (IQR 9·6-27·8). 203 (74%) had programmatically incurable tuberculosis and unfavourable outcomes (treatment failure, relapse, default, or death despite treatment with a regimen based on capreomycin, aminosalicylic acid, or both). 172 (63%) patients were discharged home, of whom 104 (60%) had an unfavourable outcome. 54 (31%) home-discharged patients had failed treatment, with a median time to death after discharge of 9·9 months (IQR 4·2-17·4). 35 (20%) home-discharged cases were smear-positive at discharge. Using CASS, six (23%) of 26 home-discharged cases with data available expectorated infectious culture-positive cough aerosols in the respirable range (<5 μm), and most reported inter-person contact with suboptimal protective mask usage. WGS identified 17 (19%) of the 90 patients (with available sequence data) that were discharged home before the diagnosis of 20 downstream cases of extensively drug-resistant tuberculosis with almost identical sequencing profiles suggestive of community-based transmission (five or fewer single nucleotide polymorphisms different and with identical resistance-encoding mutations for 14 drugs). 11 (55%) of these downstream cases had HIV co-infection and ten (50%) had died by the end of the study. 22 (56%) of 39 isolates in patients discharged home after treatment failure were resistant to eight or more drugs. However, five (16%) of 31 isolates were susceptible to rifabutin and more than 90% were likely to be sensitive to linezolid, bedaquiline, and delamanid. INTERPRETATION: More than half of the patients with programmatically incurable tuberculosis were discharged into the community where they remained for an average of 16 months, were at risk of expectorating infectious cough aerosols, and posed a threat of transmission of extensively drug-resistant tuberculosis. Urgent action, including appropriate containment strategies, is needed to address this situation. Access to delamanid, bedaquiline, linezolid, and rifabutin, when appropriate, must be accelerated along with comprehensive drug susceptibility testing. FUNDING: UK Medical Research Council, South African Medical Research Council, South African National Research Foundation, European & Developing Countries Clinical Trials Partnership, Oppenheimer Foundation, Newton Fund, Biotechnology and Biological Sciences Research Council, King Abdullah University of Science & Technology

Chromone Studies. Part 14.¹ Unprecedented Dimerisation of Chromone-3-Carbaldehyde-Derived Baylis–Hillman Adducts

1,4-Diazabicyclo[2.2.2]octane (DABCO)-catalysed Baylis-Hillman reactions of selected chromone-3-carbaldehydes with methyl acrylate have been shown to afford mixtures of the expected Baylis-Hillman products and unprecedented dimeric derivatives. The Baylis–Hillman products, on heating at 80°C in the presence of DABCO, are converted to the corresponding dimers, the structures of which have been unambiguously established by NMR and X-ray crystallographic analysis. Electron-impact and electrospray MS data for the dimeric systems are discussed. </jats:p

Framework to assess the quality of mHealth apps: a mixed-method international case study protocol

INTRODUCTION: Healthcare professionals (HCPs) often recommend their patients to use a specific mHealth app as part of health promotion, disease prevention and patient self-management. There has been a significant growth in the number of HCPs downloading and using mobile health (mHealth) apps. Most mHealth apps that are available in app stores employ a ‘star rating’ system. This is based on user feedback on an app, but is highly subjective. Thus, the identification of quality mHealth apps which are deemed fit for purpose can be a difficult task for HCPs. Currently, there is no unified, validated standard guidelines for assessment of mHealth apps for patient safety, which can be used by HCPs. The Modified Enlight Suite (MES) is a quality assessment framework designed to provide a means for HCPs to evaluate mHealth apps before they are recommended to patients. MES was adapted from the original Enlight Suite for international use through a Delphi method, followed by preliminary validation process among a population predominantly consisting of medical students. This study aims to evaluate the applicability and validity of the MES, by HCPs, in low, middle and high income country settings. METHODS AND ANALYSIS: MES will be evaluated through a mixed-method study, consisting of qualitative (focus group) and quantitative (survey instruments) research, in three target countries: Malaŵi (low income), South Africa (middle income) and Ireland (high income). The focus groups will be conducted through Microsoft Teams (Microsoft, Redmond, Washington, USA) and surveys will be conducted online using Qualtrics (Qualtrics International, Seattle, Washington, USA). Participants will be recruited through the help of national representatives in Malawi (Mzuzu University), South Africa (University of Fort Hare) and Ireland (University College Cork) by email invitation. Data analysis for the focus group will be by the means of thematic analysis. Data analysis for the survey will use descriptive statistics and use Cronbach alpha as an indicator of internal consistency of the MES. The construct validity of the mHealth app will be assessed by computing the confirmatory factor analysis using Amos. ETHICS AND DISSEMINATION: The study has received ethical approval from the Social Research Ethics Committee (SREC) SREC/SOM/03092021/1 at University College Cork, Ireland, Malaŵi Research Ethics Committee (MREC), Malaŵi MZUNIREC/DOR/21/59 and Inter-Faculty Research Ethics Committee (IFREC) of University of Fort Hare (REC-2 70 710-028-RA). The results of the study will be disseminated through the internet, peer-reviewed journals and conference presentations