Musculoskeletal asymmetry in football athletes: A product of limb function over time

Purpose Asymmetrical loading patterns are commonplace in football sports. Our aim was to examine the influence of training age and limb function on lower-body musculoskeletal morphology. Methods Fifty-five elite football athletes were stratified into less experienced (≤3 yr; n = 27) and more experienced (\u3e3 yr; n = 28) groups by training age. All athletes underwent whole-body dual-energy x-ray absorptiometry scans and lower-body peripheral quantitative computed tomography tibial scans on the kicking and support limbs. Results Significant interactions between training age and limb function were evident across all skeletal parameters (F16, 91 = 0.182, P = 0.031, Wilks Λ = 0.969). Asymmetries between limbs were significantly larger in the more experienced players than the less experienced players for tibial mass (P ≤ 0.044, d ≥ 0.50), total cross-sectional area (P ≤ 0.039, d ≥ 0.53), and stress-strain indices (P ≤ 0.050, d ≥ 0.42). No significant asymmetry was evident for total volumetric density. More experienced players also exhibited greater lower-body tibial mass (P ≤ 0.001, d ≥ 1.22), volumetric density (P ≤ 0.009, d ≥ 0.79), cross-sectional area (P ≤ 0.387, d ≥ 0.21), stress-strain indices (P ≤ 0.012, d ≥ 0.69), fracture loads (P ≤ 0.018, d ≥ 0.57), and muscle mass and cross-sectional area (P ≤ 0.016, d ≥ 0.68) than less experienced players. Conclusions Asymmetries were evident in athletes as a product of limb function over time. Chronic exposure to routine high-impact gravitational loads afforded to the support limb preferentially improved bone mass and structure (cross-sectional area and cortex thickness) as potent contributors to bone strength relative to the high-magnitude muscular loads predominantly afforded to the kicking limb. Copyright © 2016 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited

The relationship between individual and composite FMS™ score with the anthropometric and physical characteristics of elite Touch (rugby) players

Purpose 1). To describe and compare the movement patterns, anthropometric and physical characteristics of male and female Touch players; and 2). to examine the relationships between Functional Movement Screening (FMS™) scores and the anthropometric and physical characteristics. Methods This was a cross-sectional study with 35 elite Touch players (18 males, age=24.7±4.9 y and 17 females, age=26.7±5.2 y). Anthropometric (stature, body mass) and physical characteristics (sprint times, glycolytic change-of-direction test, and countermovement jump (CMJ) flight time and peak power) were assessed alongside movement patterns using the FMS™ battery. Data were analysed for between-sex differences (independent t-test, Mann Whitney U) and associations (Spearman’s correlation coefficient). Results Between-sex differences in body mass (t=6.082, p<0.001), stature (t=9.247, p<0.001), CMJ flight time (t=3.576, p=0.001), relative CMJ peak power (t=6.578, p<0.001), 10 m sprint time (t=15.861, p<0.001), glycolytic change of direction test time (t=-11.831, p<0.001) and Yo-Yo IR1 (t=6.842, p<0.001) were observed. There was minimal differences for deep squat (Z=-1.036, p=0.443), in-line lunge (Z=-1.284, p=0.303), shoulder mobility (Z=-0.173, p=0.883), trunk stability push-up (Z=-0.896, p=0.483) and rotary stability (Z=-1.537, p=0.273). The correlation between total and individual FMSTM scores with anthropometric and physical characteristics ranged from trivial-to-moderate (r=-0.502 to 0.488). Conclusion The lack of difference for the FMS™ composite score and small-to-trivial differences in individual scores allows a comparison between mixed populations within Touch. Whilst many of the correlations were trivial-to-small, there were differences between sexes in the associations and evidence that improvements in functional deficiencies could translate into improved physical performance

Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians

Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout. Methods: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout. Recommendation 1: ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence). Recommendation 2: ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence). Recommendation 3: ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence). Recommendation 4: ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence)

The need for a network to establish and validate predictive biomarkers in cancer immunotherapy.

Immunotherapies have emerged as one of the most promising approaches to treat patients with cancer. Recently, the entire medical oncology field has been revolutionized by the introduction of immune checkpoints inhibitors. Despite success in a variety of malignancies, responses typically only occur in a small percentage of patients for any given histology or treatment regimen. There are also concerns that immunotherapies are associated with immune-related toxicity as well as high costs. As such, identifying biomarkers to determine which patients are likely to derive clinical benefit from which immunotherapy and/or be susceptible to adverse side effects is a compelling clinical and social need. In addition, with several new immunotherapy agents in different phases of development, and approved therapeutics being tested in combination with a variety of different standard of care treatments, there is a requirement to stratify patients and select the most appropriate population in which to assess clinical efficacy. The opportunity to design parallel biomarkers studies that are integrated within key randomized clinical trials could be the ideal solution. Sample collection (fresh and/or archival tissue, PBMC, serum, plasma, stool, etc.) at specific points of treatment is important for evaluating possible biomarkers and studying the mechanisms of responsiveness, resistance, toxicity and relapse. This white paper proposes the creation of a network to facilitate the sharing and coordinating of samples from clinical trials to enable more in-depth analyses of correlative biomarkers than is currently possible and to assess the feasibilities, logistics, and collated interests. We propose a high standard of sample collection and storage as well as exchange of samples and knowledge through collaboration, and envisage how this could move forward using banked samples from completed studies together with prospective planning for ongoing and future clinical trials

In Search of the High Road: Meaning and Evidence

This article is the first in a series to celebrate the 70th anniversary of the ILR Review. We will be highlighting important research themes that have been featured in the journal over its many years of publication. In this article, Paul Osterman reviews research on the quality of jobs and recent debates over “High Road” and “Low Road” approaches to employment practices. Scholars and policy advocates frequently utilize the distinction between High Road and Low Road firms as a framework for efforts to improve the quality of work in low-wage employers. This article assesses the logic and evidence that underlies this construct. The author provides a definition of the concept and examines the evidence behind the assumption that firms have a choice in how they design their employment policies. He then takes up the assertion that firms that adopt a High Road model can “do well by doing good” and adds precision to this claim by reviewing the evidence that a profit-maximizing firm would benefit from following the High Road path. The article concludes by suggesting a research agenda and providing a framework for policy that flows from the conclusions drawn from the existing research base

Buprenorphine-Naloxone in the Treatment of Codeine Dependence: a Scoping Review of Clinical Case Presentations

Misuse of prescribed and over the counter (OTC) codeine containing medicines is an increasing public health concern in recent times. Studies have called for low threshold treatment services for individuals experiencing codeine dependence using buprenorphine naloxone therapy. We present a scoping review of clinical case presentation literature on the use of buprenorphine-naloxone in the treatment of codeine dependence. Seven records (four single case studies and three case series) on codeine dependence treated with buprenorphine-naloxone were included. Five themes emerged following a review of the cases for the treatment of codeine dependence with buprenorphine-naloxone. They are: (1) Patient Profiles; (2) History of Codeine Misuse; (3) Medical Problems; (4) Use of Other Substances; and (5) Buprenorphine-naloxone in the treatment of Codeine Dependence. The review highlights the complexities of patients with regards to pain, psychiatric illness, poly substance use and iatrogenic dependence, with findings encouraging in terms of patient stabilisation and recovery

Does board independence influence financial performance in IPO firms? The moderating role of the national business system

Prior evidence suggests that board independence may enhance financial performance, but this relationship has been tested almost exclusively for Anglo-American countries. To explore the boundary conditions of this prominent governance mechanism, we examine the impact of the formal and information institutions of 18 national business systems on the board independence-financial performance relationship. Our results show that while the direct effect of independence is weak, national-level institutions significantly moderate the independence-performance relationship. Our findings suggest that the efficacy of board structures is likely to be contingent on the specific national context, but the type of legal system is insignificant

A Comparative Exploration of Community Pharmacists' Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom

Misuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over-the-counter (OTC) and prescribed codeine. A qualitative design comprising six focus groups (n = 45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine-containing products and the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer–pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine and difficulties in relationships between pharmacists and prescribers. A number of recommendations were put forward as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and potential ways to deal with misuse and dependence