Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol

Background There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illnesshowever, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested. Hypothesis Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function. Design Double blind, placebo-controlled, parallel groups, randomised clinical trial. Materials and methods 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the (2) test and the analysis of variance for statistical analyses. Discussion This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course. Ethics and dissemination The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481). Trial registration number 8094833648737701 (NCT02757664)Pre-results.Univ Fed Sao Paulo, Dept Orthopaed, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP EPM, Orthoped & Traumatol Div Hand Surg & Upper Limb, Sao Paulo, SP, BrazilDepartment of Orthopaedics, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, BrazilOrthopedics and Traumatology—Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilWeb of Scienc

Lesões musculoesqueléticas em policiais militares

INTRODUCTION: The physical qualities need to be analyzed and are risk factors associated with the development of musculoskeletal injuries during military sports training. OBJECTIVE: Epidemiological studies of musculoskeletal injuries occurred in the ankle and foot of military police officers. METHODS: We collected all the medical records of military police officers who have suffered previous injuries in the ankle and foot during the period September 2005 to August 2011. The information was obtained through physical therapy evaluation form found in the records and subsequently the data were tabulated and analyzed. RESULTS: After collecting the data from the medical records, it was found that there 29% bone injuries, 32% ligament injuries and 35% muscle injuries. CONCLUSION: A sprained ankle demonstrates a risk to public health is described by the international statistical classification of diseases and related health problems, which is also in the military environment, described as risk during sports practice.INTRODUCCIÓN: Las cualidades físicas precisan ser analizadas y se vinculan como factores de riesgos para desarrollar lesiones musculoesqueléticas durante el entrenamiento deportivo-militar. OBJETIVO: Recolectar datos sobre epidemiología de las lesiones musculoesqueléticas ocurridas en tobillos y pies de policías militares. MATERIALES Y MÉTODOS: Se analizaron todas las fichas médicas de policías militares que sufrieron lesiones previas en tobillos y pies durante el período de septiembre de 2005 a agosto de 2011; las informaciones fueron obtenidas mediante los formularios de evaluación fisioterapéutica que se encontraban en las fichas médicas; posteriormente, los datos obtenidos fueron tabulados y analizados. RESULTADOS: Después de la recolección de datos de las fichas médicas se observó 29% de lesiones óseas, 32% de ligamentarias y 35% de musculares. CONCLUSIÓN: La torcedura de tobillo demuestra ser un riesgo para la salud pública como se describe en la clasificación estadística internacional de enfermedades y problemas relacionados con la salud, siendo en el medio militar señalada también como un riesgo durante la práctica deportiva.INTRODUÇÃO: As qualidades físicas precisam ser analisadas e estão associadas como fatores de risco a desenvolver lesões musculoesqueléticas durante o treinamento esportivo militar. OBJETIVO: Levantar a epidemiologia das lesões musculoesqueléticas ocorridas em tornozelo e pé de policiais militares. MATERIAIS E MÉTODOS: Foram coletados todos os prontuários de policiais militares que sofreram lesões prévias no tornozelo e pé durante o período de setembro de 2005 a agosto de 2011, as informações foram obtidas através da ficha de avaliação fisioterapêutica constatada nos prontuários, posteriormente os dados obtidos foram tabulados e analisados. RESULTADOS: Após a coleta de dados dos prontuários foi observado que houve 29% de lesões ósseas, 32% de ligamentares e 35% de musculares. CONCLUSÃO: A entorse de tornozelo demonstra um risco à saúde pública como descrita pela classificação estatística internacional de doenças e problemas relacionados à saúde, sendo no meio militar também descrita como um risco durante a prática esportiva.Centro de Reabilitação da Polícia MilitarUniversidade Federal de São Paulo (UNIFESP) Centro de Traumatologia do EsporteUNIFESP, Centro de Traumatologia do EsporteSciEL

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Validation of a new instrument for unipedal assessment in patients with calcaneal tendon disorders: a cross-sectional study

Introdução: Lesões no tendão calcâneo têm como consequência déficits funcionais e afastamento esportivo. Para um programa de tratamento adequado, utilizam-se métricas que possam mensurar a evolução do paciente, desde o início da reabilitação até a alta terapêutica. Existem vários testes que medem a função dos músculos flexores plantares, entre eles, o teste de elevação do calcanhar. Há na literatura diversas formas descritas para a aplicação desse teste, entretanto, adaptações tecnológicas podem ajudar na diminuição dos erros de medida e facilitar a aplicação do mesmo. Objetivo: Propor um novo instrumento para a avaliação da função dos músculos flexores plantares do tornozelo e avaliar as propriedades de medida desse instrumento em pacientes com doenças do tendão calcâneo. Hipótese: O novo instrumento desenvolvido para o Teste de Elevação Monopodal do Calcanhar tem alta confiabilidade e validade de construto adequada na avaliação funcional dos músculos flexores do tornozelo. Métodos: Um comitê de especialistas foi formado para propor modificações tecnológicas no teste de função dos músculos flexores plantares do tornozelo. Foram incluídos pacientes com doença do tendão calcâneo, que responderam ao questionário sociodemográfico e a versão brasileira do questionário Victorian Institute of Sport Assessment-Achilles (VISA-A-Br). Em seguida, foram submetidos ao teste da elevação unipodálica da ponta dos pés com as modificações propostas para avaliação de função dos músculos flexores. Foram analisadas as seguintes propriedades de medida do teste modificado: confiabilidade, erro de medida e validade do construto. A confiabilidade foi calculada pelo coeficiente de correlação intraclasse (CCI) do tipo 2,1 e seus respectivos intervalos de confiança 95% (IC 95%). O erro de medida foi calculado através de duas medidas: erro padrão da medida (EPM) e menor mudança detectável (MMD). O EPM foi calculado por meio da razão do desvio padrão da média das diferenças pela raiz quadrada de 2 (DP das diferenças/√2). Já a MMD foi calculada através da fórmula MMD = 1,645 x √2 x EPM. A validade do construto foi avaliada pelo teste de correlação de Pearson com o questionário VISA-A-Br. Resultados: A confiabilidade entre as avaliações, tanto no lado acometido, quanto do lado não acometido, foi de 0,99, sendo classificada como excelente. O EPM foi de 1,95 ponto. A MMD foi de 4,56 pontos. Houve correlação positiva e moderada da pontuação do questionário VISA-A-Br com o teste de elevação monopodal do calcanhar na plataforma. Conclusão: O instrumento apresentou propriedades de medida adequadas para auxiliar profissionais e pacientes na avaliação objetiva de suas doenças, provendo informações com potencial valor diagnóstico, prognóstico e de resposta ao tratamento.Introduction: Achilles tendon injuries result in functional déficits and sporting distance. For a treatment program appropriate, metrics are used that can measure the evolution of the patient, from the beginning of the rehabilitation until the therapeutic discharge. There are several tests that measure the function of the plantar flexor muscles, among them, the test of heel lift. In the literature, there are several ways described for the application of this test, however, technological adaptations can help in the reduction of measurement errors and facilitate its application. Objective: Proposing a new instrument to assess the function of the ankle plantar flexors and evaluate the measurement properties of this instrument in patients with calcaneal tendon disorders. Hypothesis: The new instrument developed for the Single Foot Heel Rise Test has high reliability and adequate construct validity in the functional assessment of ankle flexor muscles. Methods: An expert committee was formed to propose technological modifications in the function test of the ankle flexor muscles. Patients with calcaneal tendon disorder were included, they answered the sociodemographic questionnaire and the questionnaire Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Achilles (VISA-A-Br). Then, the patients underwent to the test of single-legged elevation of the toes with the modifications proposals for evaluating the function of the flexor muscles. Were analysed the following modified test measurement properties: reliability, mesurement error and construct validity. The reliability was calculated by type 2.1 intraclass correlation coefficient (ICC) and their respective 95% confidence intervals (95% CI). The measurement error was calculated using of two measurements: standard error of measurement (SEM) and smallest detectable change (SDC). The SEM was calculated through the ratio of the standard deviation of the mean of the differences by the square root of 2 (SD of differences/√2). The SDC was calculated using the formula SDC = 1.645 x √2 x SEM. The validity of construct was evaluated by Pearson's correlation test with the questionnaire VISA-A-Br. Results: The reliability among the assessments, both on the affected, and on the unaffected side, was 0.99, being classified as great. The SEM was 1.95 points. SDC was 4.56 points. There was positive and moderate correlation of the VISA-A-Br questionnaire score with the unipedal heel lift test on the platform. Conclusion: The instrument showed adequate measurement properties for use in the clinical and research environment, proving to be a valid tool for initial assessment and functional evolution of patients with calcaneal tendon disorders

Lesiones musculoesqueléticas en policías militares

INTRODUCTION: The physical qualities need to be analyzed and are risk factors associated with the development of musculoskeletal injuries during military sports training. OBJECTIVE: Epidemiological studies of musculoskeletal injuries occurred in the ankle and foot of military police officers. METHODS: We collected all the medical records of military police officers who have suffered previous injuries in the ankle and foot during the period September 2005 to August 2011. The information was obtained through physical therapy evaluation form found in the records and subsequently the data were tabulated and analyzed. RESULTS: After collecting the data from the medical records, it was found that there 29% bone injuries, 32% ligament injuries and 35% muscle injuries. CONCLUSION: A sprained ankle demonstrates a risk to public health is described by the international statistical classification of diseases and related health problems, which is also in the military environment, described as risk during sports practice.INTRODUCCIÓN: Las cualidades físicas precisan ser analizadas y se vinculan como factores de riesgos para desarrollar lesiones musculoesqueléticas durante el entrenamiento deportivo-militar. OBJETIVO: Recolectar datos sobre epidemiología de las lesiones musculoesqueléticas ocurridas en tobillos y pies de policías militares. MATERIALES Y MÉTODOS: Se analizaron todas las fichas médicas de policías militares que sufrieron lesiones previas en tobillos y pies durante el período de septiembre de 2005 a agosto de 2011; las informaciones fueron obtenidas mediante los formularios de evaluación fisioterapéutica que se encontraban en las fichas médicas; posteriormente, los datos obtenidos fueron tabulados y analizados. RESULTADOS: Después de la recolección de datos de las fichas médicas se observó 29% de lesiones óseas, 32% de ligamentarias y 35% de musculares. CONCLUSIÓN: La torcedura de tobillo demuestra ser un riesgo para la salud pública como se describe en la clasificación estadística internacional de enfermedades y problemas relacionados con la salud, siendo en el medio militar señalada también como un riesgo durante la práctica deportiva.INTRODUÇÃO: As qualidades físicas precisam ser analisadas e estão associadas como fatores de risco a desenvolver lesões musculoesqueléticas durante o treinamento esportivo militar. OBJETIVO: Levantar a epidemiologia das lesões musculoesqueléticas ocorridas em tornozelo e pé de policiais militares. MATERIAIS E MÉTODOS: Foram coletados todos os prontuários de policiais militares que sofreram lesões prévias no tornozelo e pé durante o período de setembro de 2005 a agosto de 2011, as informações foram obtidas através da ficha de avaliação fisioterapêutica constatada nos prontuários, posteriormente os dados obtidos foram tabulados e analisados. RESULTADOS: Após a coleta de dados dos prontuários foi observado que houve 29% de lesões ósseas, 32% de ligamentares e 35% de musculares. CONCLUSÃO: A entorse de tornozelo demonstra um risco à saúde pública como descrita pela classificação estatística internacional de doenças e problemas relacionados à saúde, sendo no meio militar também descrita como um risco durante a prática esportiva

Käytännön kosteikkosuunnittelu

Maatalouden vesiensuojelua edistetään monin tavoin. Ravinteita ja eroosioainesta sisältäviä valumavesiä pyritään puhdistamaan erilaisissa kosteikoissa. Tämä opas on kirjoitettu avuksi pienimuotoisten kosteikkojen perustamiseen. Oppaassa esitetään käytännönläheisesti kosteikon toteuttamisen eri vaiheet paikan valinnasta suunnitteluun ja rakentamiseen. Vuonna 2010 julkaistun painoksen tiedot on saatettu ajantasalle. Julkaisu on toteutettu osana Tehoa maatalouden vesiensuojeluun (TEHO) -hanketta ja päivitetty TEHO Plus -hankkeen toimesta. Oppaan toivotaan lisäävän kiinnostusta kosteikkojen suunnitteluun ja edelleen niiden rakentamiseen