Painful shoulder? Remote clinical management of a field guide with shoulder pain and loss of shoulder function in Antarctica

© 2017, Australasian Medical Journal Pty Ltd. All rights reserved. We report the case of a female Field Guide based at the British Antarctic Survey’s Rothera Science Research Station on Adelaide Island, Antarctica who independently contacted a physiotherapist specialising in climbing related injuries (GJ) located in the UK. For a second opinion. The Field Guide was experiencing significant work difficulties due to shoulder pain and subsequent loss of function particularly in overhead activities. The case raises important issues about the medical management of Field Guides operating in extreme environments and remote locations

Characterisation of Delayed Onset of Muscle Soreness (DOMS) in the hand, wrist and forearm using a finger dynamometer: A pilot study

Background: Experimentally-induced delayed-onset muscle soreness of large muscle groups is frequently used in as an injurious model of muscle pain. We wanted to develop an experimental model of DOMS to mimic overuse injuries from sports where repeated finger flexion activity is vital such as rock climbing. The aim of this pilot study was to evaluate the utility of a ‘finger trigger device’ to induce DOMS in the fingers, hands, wrists and lower arms. Methods: A convenient sample of six participants completed an experiment in which they undertook finger exercises to exhaustion after which measurements of pain, skin sensitivity to fi ne touch, forearm circumference and grip strength in the hand, wrist and forearm were taken from the experimental and contralateral none-exercised (control) arms. Results: Pain intensity was greater in the experimental arm at rest and on movement when compared with the control arm up to 24 hours after exercise, although the location of pain varied between participants. Pressure pain threshold was significantly lower in the experimental arm compared with the control arm immediately after exercises locations close to the medial epicondyle but not at other locations. There were no statistical significant differences between affected and non-affected limbs for mechanical detection threshold, forearm circumference or grip strength. Conclusion: Repetitive finger flexion exercises of the index finger by pulling a trigger against a resistance can induced DOMS. We are currently undertaking a more detailed characterization of sensory and motor changes following repetitive finger flexion activity using a larger sample

Previous injury as a risk factor for re-injury in rock climbing: A secondary analysis of data from a retrospective cross sectional cohort survey of active rock climbers

Background The aim of this article is to report the findings of a secondary analysis of a previous injury study to consider previous injury as a risk factor for reinjury in rock climbing. Methods We completed a secondary analysis of 201 questionnaires that were gathered as part of a retrospective cross-sectional cohort survey that investigated the epidemiology of injuries in a representative sample of British rock climbers. Participants had actively engaged in rock climbing over the previous 12-month period and were recruited from six indoor climbing centres and five outdoor climbing venues (men n=163, mean±SD, age=35.2±11.8 years, participating in rock climbing=13.88+11.77 years; women n=38, mean±SD, age=35.1±10.7 years, participating in rock climbing=11.62+9.19 years). Results Of the 101 participants who sustained a previous injury, 36 were found to have sustained at least one reinjury. The total number of reinjuries was 82, with the average probability of sustaining at least one reinjury being 35.6% (95% CI 34.71% to 36.8%; p<0.001, McNemar's χ2 test) with the relative risk of reinjury being 1.55 (95% CI 1.34 to 1.80). The fingers were the most common site of reinjury (12 participants, 26%; χ2=43.12, df=5, p<0.001). Conclusions Previous injury was found to be a significant risk factor for reinjury, particularly at the site of the fingers. Technical difficulty in bouldering and sport climbing behaviours were significantly associated with repetitive overuse reinjury. As participatory figures increase, so does the likelihood that a high proportion of climbers may sustain a reinjury of the upper extremity

The Impact of Sleep on Mental Toughness: Evidence From Observational and N-of-1 Manipulation Studies in Athletes

This is the author accepted manuscript. The final version is available from American Psychological Association via the DOI in this recordhe purpose of this study was to explore the direction and magnitude of the relationship between sleep and mental toughness and examine the effect of time in bed extension and restriction on mental toughness. Study 1 was an observational study examining the relationship between sleep quality and duration (hours) and mental toughness in 181 participants. Winsorized correlations revealed both longer sleep duration (ρω = .176 [.033, .316], p = .016) and higher quality (ρω = .412 [.270, .541], p ≤ .001) were associated with increased mental toughness. Follow-up regression analyses revealed sleep quality (b = 0.177, [0.117, 0,238], p ≤ .001), but not sleep duration (b = 0.450, [0.3254, 1.22], p = .256), predicted mental toughness score. In Study 2, we utilized a longitudinal N-of-1 influenced methodology with 6 participants to further examine whether manipulated time in bed (i.e., sleep duration) influenced mental toughness. Participants recorded sleep quality, duration, and mental toughness over 5 weekdays during 2 separate 2-week periods of baseline (normal sleeping pattern) followed by manipulated time in bed (counterbalanced 9 hr or 5 hr). Visual analyses (including determination of nonoverlapping data points between baseline and intervention weeks) revealed reduced time in bed negatively impacted the mental toughness of 4 of the participants. Social validation interviews were conducted to further explore participants' perceptions of the sleep manipulation. A cumulative effect of reduced sleep on mental toughness was noted by specific individuals. In addition, participants identified potential buoys of mental toughness in the absence of sleep

An exploratory case study of mental toughness variability and potential influencers over 30 Days

This is the final version. Available from the publisher via the DOI in this record.The purpose of this study was to explore whether mental toughness varies across a 30-day training block and whether such variability is associated with specific antecedents. This exploratory case study research investigated mental toughness variability using the Mental Toughness Index (MTI) with thirteen elite master runners across a series of self-selected training sessions, followed by interviews and follow-up questionnaires, to identify primary influencers of variability. There were significant differences in the MTI scores between baseline (before the training period), and the minimum and the maximum reported score over five self-selected training sessions (p's < 0.004). The proceeding follow-up interviews and questionnaires then provided insights into factors influencing this intra-individual variability. These higher-level themes included foundational wellbeing, specific preparation, and actions utilized in the moment. This study is the first to demonstrate within-person MTI variability across specific training sessions and provides initial insights for both athletes and practitioners into potential influencers of mental toughness

The Effect of Hypermobility on the Incidence of Injury in Professional Football: A multi-site cohort study

Background: A recent study demonstrated joint hypermobility increased the incidence of injury in an elite football team utilising a univariate statistical model. Objectives: To compare injury incidence between hypermobile and non-hypermobile elite football players incorporating a multi-site design and multivariate inferential statistics. Methods: 80 players comprising 3 English Championship football teams were followed prospectively during the 2012-2013 season. Joint hypermobility was assessed according to the 9-point Beighton Criteria at the start of the study period. A cut-off score of ≥4 categorised a participant as hypermobile. Player exposure and time-loss injuries were recorded throughout. Results: Mean ± standard deviation incidence of injuries was 9.2 ± 10.8 injuries/1000h. The prevalence of hypermobility was 8.8%. Hypermobiles had a tendency for higher injury incidence (mean [95% confidence interval] difference, 5.2 [0.9-2.7] injuries/1000 h; p = 0.06). Cox regression analyses found training exposure to be highly significant in terms of injury risk (p < 0.001) for all participants. Non-hypermobiles had a lower injury risk (p = 0.11), according to the Cox model, which is suggestive but not conclusive that hypermobility predisposes injury risk. Conclusions Hypermobility showed a trend towards increased risk of injury. Training exposure is a significant injury risk factor in elite football

Development of a baseline-temperature correction methodology for electrochemical sensors and its implications for long-term stability

Recent studies have shown that (three-electrode) electrochemical sensors can be utilised for air quality monitoring and exposure assessment. The long-term performance of these sensors is however, often limited by the effects of ambient meteorological parameters on the sensor baseline, in particular temperature. If electrochemical (EC) sensors are to be adopted for air quality measurement over extended periods (months), this effect must be accounted for. Recent long-term, ambient measurements of CO, NO and NO$_2$ using EC sensors have revealed that temperature (and relative humidity (RH)) had an effect on the baseline which was more pronounced in the case of NO sensors with coefficient of determination, $R^2$ of 0.9 when compared to CO and NO$_2$ with $R^2$ < 0.2. In this paper we present a correction methodology that quantifies this effect (referred to here as fitted baseline), implementing these correction on the EC measurements. We found that EC sensors corrected for baseline-temperature effect using the method describe in this paper show good agreement when compared with traditional reference instrument. The coefficient of determination $R^2$ of 0.7-0.8 and gradient of 0.9 was observed for baseline-temperature corrected NO compared to $R^2$ = 0.02 prior to baseline-temperature correction. Furthermore, the correction methodology was validated by comparing the temperature-baseline with proxy temperature compensating measurements obtained from the fourth electrode of a set of novel four-electrode electrochemical sensors. A good agreement (R$^2$ = 0.9, with gradients = 0.7-1.08 for NO and 0.5 < R$^2$ < 0.73 for CO) was observed between temperature fitted baselines and outputs from the fourth electrodes (also known non-sensing/auxiliary electrode). Meanwhile, the long-term stability (calibrated signal output) of temperature-corrected data was evaluated by comparing the change in sensor gain to meteorological parameters including temperature, relative humidity, wind speed and wind direction. The results showed that there was no statistically significant change in sensitivity (two-sided $t$-test, p = 0.34) of the temperature-corrected electrochemical sensor with respect to these parameters (over several months). This work demonstrates that using the baseline-temperature correction methodology described in this paper, electrochemical sensors can be used for long-term (months), quantitative measurements of air quality gases at the parts per billion volume (ppb) mixing ratio level typical of ambient conditions in the urban environment.The authors would like to thank Cambridge Commonwealth Trust & Cambridge Overseas Trust and Dorothy Hodgkin Studentship for the PhD studentship awarded to Olalekan Popoola. We will like to thank NERC for funding the SNAQ Heathrow project as well as DfT and EPSRC for funding the MESSAGE project

Metabolic Profiles Distinguish Non-Dampness-Phlegm and Dampness-Phlegm Patterns among Korean Patients with Acute Cerebral Infarction

Traditional Korean Medicine classifies stroke into four subtype patterns according to symptomatic pattern identification: Qi deficiency (QD), Yin deficiency (YD), Dampness-phlegm (DP), and Fire and Heat (FH). This study investigated the difference in metabolic profiles of plasma comparing subjects displaying non-DP and DP patterns. A total of 141 patients with cerebral infarction enrolled in this study were distributed as non-DP (N=68) and DP (N=73). Anthropometric parameters and symptom/sign index were measured. Metabolic profiling was performed using ultrahigh-performance liquid chromatography-mass spectrometry. The Ratio of subjects with slippery pulse was higher in DP pattern, but fine pulse was lower than that in non-DP pattern. As a result of metabolomics analysis, twenty-one metabolites displayed different levels between non-DP and DP patterns. Two were identified as lysophosphatidylcholines (LPCs), LPC(18:2), and LPC(20:3) having an unsaturated acyl chain and showed lower levels in DP pattern than in non-DP pattern (P=0.015, 0.034, resp.). However, the saturated LPCs, LPC(18:0) and LPC(16:0), exhibited slight but statistically insignificant elevation in DP pattern. Our results demonstrated that plasma LPCs with polyunsaturated fatty acid groups were associated with DP pattern and suggest that variation of plasma lipid profiles may serve as potential biomarker for diagnosis of DP pattern

Tissue engineering a fetal membrane

The aim of this study was to construct an artificial fetal membrane (FM) by combination of human amniotic epithelial stem cells (hAESCs) and a mechanically enhanced collagen scaffold containing encapsulated human amniotic stromal fibroblasts (hASFs). Such a tissue-engineered FM may have the potential to plug structural defects in the amniotic sac after antenatal interventions, or to prevent preterm premature rupture of the FM. The hAESCs and hASFs were isolated from human fetal amniotic membrane (AM). Magnetic cell sorting was used to enrich the hAESCs by positive ATP-binding cassette G2 selection. We investigated the use of a laminin/fibronectin (1:1)-coated compressed collagen gel as a novel scaffold to support the growth of hAESCs. A type I collagen gel was dehydrated to form a material mimicking the mechanical properties and ultra-structure of human AM. hAESCs successfully adhered to and formed a monolayer upon the biomimetic collagen scaffold. The resulting artificial membrane shared a high degree of similarity in cell morphology, protein expression profiles, and structure to normal fetal AM. This study provides the first line of evidence that a compacted collagen gel containing hASFs could adequately support hAESCs adhesion and differentiation to a degree that is comparable to the normal human fetal AM in terms of structure and maintenance of cell phenotype

Pain and Function in the Runner a Ten (din) uous Link

A male runner (30 years old; 10-km time: 33 min, 46 sec) had been running with suspected insertional Achilles tendinopathy (AT) for ~2 years when the pain reached a threshold that prevented running. Diagnostic ultrasound (US), prior to a high-volume stripping injection, confirmed right-sided medial insertional AT. The athlete failed to respond to injection therapy and ceased running for a period of 5 weeks. At the beginning of this period, the runner completed the Victoria institute of sports assessment-Achilles questionnaire (VISA-A), the foot and ankle disability index (FADI), and FADI sport prior to undergoing an assessment of bi-lateral gastrocnemius medialis (GM) muscle architecture (muscle thickness (MT) and pennation angle (PA); US), muscle contractile properties (maximal muscle displacement (Dm) and contraction time (Tc); Tensiomyography (TMG)) and calf endurance (40 raises/min). VISA-A and FADI scores were 59%/100% and 102/136 respectively. Compared to the left leg, the right GM had a lower MT (1.60 cm vs. 1.74 cm), a similar PA (22.0° vs. 21.0°), a lower Dm (1.2 mm vs. 2.0 mm) and Tc (16.5 ms vs. 17.7 ms). Calf endurance was higher in the right leg compared to the left (48 vs. 43 raises). The athlete began a metronome-guided (15 BPM), 12-week progressive eccentric training protocol using a weighted vest (1.5 kg increments per week), while receiving six sessions of shockwave therapy concurrently (within 5 weeks). On returning to running, the athlete kept daily pain (Numeric Rating Scale; NRS) and running scores (miles*rate of perceived exertion (RPE)). Foot and ankle function improved according to scores recorded on the VISA-A (59% vs. 97%) and FADI (102 vs. 127/136). Improvements in MT (1.60 cm vs. 1.76 cm) and PA (22.0° vs. 24.8°) were recorded via US. Improvements in Dm (1.15 mm vs. 1.69 mm) and Tc (16.5 ms vs. 15.4 ms) were recorded via TMG. Calf endurance was lower in both legs and the asymmetry between legs remained (L: 31, R: 34). Pain intensity (mean weekly NRS scores) decreased between week 1 and week 12 (6.6 vs. 2.9), while running scores increased (20 vs. 38) during the same period. The program was maintained up to week 16 at which point mean weekly NRS was 2.2 and running score was 47