Cumulative Load Research Articles

The impact of lifetime coffee and tea loads on Multiple Sclerosis severity.

The association between lifestyle factors and Multiple Sclerosis (MS) disease severity and progression has been investigated to a lesser extent compared with susceptibility to the disease. We aimed to assess the impact of lifetime coffee and tea consumption on MS severity. Design: cross-sectional study. Two hundred and eight patients (139 females and 69 males) consecutively recruited at the Department of Neurology in Novara, Italy were asked about their lifetime consumption of coffee and tea. The lifetime intensity of consumption (cups/day) was estimated as the weighted sum of the mean number of standard cups drunk per day at different ages. A measure of cumulative lifetime load of the exposure was expressed in terms of cup-years. Disease severity was estimated by the Multiple Sclerosis Severity Score (MSSS). HLA-DRB1∗15 and HLA-A∗02 genotyping was performed in 167 patients. The MSSS was not associated with the status of coffee or tea consumer, or the amount of cups/day or cup-years. The Odds Ratios (OR) for falling in the upper tertile of the MSSS distribution was 1.30 (95% Confidence Interval (CI): 0.47-3.58) for coffee consumers of 1-3 cups/day and 1.14 (95%CI: 0.33-3.95) for 4-8 cups/day vs. non-consumers. The OR was 0.69 (95%CI: 0.35-1.34) for tea consumers vs. non-consumers. However, heavy consumers of coffee (4-8 cups/day) more frequently had a progressive form than small consumers (1-3 cups/day) and non-consumers (19% vs. 14% vs. 0%), and had a significantly higher age at MS onset (36.6±10.3; 31.5±9.5; 28.6±8.1 years, p=0.001). Although not reaching statistical significance, coffee consumers positive for HLA-A∗02 had a six-fold risk of being in the worst tertile compared to never consumers, whereas the risk was only 1.3 for coffee consumers negative for the same allele. Coffee or tea intake is not associated with different severity of MS. However, we cannot exclude a possible effect of higher doses of coffee for the subgroup of progressive patients.

Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers.

Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years. Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into "high," "medium," and "low" volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period. From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18-258). Four institutions (21%) were classified as "high volume" centers, four (21%) as "medium volume" centers, and 11 (58%) as "low volume" centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%. This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.

Blood Pressure Load: An Effective Indicator of Systemic Circulation Status in Individuals With Acute Altitude Sickness.

Background: Acute high altitude (HA) exposure results in blood pressure (BP) variations in most subjects. Previous studies have demonstrated that higher BP is potentially correlated with acute mountain sickness (AMS). The BP load may be of clinical significance regarding systemic circulation status.Objectives: This study aimed to examine HA-induced BP changes in patients with AMS compared to those in healthy subjects. Further, we provided clinical information about the relationship between variations in 24-h ambulatory parameters (BP level, BP variability, and BP load) and AMS.Methods: Sixty-nine subjects were enrolled and all participants ascended Litang (4,100 m above sea level). They were monitored using a 24-h ambulatory blood pressure device and underwent echocardiography within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS.Results: The AMS group comprised more women than men [15 (65.2%) vs. 13 (28.3%), P < 0.001] and fewer smokers [4 (17.4%) vs. 23 (50.0%), P = 0.009]. The AMS group exhibited significant increases in 24-h BP compared to the non-AMS group (24-h SBP variation: 10.52 ± 6.48 vs. 6.03 ± 9.27 mmHg, P = 0.041; 24-h DBP variation: 8.70 ± 4.57 vs. 5.03 ± 4.98 mmHg, P = 0.004). The variation of mean 24-h cBPL (cumulative BP load) (mean 24-h cSBPL: 10.58 ± 10.99 vs. 4.02 ± 10.58, P = 0.016; 24-h mean cDBPL: 6.03 ± 5.87 vs. 2.89 ± 4.99, P = 0.034) was also obviously higher in AMS subjects than in non-AMS subjects after HA exposure. 24-h mean cSBPL variation (OR = 1.07, P = 0.024) and 24-h mean cDBPL variation (OR = 1.14, P = 0.034) were independent risk factors of AMS. Moreover, variation of 24-h mean cSBPL showed a good correlation with AMS score (R = 0.504, P < 0.001).Conclusions: Our study demonstrated that patients with AMS had higher BP and BP load changes after altitude exposure than healthy subjects. Excessive BP load variations were associated with AMS. Thus, BP load could be an effective indicator regarding systemic circulation status of AMS.

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Background:Schizophrenia is a chronic disease. It is characterized by disorders of thought, perceptions, sense of self and behavior. It was found that stress play an important role in pathophysiology of schizophrenia. It is time to know regarding particular type of stress experienced by schizophrenic patient.AIMS:Aim of our study was to find out perceived stress in patient with schizophrenia and correlation with psychopathology.METHODS:We had assessed total 100 participants (50 patients with schizophrenia and 50 healthy controls). We applied PANSS to assess psychopathology and we applied students stress dimension questionnaire (SSDQ) to assess stress loading. Correlation between Psychopathology and stress was analyzed by using Pearson’s correlation.RESULTS:Mean of PANSS score among patients with schizophrenia was 65.56 (SD 13.58). Mean of cumulative stress loading on SSDQ was 341.23 (SD 77.61) in patients with schizophrenia and 226.97 (SD 69.14) in healthy control. We found that there was negative correlation between PANSS and cumulative stress loading. Pearson’s correlation coefficient between PANSS and cumulative stress loading was r : 0.522 ( p value .000).CONCLUSION:Positive correlation between Psychopathology and stress is found. It clears that it’s time to address stress in patient with schizophrenia and non pharmacotherapy for stress must be included in patient with schizophrenia.

Dynamic Work Analysis of Manual Material Handling With Digital Human Modeling

The activity of loading and unloading rice in Indonesia is still carried out using human power. Porters transport rice manually from truck to warehouse or the otherwise. Manual material handling work (MMH) will pose a risk of musculoskeletal disorders (MSDs). The application of the work analysis method generates an analysis per one body position only. There is a need for a model that can perform a work analysis quickly for any change in body movement if it is carried out in dynamic work, for instances on rice porters. In this research, Digital Human Modeling Tecnomatix Jack is used in the Task Simulation Builder menu to simulate dynamic work and generate analysis. The dynamic work carried out is to compare the risk of transporting rice weighing 10 kg and 25 kg. The results obtained are Ergonomic Report, Static Strength Prediction (SSP), Low Back Compression Analysis (LBA), Fatigue, Cumulative Loading and Metabolic Energy Expenditure (MEE). The simulator also provides the SSV file extension as in SSP. If needed, this result can be entered in a formula according to work analysis method such as RULA or REBA so that every change in movement obtained results related to the risk that may occur.

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BACKGROUND:Schizophrenia is a chronic mental illness. It is necessary to increase well-being in patient with schizophrenia. Positive Psychological Factors play important role in wellbeing of patients with schizophrenia.AIMS:Aim of our study is to find out Positive Psychological Factors in patient with schizophrenia and interplay with psychopathology.METHODS:We assessed total 100 participants (50 patients with schizophrenia and 50 healthy controls). We measured severity of psychopathology on PANSS and Positive Psychological Factors (optimism, resilience, perceived stress, subjective happiness, satisfaction with life) on Flourishing scale, SSDQ, Subjective Happiness Scale, satisfaction with Life scale. Correlation between psychopathology and positive psychological factors was analyzed using person’s correlation.RESULTS:We found that mean of PANSS in patient with schizophrenia was 65.5 (SD 13.58). Mean of Flourishing Scale was 34.90(SD 5.13),mean of cumulative stress loading was 341.23(SD 77.61),mean of subjective happiness scale was 15.58(SD 2.29), mean of Satisfaction with life scale was 17.10(SD 3.05). We found there was negative correlation with FS, SHS, SWLS and positive correlation with stress. Pearson’s correlation coefficient between PANSS with FS was r:-.060 (p value: .000),with SHS was r:-.826(pvalue:.000),with SWLS was r:-.537 and with CSL was r:.522(p value .000).CONCLUSION:Positive psychological factors play important role in well-being of patient with schizophrenia. Psychotherapy must be included to increase positive psychological factors in patient with schizophrenia.

Cumulative Systolic Blood Pressure Load and Risk of Cardiovascular Outcomes in Patients With Diabetes

Standard measures of blood pressure (BP) do not account for both the magnitude and duration of exposure to elevated BP over time. We aimed to assess the association between cumulative SBP load and risk of major adverse cardiovascular events (MACE).

The influence of maturity on recovery and perceived exertion, and its relationship with illnesses and non-contact injuries in young soccer players.

A high training load could increase the risk of injury in soccer players. However, there is still a lack of knowledge regarding the effect on young athletes, in whom a different maturity status could lead to different physiological responses to training. Therefore, the aim of this study was to investigate the association of internal load markers and recovery status with risk of illnesses and non-contact injuries in young soccer players characterised by different maturity status. Twenty-three U14 soccer players were monitored during a full season and categorised according to years from peak height velocity (PHV). Based on the estimated values, athletes were divided into three different groups: Pre-PHV, Circa-PHV and Post-PHV players. The following internal load markers were monitored: rating of perceived exertion (RPE), session rating of perceived exertion (S-RPE), weekly load (WL), cumulative loads for 2, 3, and 4 weeks (WL2, WL3, WL4), acute to chronic workload ratio for 2, 3 and 4 weeks (A:C2, A:C3, A:C4) and week-to-week percentage variation (%WL). Recovery status was quantified using the total quality recovery (TQR) scale. Z-score transformation was adopted for TQR and RPE values and the difference between the parameters was calculated (Z-TQR-RPE). The Kruskal-Wallis test was adopted to evaluate differences in TQR and RPE with respect to maturity offset. A multinomial regression analysis was performed to evaluate the association between internal load markers and risk of illness and non-contact injuries. The variables that showed a significant association were included in the receiver operating characteristic (ROC) curve analysis. The results revealed that RPE was significantly higher (p < 0.01) and TQR significantly lower (p < 0.05) in Post-PHV compared to Pre- and Circa-PHV. Moreover, RPE, A:C4, TQR and Z-TQR-RPE showed a significant (p < 0.01) association with non-contact injuries. The internal load markers included in ROC curve analysis showed poor predictive ability (AUC ≤ 0.6). A rapid increase in training load together with a decrease in recovery status may produce higher susceptibility to illnesses and non-contact injuries. The contrasting physiological responses found in relation to maturity status could explain the different injury predisposition in young soccer players.

Pelvic floor tissue damping during running using an intra-vaginal accelerometry approach

BackgroundWhile cumulative loading of the pelvic floor during exercise appears to increase the risk of developing pelvic floor disorders, the pathophysiologic role of pelvic floor loading is poorly understood. The aim of this exploratory study was to present a method for evaluating vibrational frequency damping of the female pelvic floor and to investigate the potential utility of this approach in a preliminary evaluation. MethodsFemale participants were instrumented with an intravaginal accelerometer and a hip-mounted accelerometer, then ran on a treadmill at 7 km/h and 10 km/h both before and after a 30-min self-selected pace. Displacement of the pelvic floor relative to the bony pelvis was calculated using double integration of the accelerometer data. Vibrational damping coefficients were calculated using a wavelet-based approach to determine the effect of continence status, parity, running speed and time on vibrational damping. FindingsSeventeen women (n = 10 reported regularly leaking urine while exercising, while n = 7 reported not leaking) completed the running protocol. No differences in vibrational damping were detected between continent and incontinent women when all frequency bands were evaluated together, however significant effects of parity, time, running speed and continence status were found within specific frequency bands. Parous women demonstrated less damping in the 25-40 Hz band compared to nulliparae, damping in the 13-16 Hz band was lower after the 30-min run, and incontinent women demonstrated lower damping in the 4.5–5.5 Hz band than continent women when running at 7 km/h. InterpretationIntra-vaginal vibrational damping may be useful in detecting biomechanical mechanisms associated with pelvic floor disorders experienced by females during exercise.

Predictive Analytic Techniques to Identify Hidden Relationships between Training Load, Fatigue and Muscle Strains in Young Soccer Players.

This study aimed to analyze different predictive analytic techniques to forecast the risk of muscle strain injuries (MSI) in youth soccer based on training load data. Twenty-two young soccer players (age: 13.5 ± 0.3 years) were recruited, and an injury surveillance system was applied to record all MSI during the season. Anthropometric data, predicted age at peak height velocity, and skeletal age were collected. The session-RPE method was daily employed to quantify internal training/match load, and monotony, strain, and cumulative load over the weeks were calculated. A countermovement jump (CMJ) test was submitted before and after each training/match to quantify players’ neuromuscular fatigue. All these data were used to predict the risk of MSI through different data mining models: Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM). Among them, SVM showed the best predictive ability (area under the curve = 0.84 ± 0.05). Then, Decision tree (DT) algorithm was employed to understand the interactions identified by the SVM model. The rules extracted by DT revealed how the risk of injury could change according to players’ maturity status, neuromuscular fatigue, anthropometric factors, higher workloads, and low recovery status. This approach allowed to identify MSI and the underlying risk factors.

Effects of Different Surface Heat Transfer Coefficients on Predicted Heating and Cooling Loads towards Sustainable Building Design

The transfer of surface heat between a building and the outdoor environment is the energy transfer channel and it is important for the energy efficiency of buildings. Early stage building design is a critical stage and it can directly determine the energy consumption by a building. Therefore, selecting appropriate surface heat transfer coefficients (SHTCs) is a key issue in building energy consumption prediction. In this study, EnergyPlus was employed to investigate the building load in Chinese cities with different SHTCs: (1) constant SHTCs based on national standards; and (2) dynamically changing SHTCs based on the Thermal Analysis Research Program (TARP). Based on investigations of the hourly load, daily cumulative load in a typical day, and annual cumulative load with different SHTCs, corrections for the annual cumulative load were obtained according to the relative deviations between the results produced with the TARP model and traditional SHTCs. The greatest relative deviations were 67.5% and 25.3% for the building shape factor φ = 0.49 and 0.29 in Lhasa. The relative deviations were 13.3% and 12.0% for φ = 0.49 in Xi’an and Beijing, respectively. Corrections were not essential for other conditions because the relative deviations were lower than 5.0%. Considering the current characteristics of engineering calculations and the need to obtain more accurate design results, dynamically changing SHTCs should be applied. These correction factors can obtain more accurate results for the current building energy efficiency system with traditional SHTCs.

Regulating Movement Frequency and Speed: Implications for Lumbar Spine Load Management Strategies Demonstrated Using an In Vitro Porcine Model.

The relationship between internal loading dose and low-back injury risk during lifting is well known. However, the implications of movement parameters that influence joint loading rates-movement frequency and speed-on time-dependent spine loading responses remain less documented. This study quantified the effect of loading rate and frequency on the tolerated cumulative loading dose and its relation to joint lifespan. Thirty-two porcine spinal units were exposed to biofidelic compression loading paradigms that differed by joint compression rate (4.2 and 8.3kN/s) and frequency (30 and 60 cycles per minute). Cyclic compression testing was applied until failure was detected or 10,800 continuous cycles were tolerated. Instantaneous weighting factors were calculated to evaluate the cumulative load and Kaplan-Meier survival probability functions were examined following nonlinear dose normalization of the cyclic lifespan. Significant reductions in cumulative compression were tolerated when spinal units were compressed at 8.3kN/s (P < .001, 67%) and when loaded at 30cycles per minute (P = .008, 45%). There was a positive moderate relationship between cumulative load tolerance and normalized cyclic lifespan (R2 = .52), which was supported by joint survivorship functions. The frequency and speed of movement execution should be evaluated in parallel to loading dose for the management of low-back training exposures.

Association of Bacterial Load in Drinking Water and Allergic Diseases in Childhood

To determine if high microbial content in drinking water alters the risk of allergic disease in children.Children aged 6 to 16 years living in Eastern Croatia between 2011 and 2013 were recruited for the study. The authors report that this area of Croatia is unique in that individuals have access to drinking water through 2 different supply systems: public mains or individual wells.There were 2 phases of the study. In phase 1, parents were asked to complete a survey regarding their child’s symptoms, physician-diagnosed illnesses, medication use and type of drinking water supply: public mains and/or individual wells. In phase 2, one-half of the study participant’s parents were randomly selected to complete a questionnaire about home location, farming practices, and socioeconomic status. Their children underwent skin-prick testing for 9 aeroallergens: dust mites, cockroach, molds (Alternaria and Cladosporium) and pollens (birch, hazelnut, grass, and ragweed). Data on the microbial content of drinking water from 1997 to 2007 were reviewed to ascertain information about early-life exposure for the study participants. Water samples were collected at random points from public mains and from each individual well in participating households.A total of 1110 children were recruited for phase 1 of the study, with 978 children fulfilling study criteria. A total of 51.5% (n = 504) of the children attended urban schools, and 48.5% (n = 474) attended rural schools. A total of 494 children accessed drinking water through the public main water supply, whereas 484 accessed it through individual wells. More than 90% of the 484 children with individual wells attended rural schools. There were only 21 children living in urban areas who accessed individual well water. There was a significant difference in the cumulative bacterial load in drinking water, with samples from individual wells having a much higher bacterial load: individual wells (6390 colony forming units per mL [4190–9550]) versus public (0 colony forming units per mL [0–0]); P < .0001. Children who had access to individual wells had significantly lower rates of lifetime prevalence of asthma (2.3% vs 5.5%; P = .011), atopic dermatitis (6.7% vs 14.4%; P < .001), and rhinitis (15.1% vs 25.2%; P < .001), compared with that of those children who had access to a public main water supply.Exposure to high microbial content in drinking water may confer protection against allergic disease development in childhood.Here is one more study that lends further support to the hygiene hypothesis revealing that high microbial exposures in drinking water may protect children against the development of atopic diseases. The authors also add another possible route of exposure to explain the lower prevalence of allergic disease found in those living in rural environments.

Optimum Sizing of Photovoltaic-Battery Power Supply for Drone-Based Cellular Networks

In order to provide Internet access to rural areas and places without a reliable economic electricity grid, self-sustainable drone-based cellular networks have recently been presented. However, the difficulties of power consumption and mission planning lead to the challenge of optimal sizing of the power supply for future cellular telecommunication networks. In order to deal with this challenge, this paper presents an optimal approach for sizing the photovoltaic (PV)-battery power supply for drone-based cellular networks in remote areas. The main objective of the suggested approach is to minimize the total cost, including the capital and operational expenditures. The suggested framework is applied to an off-grid cellular telecommunication network with drone-based base stations that are powered by PV-battery systems-based recharging sites in a rural location. The PV-battery system is optimally designed for three recharging sites with three different power consumption profiles with different peak and cumulative loads. Results show that the optimal design of the PV-battery system is dependent on geographical data, solar irradiation, and ambient temperature, which affect the output power of the PV system, as well as the power consumption profile, which affects the required number of PV panels and battery capacity.

Comparison of player-dependent and independent high-speed running thresholds to model injury risk in football

ABSTRACT High-speed running (HSR) loads have been linked with non-contact injury risks in team-sports. This study investigated whether player-specific speed zones, reflecting individual fitness characteristics, impact the associations between non-contact injury and acute and chronic HSR loads. Semi-professional soccer players from two clubs (n = 47) were tracked over two seasons using 10 Hz GPS (5552 observations). HSR distances were calculated arbitrarily (≥5.5 m·s−1), and in an individualised fashion based on the final speed of the 30–15 intermittent fitness test. Cumulative running loads were represented by exponentially weighted moving averages with 7-(acute) and 28-day (chronic) decay parameters. Physiotherapists collected non-contact, lower-limb, time-loss injury data (n = 101). Injury models using session type (training vs matches), coach, as well as arbitrary or individualised running loads were constructed via mixed-effect logistic regression. Session type had the largest effect on injury (training vs match OR = 0.28; 95%CI:0.17–0.44). Variations in individualised or arbitrary acute and chronic HSR loads within the mid-range of the observed data had negligible effects on predicted injury risk. However, the uncertainty of estimated effects at extreme values of acute and chronic HSR loads prevented any conclusive findings. Therefore, the efficacy of using customised speed thresholds in quantifying load for injury risk mitigation purposes remains unclear.

Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes: a systematic review with meta-analysis

IntroductionMilitary members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review...

Effects of training load and non‐training stress on injury risk in collegiate ice hockey players

This prospective cohort study investigated the relationships between cumulative training loads measured in arbitrary units (AU), non-training stress levels, and athletic injury risk in one team of male collegiate ice hockey players. Measures of athlete training load and non-training stress were recorded each on-ice session over one season. Daily load and stress sums were calculated for the two-day and two-week periods preceding each on-ice session. Athletic injuries were also recorded, and odds ratio analyses were used to determine relationships between training load and injury risk, as well as non-training stress and injury risk. Athletes who exerted training loads of 360 AU-540 AU and of 540 AU-1380 AU over 2 days experienced significantly greater odds of injury compared to athletes who exerted training loads <360 AU and <540 AU, respectively. This study concluded that as two-day training load increases, so do the odds of injury in this sample. In an effort to reduce the odds of athletic injury, the monitoring of individual two-day cumulative training load should be incorporated into the training programs of elite ice hockey players.

A clustering method with target supervision for the thermal climate division of residential buildings in the Hot Summer and Cold Winter Area of China

Aiming at the problem of climate diversity in the hot summer and cold winter (HSCW) area in China, an objective clustering method of the climate zoning for building thermal design guided by the target building load is proposed. Guided by the load, zone indexes with weights were established. In addition, this study proposes the least controversial estimation model for selecting the most appropriate hierarchical clustering criterion. Then, the climate zoning of the HSCW area is carried out, and three climate zones are obtained: the cold transition (CT) zone, the hot summer and cold winter core (HSCWC) zone, and the hot summer and warm winter transition (HSWWT) zone. It can be seen from the climate zoning results that the climate distribution in this area is highly related to the terrain distribution. Finally, according to the typical residential buildings in this area, the differential design of the building envelope thermal parameters is determined based on the different climate zones. The simulation results show that compared with the non-differential design, the annual cumulative building load per unit area of residential buildings in the CT zone is reduced by 17.1% on average and that in the HSWWT zone is reduced by 7.3% on average. This also confirms the significance of climate zoning for building energy conservation, and the study findings are informative for policymakers.

Consensus statement for preventing and managing low back pain in elite and sub-elite adult rowers

Background: Low back pain (LBP) is the most frequently reported musculoskeletal disorder, and can result in long term pain and disability. Rowing is a sport associated with large volumes of training and high cumulative loading of the lumbar spine. The most frequently reported site of pain for rowers is the low back. Recent research has focused on epidemiology and biomechanical analyses to understand mechanisms that contribute to LBP onset. There has been a limited focus on management or prevention strategies. There are currently no guidelines for managing LBP in rowers or in athletes who participate in other sports. There are guidelines for managing LBP in the general population. While many principles of management are transferable, there is a need to consider issues that are particular to rowers. We aimed to synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice. Methods: There were five key steps to develop the management guideline. In step one, seven expert clinicians and researchers examined current evidence, and identified five sections that comprised the scope of the consensus statement: epidemiology; biomechanics; management; the athlete’s voice and clinical expertise. In step two, working groups were established for each section of the consensus statement to discuss and summarise key issues relevant to their section. In step three, the evidence from each group was synthesised to create the overall consensus statement. In step four, modified Delphi processes were used to create summaries and recommendations. In step five, information from the consensus statement and that from a survey of clinical experts were combined to produce the management guideline. Results: The scope of the consensus statement included epidemiology, biomechanics, management, the athlete’s voice and clinical expertise. Prevention and management of LBP in rowers include education on risk factors, rowing biomechanics and training load. If treatment is needed, non-invasive management, including early unloading from aggravating activities, effective pain control and exercise therapy. Fitness should be maintained with load management and progression to full training and competition. The role of surgery is unclear. Management should be athlete focused and a culture of openness within the team encouraged. Discussion: Recommendations are based on current evidence and consensus and aligned with international LBP guidelines in non-athletic populations, but with advice aimed specifically at rowers. We recommend that research in relation to aspects of prevention and management of LBP in rowers be intensified. Conflict of Interest Statement: All authors acknowledge no conflict of interest relevant to the submission of this abstract.

Predictability performance enhancement for suspended sediment in rivers: Inspection of newly developed hybrid adaptive neuro-fuzzy system model

Reliable modeling of river sediments transport is important as it is a defining factor of the economic viability of dams, the durability of hydroelectric-equipment, river susceptibility to pollution, suitability for navigation, and potential for aesthetics and fish habitat. The capability of a new machine learning model, fuzzy c-means based neuro-fuzzy system calibrated using the hybrid particle swarm optimization-gravitational search algorithm (ANFIS-FCM-PSOGSA) in improving the estimation accuracy of river suspended sediment loads (SSLs) is investigated in the current study. The outcomes of the proposed method were compared with those obtained using the fuzzy c-means based neuro-fuzzy system calibrated using particle swarm optimization (ANFIS-FCM-PSO), ANFIS-FCM, and sediment rating curve (SRC) models. Various input combinations involving lagged river flow (Q) and suspended sediment (S) values were used for model development. The effect of Q and S on the model's accuracy also was assessed by including the difference between lagged Q and S values as inputs. The model performance was assessed using the root mean square error (RMSE), mean absolute error (MAE), Nash–Sutcliffe Efficiency (NSE), and coefficient of determination (R2) and several graphical comparison methods. The results showed that the proposed model enhanced the prediction performance of the ANFIS-FCM-PSO (or ANFIS-FCM) models by 8.14% (1.72%), 14.7% (5.71%), 12.5% (2.27%), and 25.6% (1.86%), in terms of the RMSE, MAE, NSE and R2, respectively. The current study established the potential of the proposed ANFIS-FCM-PSOGSA model for simulation of the cumulative sediment load. The modeling results revealed the potential effects of the river flow lags on the sediment transport quantification.