Long-term Injury Research Articles

Thrombocytopenia in solid malignancies: A review

Thrombocytopenia is one of the most frequent complications associated with cancer or its treatment. Since Radiotherapy and chemotherapy are commonly used for treatment of cancer, Unfortunately, these treatments frequently cause acute and/or long-term bone marrow injury that can adversely affect the quality of life and the course of treatment. There is a need to maintain a safe platelet count to allow effective treatment of the underlying malignancy, prevent bleeding complications and to minimize the use of platelet product transfusion.

Hand Function After an Electrical Accident-A Case-Control Study.

Electrical accidents cause both acute and long-term injuries. The care of acute injuries is somewhat standardized, but currently recommendations or assessment tools are not available for assessing the long-term effects of an accident on hand function. A case-control study of 24 healthy controls and 24 cases, 1 to 5 years after an electrical accident and with self-reported neurosensory symptoms, was performed using three hand-function tests: the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Purdue Pegboard test, and the Shape and Texture Identification test. Compared with the control group, patients received statistically significantly lower scores for the Disabilities of the Arm, Shoulder, and Hand outcome measure and the Purdue Pegboard and for one finger on the Shape and Texture Identification test. Hand function is affected after an electrical accident in individuals with self-reported neurosensory symptoms.

Long-COVID Syndrome and the Cardiovascular System: A Review of Neurocardiologic Effects on Multiple Systems.

Purpose of ReviewLong-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2 infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the effects of (1) angiotensin-converting enzyme 2 receptors (the entry points for the virus), (2) inflammation, and (3) oxidative stress (the resultant effects of the virus).Recent FindingsThese effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia, and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress. Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology.SummaryLong-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms of Long-COVID to the documented autonomic dysfunction(s).

Change Patterns in Corneal Intrinsic Aberrations and Nerve Density after Cataract Surgery in Patients with Dry Eye Disease.

This study aimed to evaluate the change patterns in corneal intrinsic aberrations and nerve density after cataract surgery in dry eye disease. The preoperative, 1- and 3-month postoperative dry eye-related parameters were obtained by the Oculus keratograph and the ocular surface disease index questionnaire. The corneal intrinsic aberrations were measured using the Pentacam HR system. In vivo confocal microscopy was performed to observe the vortical and peripheral corneal nerves. An artificial intelligence technique run by the deep learning model generated the corneal nerve parameters. Corneal aberrations on the anterior and total corneal surfaces were significantly increased at 1 month compared with the baseline (p < 0.05) but gradually returned to the baseline by 3 months (p > 0.05). However, the change in posterior corneal aberration lasted up to 3 months (p < 0.05). There was a significant decrease in the corneal vortical nerve maximum length and average density after the operation (p < 0.05), and this damage lasted approximately 3 months. The corneal vortical nerve maximum length and average density were negatively correlated with the anterior corneal surface aberrations before and 1 month after the operation (correlation coefficients, CC = −0.26, −0.25, −0.28; all p < 0.05). Corneal vortex provided a unique site to observe long-term corneal nerve injury related to eye dryness. The continuous damage to the corneal vortical nerve may be due to the continuous dry eye state.

Importance of an In-Season Strength Training Program: A Reminder to Sport Coaches

ABSTRACT The importance of an in-season strength training program has been lost by many sports coaches. It is up to the strength and conditioning professionals at all levels to reeducate those coaches who do not understand that this phase of the macrocycle is vital to long-term player development, injury prevention, and performance. Two-day-a-week interventions can help maintain or even improve athletes' physical capacities and sports performances. Not having an in-season program can result in detraining and increase the potential for injury with the loss of muscle and connective tissue strength and density.

Queer and Present Danger: Freakery and Sapphic Desire in Maria Edgeworth’s Belinda

This essay examines the relationship between (dis)ability and sexuality in Maria Edgeworth’s Belinda (1801). Jason Farr argues that (dis)ability and sexuality are “mutually constitutive” in the eighteenth century and demonstrates the link between conceptions of (dis)ablebodiedness and non-heteronormativity. I argue that the constitutive relationship is bifurcated across two characters from Edgeworth’s novel: Harriet Freke’s sexual divergence constitutes her disability, and Lady Delacour’s experience of disability and chronic pain constitutes her sexual ambiguity and Sapphic possibilities. A queer-crip reading of Belinda demonstrates that Lady Delacour experiences intimate relationships with women and her husband through her injured breast and chronic pain. Harriet Freke’s divergent gender performance disables her under the chastising gaze of the other characters, and, in the end, she is permanently, physically marked by an injury. Lady Delacour experiences a cure of her long-term injury that results in a transformation to the ennobled, contemporary form of heterosexual domesticity.

Cardiovascular mortality post burn injury.

Burn injury is responsible for both acute and ongoing inflammation, resulting in systematic changes impacting the cardiovascular, hepatobiliary, endocrine, and metabolic systems, but there is minimal investigation into long-term clinical outcomes. This study aimed to investigate mortality due to cardiovascular related long-term postburn injury. This was a retrospective cohort study linking a burns unit database with mortality outcomes from a Registry of Births, Deaths and Marriages. Data were extracted from the Australian Institute of Health and Welfare and stratified into three age groups: 15 to 44 years, 45 to 64 years, and 65+ years. Mortality rate ratios (MRRs) and 95% confidence interval (CI) were calculated to compare the burns cohort mortality incidence rates with the national mortality incidence rates for each of the three age groups. Logistic regression was used to identify demographic and clinical factors associated with cardiovascular mortality. A total of 4,134 individuals in the database were analyzed according to demographic and clinical variables. The 20-year age-standardized cardiovascular mortality rate for the burns cohort was significantly higher compared with the Australian population (250.6 per 100,000 person-years vs. 207.9 per 100,000 person-years) (MRR, 1.21; 95% CI, 1.001-1.45). Cardiovascular mortality was significantly higher in males aged 15-44 and 45-64 years had a cardiovascular mortality rate significantly higher than the Australian population (MRR = 10.06, 95% CI 3.49-16.63), and (MRR = 2.40, 95% CI 1.42-3.38) respectively. Those who died of cardiovascular disease were more frequently intubated postburn injury ( p = 0.01), admitted to intensive care ( p < 0.0001), and had preexisting comorbid physical conditions (60.9% vs. 15.0%, p < 0.0001). Survivors from burn injury, especially young males, are at increased long-term risk of death from cardiovascular disease. Increased screening and counseling pertaining to lifestyle factors should be standard management postburn injury. Longitudinal observation of physiological changes, investigation of mechanistic factors, and investigation of interventional strategies should be instituted. Prognostic and Epidemiologic; Level IV.

Accessing Injury Risk Association With Asymmetry During The Countermovement Jump In Male American Football Players

PURPOSE: To determine the association of between-limb asymmetry during the double-leg countermovement jump task with injury risk in NCAA Division I football players. METHODS: NCAA Division I male American football players (N = 112) participated in this study. Participants performed a double-leg countermovement jump (DLCMJ) on dual force plates and 2D ground reaction force data were recorded at 1000 Hz. Participants were designated as having a between-limb asymmetry if the calculated asymmetry in concentric impulse measured from their force-time trace was one standard deviation above all participant scores. Long-term injury history, short-term injury history and player position were also recorded. Injury surveillance took place over the course of two weeks during the team’s pre-season training camp. The definition of injury for this study was any musculoskeletal ailment that required attention from the sports medicine staff. Odds-ratio (OR), relative-risk (RR), and 90% confidence intervals were reported from a contingency table analysis. Furthermore, a multivariate logistic regression model was created accessing DLCMJ asymmetry while controlling for injury history and player position. RESULTS: Twelve out of 112 players were designated as having a double-leg asymmetry. Fourteen lower-extremity injuries were recorded during training camp with four of these injuries being associated with a double-leg asymmetry. Contingency table analysis showed that DLCMJ asymmetry was associated with a 4.3 greater likelihood of injury (OR = 4.3 (90% CI = 1.9 – 7.2), RR = 3.2 (90% CI = 1.5 – 6.6). The logistic regression models showed that an asymmetry designation presented a 6.4 times greater likelihood of injury (OR = 6.4, 95% CI = 1.9 – 22.0, p < 0.01). CONCLUSION: Participants who presented an asymmetry during the DLCMJ had an increased risk of injury compared to athletes who did not have an asymmetry. The results of this study provide insight to practitioners on the potential of screening protocols to identify athletes at risk for injury based on between-limb force production asymmetries. Practitioners could then provide an exercise intervention to screened individuals to correct these asymmetries. Future research may then be conducted to identify if an exercise intervention reduces injury risk within this population.

O8-8 Foundation of Move Healthy: athletic skill development in children from a motor learning perspective

BackgroundIn the European Union, 6.1 million people are being treated in hospital annually for a sports injury. Of this, 31% of these injuries affect young people (15-24 years). Injury incidence, medical and lost productivity costs can be reduced by promoting a healthy and active lifestyle, where attention is paid to primary injury prevention. However, after two decades of initiatives, traditional injury prevention prevention programs seem effective in the short-term and controlled study settings, but have not decreased long-term injury incidence. One reason for this is the content of the exercises, currently being mainly ?closed and static? exercises. These exercises don't reflect real-world situations where unexpected and automatic movements are required involving complicated motor control adaptations. In addition, physical educators (PE) and trainers/coaches (TC) neither experience current exercises as being context specific and contributing to their training goals. To overcome this implementation gap, the purpose of the MoveHealthy project is to create exercise routines PE and TC can use, where children acquire the ability to sustain optimal automatic motor control while engaging in complex athletic, unpredictable environments (e.g. movement of another child, or a ball), whilst minimising their risk to sustain an injury.MethodsExercise routines (3 for primary and 3 for secondary education, 3 for soccer and 3 for basketball) were co-created with the end-users (PE & TC) and their wishes and needs have been incorporated. Furthermore, to train the complex task-person-environmental interaction, real-world aspects such as visual-motor control where quickly processing environmental cues and anticipation and decision is crucial, was included into all conceptual considerations.ResultsTwelve prototype exercises have been developed. Merging theoretical foundations of motor learning and wishes and needs of end-users made it possible to create exercises that serve both needs.ConclusionsThe development of these prototype exercises guides towards further validation and final development of innovative exercise routines where real-world aspects are incorporated. With this, we will better ensure real-world effects of injury reduction.AcknowledgementsThis project is financially co-funded by the Erasmus+ Sport program from the European Union.

Donor-derived Cell-free DNA Measurement in Kidney Transplant Patients Without Allograft Dysfunction: More Evidence and More Questions.

Donor-derived Cell-free DNA Measurement in Kidney Transplant Patients Without Allograft Dysfunction: More Evidence and More Questions.

Limbal stem cell deficiency (LSCD) in rats and mice following whole body exposure to sulfur mustard (SM) vapor

Ocular injuries following sulfur mustard (SM) exposure are characterized by an acute phase expressed by corneal erosions and inflammation of the anterior segment that after a clinically silent period may be followed by irreversible corneal injuries. The latter includes epithelial defects, chronic inflammation and neovascularization (NV), and were defined in rabbits and in humans as Limbal Stem Cell Deficiency (LSCD), that derived from a delayed loss of corneal epithelial stem cells (ESC), due to secondary processes most likely in the epithelial stem cell (SC) niche.The present study expands our research on SM-induced ocular injury to rodents (rats and mice) following whole body vapor exposure, aiming to define whether the delayed development of LSCD is a general characteristic of SM ocular toxicity.Freely moving rats and mice were exposed to SM vapor (155 μg/l, 10 min). Clinical examination was carried out in rats and included a slit-lamp bio-microscopy, up to 6 months. Eyes were taken for histology at different time points following exposure and evaluation included hematoxylin and eosin (H&E) staining for general morphology, PAS for identification of goblet cells and p63 immunohistochemistry for progenitor epithelial cells.Whole body exposure to SM vapor in rats and mice resulted in acute ocular injury characterized by corneal erosions and ocular inflammation. Following a brief recovery period, 80–90% of the exposed eyes developed corneal NV associated with abnormal corneal epithelium, stromal inflammation and endothelial damage. The late injury was accompanied by migration of conjunctival goblet cells to the cornea and a loss of limbal epithelial progenitor cells, indicating LSCD.The long-term ocular injury shown hereby in rats and mice was consistent with the lesions described in rabbits and in human casualties and demonstrated the general phenomenon of limbal epithelial stem cells deficiency in SM ocular toxicity. The delayed manifestation of this pathology points towards a therapeutic window for the development of medical countermeasures in small animals following exposure in a real life scenario.

Chlamydia trachomatis as a Current Health Problem: Challenges and Opportunities.

Chlamydia is one of the most common sexually transmitted bacterial infections (STIs) worldwide. It is caused by Chlamydia trachomatis (CT), which is an obligate intracellular bacterium. In some cases, it can occur in coinfection with other parasites, increasing the pathologic potential of the infection. The treatment is based on antibiotic prescription; notwithstanding, the infection is mostly asymptomatic, which increases the risk of transmission. Therefore, some countries have implemented Chlamydia Screening Programs in order to detect undiagnosed infections. However, in Portugal, there is no CT screening plan within the National Health Service. There is no awareness in the general healthcare about the true magnitude of this issue because most of the methods used are not Nucleic Acid Amplification Technology-based and, therefore, lack sensitivity, resulting in underreporting infection cases. CT infections are also associated with possible long-term severe injuries. In detail, persistent infection triggers an inflammatory milieu and can be related to severe sequels, such as infertility. This infection could also trigger gynecologic tumors in women, evidencing the urgent need for cost-effective screening programs worldwide in order to detect and treat these individuals adequately. In this review, we have focused on the success of an implemented screening program that has been reported in the literature, the efforts made concerning the vaccine discovery, and what is known regarding CT infection. This review supports the need for further fundamental studies in this area in order to eradicate this infection and we also suggest the implementation of a Chlamydia Screening Program in Portugal.

Esophageal image segmentation for guidance of posterior wall lesions during atrial fibrillation ablation.

Despite luminal esophageal temperature (LET) monitoring, esophageal injury remains a risk which impacts decision making during atrial fibrillation (AF) ablation. We sought to compare procedural characteristics including radiofrequency (RF) power, duration, and LET, among ablation procedures with and without image segmentation for esophageal visualization (EV). The retrospective cohort included 73 patients (mean age 65.2 ± 8.6years, 36% female, 55% paroxysmal AF) who underwent pre-procedural cardiac magnetic resonance or computed tomography and LET monitoring. Of all patients, 35 were historical patients that underwent standard AF ablation without EV, and 38 were contemporary patients, 28 of whom underwent AF ablation with EV and 10 that underwent AF ablation without EV. Total RF time was similar between the groups. The distribution of ablation power delivery was skewed toward higher power in the contemporary patients. However, among patients in the contemporary group, the proportion of > 35 Watts lesions was lower with EV (P < 0.001). There was no difference between the max or mean LET. The standard deviation of LET change within patient during posterior wall ablation was lower in those with esophageal visualization compared to historical controls, but no change was seen compared to a smaller group of contemporary controls. No long-term clinical esophageal injury was observed. In a retrospective analysis, EV was successfully performed in 28 patients. EV impacted RF power delivery decisions but was unassociated with RF time, changes in LET, or long-term safety.

Long-term ketamine infusion-induced cholestatic liver injury in COVID-19-associated acute respiratory distress syndrome

BackgroundA higher-than-usual resistance to standard sedation regimens in COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) has led to the frequent use of the second-line anaesthetic agent ketamine. Simultaneously, an increased incidence of cholangiopathies in mechanically ventilated patients receiving prolonged infusion of high-dose ketamine has been noted. Therefore, the objective of this study was to investigate a potential dose–response relationship between ketamine and bilirubin levels.MethodsPost hoc analysis of a prospective observational cohort of patients suffering from COVID-19-associated ARDS between March 2020 and August 2021. A time-varying, multivariable adjusted, cumulative weighted exposure mixed-effects model was employed to analyse the exposure–effect relationship between ketamine infusion and total bilirubin levels.ResultsTwo-hundred forty-three critically ill patients were included into the analysis. Ketamine was infused to 170 (70%) patients at a rate of 1.4 [0.9–2.0] mg/kg/h for 9 [4–18] days. The mixed-effects model revealed a positively correlated infusion duration–effect as well as dose–effect relationship between ketamine infusion and rising bilirubin levels (p < 0.0001). In comparison, long-term infusion of propofol and sufentanil, even at high doses, was not associated with increasing bilirubin levels (p = 0.421, p = 0.258). Patients having received ketamine infusion had a multivariable adjusted competing risk hazard of developing a cholestatic liver injury during their ICU stay of 3.2 [95% confidence interval, 1.3–7.8] (p = 0.01).ConclusionsA causally plausible, dose–effect relationship between long-term infusion of ketamine and rising total bilirubin levels, as well as an augmented, ketamine-associated, hazard of cholestatic liver injury in critically ill COVID-19 patients could be shown. High-dose ketamine should be refrained from whenever possible for the long-term analgosedation of mechanically ventilated COVID-19 patients.

Routine Angiography Is Not Indicated in Patients With Blunt Cerebrovascular Injury

Blunt cerebrovascular injury (BCVI) of the carotid or vertebral arteries can result in long-term neurological injury. Early diagnosis and treatment are imperative to limit neurological insults. Diagnosis has shifted from invasive digital subtraction angiography (DSA) to computed tomography angiography (CTA). We hypothesized that routine DSA for low-grade BCVI is not indicated for diagnosis or follow-up and is associated with unnecessary costs and complications.

FC052: Atrasentan for the Treatment of IGA Nephropathy: Interim Results from the Affinity Study

Abstract BACKGROUND AND AIMS IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the developed world. Up to 40% of patients with IgAN are at risk of progressing to end-stage kidney disease (ESKD), with proteinuria being a strong predictor of disease progression. Treatments that reduce proteinuria in IgAN are accompanied by eGFR preservation and improved kidney outcomes.[1] Endothelin A (ETA) receptor activation is a key driver of proteinuria, inflammation and fibrosis in patients with glomerular diseases.[2] Therefore, ETA receptor blockade has potential to be of therapeutic benefit for patients with proteinuric glomerular diseases, including IgAN. Atrasentan, a potent and selective ETA receptor antagonist that has demonstrated clinically significant reductions in proteinuria and risk of ESKD in a study of over 5300 patients with diabetic kidney disease (DKD), represents a potential therapy to reduce proteinuria and preserve kidney function in patients with IgAN and other glomerular diseases.[3] AFFINITY is a global, phase 2, open-label basket study to evaluate the efficacy and safety of atrasentan in patients with proteinuric glomerular diseases due to IgAN, Alport syndrome, focal segmental glomerulosclerosis and DKD. Here we present interim results from the first 17 patients enrolled in the IgAN cohort of the AFFINITY study, through week 12 of treatment. METHOD Approximately 20 patients will be enrolled in the IgAN cohort. They must have biopsy proven IgAN, be receiving a maximally tolerated and stable dose of renin angiotensin system inhibitor and have a urine protein creatinine ratio [UPCR] between 0.5 and &amp;lt;1.0 g/g from a first morning void urine sample. Patients are treated orally with 0.75 mg atrasentan daily. The primary endpoint is the change in 24-h UPCR from baseline to Week 12. Key exploratory endpoints include changes in eGFR from baseline to Week 56. RESULTS A total of 17 patients have enrolled in the IgAN cohort as of 4 January 2022. A total of 12 and 8 patients have completed visits through Week 6 and Week 12, respectively. The median age is 47 years and 41% are women. The geometric mean (GM) baseline proteinuria is 1.2 g/day, and median eGFR is 41 mL/min/1.73 m2 (Table 1). The 8 patients on treatment through Week 12 had a GM % reduction from baseline in 24-h UPCR of 43.6% [95% confidence interval (95% CI) 29.0–55.2] (Figure 1). Pharmacokinetic data are currently available for nine patients and showed a mean trough plasma atrasentan concentration in the targeted therapeutic range. Adverse events (AE) were observed in nne patients (53%), all mild or moderate in severity, most of which have resolved. One patient experienced an unrelated serious adverse event of traffic accident without long-term injuries. All patients remain on treatment with study drug except for one patient who discontinued drug due to an unrelated AE at week 13. CONCLUSION Treatment of patients with IgAN with atrasentan in addition to standard of care provided a &amp;gt;43% GM reduction in proteinuria after 12 weeks and was well tolerated, strongly supporting a key role of the endothelin pathway in the pathogenesis of IgAN. The ongoing phase 3 ALIGN study for patients with IgAN and proteinuria ≥1g/day will provide further assessment of the proteinuria lowering effects of atrasentan in this high-risk patient population.

Hip Injury Profile and Time Missed From Participation in Male National Collegiate Athletic Association Division I Baseball Athletes

Context: It is important to examine hip injury characteristics in baseball athletes in order to develop injury-specific prevention protocols. There is currently a lack of literature regarding collegiate baseball athletes. Objective: To report the hip injury characteristics and time missed from sport participation in National Collegiate Athletic Association Division I baseball players over a period of 5 years. Results: Forty-seven hip–groin injuries were recorded in 30 National Collegiate Athletic Association Division I baseball players. Pitchers had the highest number of hip–groin injuries (24/47, 51%), and outfielders had the longest time missed from baseball participation (33 days on average). The two most common types of hip–groin injuries were femoroacetabular impingement syndrome (14/47, 30%) and hip adductor strain (14/47, 30%). Days missed from baseball participation was 4.5 days (range: 4–7) for short-term injuries and 90 days (range: 46–131) for long-term injuries. Interpretations: Femoroacetabular impingement syndrome and adductor muscle strain were the predominant diagnoses in National Collegiate Athletic Association Division I baseball players with hip–groin injury; short-term injuries resulted in ∼5 days missed but recovery from a long-term injury took ∼3 months. Pitchers had the highest number of injuries (including adductor strain and femoroacetabular impingement syndrome).

Workplace Reintegration Facilitator Training Program for Mental Health Literacy and Workplace Attitudes of Public Safety Personnel: Pre-Post Pilot Cohort Study.

BackgroundPublic safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated.ObjectiveThe purpose of this quasi-experimental pre-post pilot cohort study is to evaluate the effectiveness of the EPSRPFT course on influencing mental health knowledge and attitudes of RPFT attendees who will be future RP peer facilitators.MethodsThis pre-post cohort study collected data via 2 questionnaires from RPFT participants (N=60) which included the Mental Health Knowledge Survey (MAKS) and the Open Minds Survey of Workplace Attitudes (OMSWA). Descriptive, parametric (sample t tests), and nonparametric (Wilcoxon signed rank tests) statistics were used to compare the pre- and post-RPFT results and to analyze results by gender and profession.ResultsStatistically significant changes were observed in pre-post questionnaire scores in the domains of mental health attitudes and knowledge.ConclusionsAlthough results are explorative, the RPFT may facilitate positive changes in workplace mental health attitudes and knowledge among PSP. It is hoped these findings will contribute to a broader evidence base that can inform changes to the program, practices, and policies, and inform decision-making regarding the EPSRP.

Low-voltage electrical accidents, immediate reactions and acute health care associated with self-reported general health 4 years later

Background and aimsElectricians frequently experience low-voltage electrical accidents. Some such accidents involve long-term negative health consequences. Early identification of victims at risk for long-term injury may improve acute medical treatment and long-term follow-up. This study aimed to determine acute exposure, health effects and treatment associated with general health ≥ 2 years after low-voltage electrical accidents. MethodsIn a cross-sectional study, 89 male electricians who had experienced an electrical accident between 1994 and 2001 participated in a 2003 follow-up health examination. They were identified from a registry of low-voltage electrical accidents and included in the study. Based on exposure descriptions in the original accident reports, they were stratified into the following three groups: a current arc accident group (N = 34, mean age 38.8 years [standard deviation, SD = 12.2, range = 21–59]) and two groups with the passage of current through the body, either fixed to the current source (“no-let-go” group; N = 35, mean age 34.0 years [SD = 10.5, range = 21–57]) or not (“let-go” group; N = 20, mean age = 38.7 years [SD = 10.3, range = 21–63]). They retrospectively described acute reactions and assessed their current general health at the health examination. Multivariate linear regression, ordinal logistic regression and Fisher’s exact test were used to compare acute reactions with health at follow-up in each exposure group. ResultsThe multivariate analysis indicated that after accidents with the passage of current through the body, severe acute headache (β = − 0.56, p = 0.013), years since the accident (β = − 0.16, p = 0.017) and the accident being perceived as frightening (β = − 0.48, p = 0.040) were negatively associated with general health ≥ 2 years later (R2 = 0.25, p = 0.002). If the exposure included a no-let-go experience, then acute severe body numbness (β = − 0.53, p = 0.029) was also negatively associated with general health (R2 = 0.38, p = 0.002). Without such experience, only acute confusion (β = − 0.90, p = 0.029) was negatively associated with the health at follow-up (R2 = 0.24, p = 0.029). In univariate analyses, after the passage of current through the body, acute dizziness (p = 0.029), apathy (p = 0.028), confusion (p = 0.007) and irregular heartbeat (p ≤ 0.05) were associated with poor long-term general health. The no-let-go group, more often than the let-go group, reported panic (p = 0.001), fear of death (p = 0.029), confusion (p = 0.014), exhaustion (p = 0.009), bodily numbness (p = 0.013) and immediate unconsciousness (p = 0.019). Acute symptoms beyond the first day after a current arc accident were associated with poor long-term general health (p = 0.015). Discussion and conclusionsThe acute reactions negatively associated with general health ≥ 2 years after low-voltage electrical accidents should alert the clinician in the acute phase after an electrical accident to the risk of developing negative long-term health effects. Future studies should specify long-term health beyond the concept of general health.

Longitudinal Tibia Stress Fracture Risk During High-Volume Training: A Multiscale Modeling Pipeline Incorporating Bone Remodeling.

Tibia stress fractures are prevalent during high-intensity training, yet a mechanistic model linking longitudinal training intensity, bone health, and long-term injury risk has yet to be demonstrated. The objective of this study was to develop and validate a multiscale model of gross and tissue level loading on the tibia including bone remodeling on a timescale of week. Peak tensile tibial strain (3517 μstrain) during 4 m/s running was below injury thresholds, and the peak anteromedial tibial strain (1248 μstrain) was 0.17 standard deviations away from the mean of reported literature values. An initial study isolated the effects of cortical density and stiffness on tibial strain during a simulated eight week training period. Tibial strains and cortical microcracking correlated with initial cortical modulus, with all simulations presenting peak anteromedial tensile strains (1047-1600 μstrain) near day 11. Average cortical densities decreased by 7-8% of their nominal value by day 11, but the overall density change was <2% by the end of the simulated training period, in line with reported results. This study demonstrates the benefits of multiscale models for investigating stress fracture risk and indicates that peak tibial strain, and thus injury risk, may increase early in a high intensity training program. Future studies could optimize training volume and recovery time to reduce injury risk during the most vulnerable training periods.