Mandatory Equipment Research Articles

Effectiveness of Protective Measures and Rules in Reducing the Incidence of Injuries in Combat Sports: A Scoping Review.

In recent years, much effort has been made to reduce the injury rate in combat sports. However, the question remains to what extent these measures are effective. Analysis of studies could provide evidence of the effectiveness of measures aimed at reducing the incidence of injuries. This scoping review aims (1) to map research articles dealing with the effectiveness of proper use of protective measures in reducing the incidence of injuries in combat sports; (2) to investigate to what extent the proper use of protective measures and compliance with sports rules help to reduce the incidence of injuries in combat sports; and (3) to identify gaps in the existing literature and suggest future research on this topic. The literature search was conducted on articles published between 2010 and 2023. The main inclusion criteria were studies investigating the effect of sports rules and protective equipment used during training or competition in combat sports on reducing the incidence of injuries. After meeting the criteria, only seven articles from boxing, karate, and taekwondo were included in this study. Results showed that mandatory head guards, along with modern thicker gloves, significantly reduced the rate of knockouts (KOs) and head injuries in boxing despite an increase in the number of head blows. However, the number of facial cuts increased significantly due to the removal of head guards as a piece of mandatory equipment. The use of mouth guards has significantly reduced the number of oral injuries. Changes in rules, such as shortening the duration of bouts, along with the introduction of greater competencies of referees in the supervision of bouts (the standing count, outclassed rule, and medical stops) have helped to reduce the rate of injuries in boxing. The application of a computerised scoring system also contributed to the rate of injuries reduction. The increase in the number of weight divisions had the same effect on U21 karate athletes. However, a higher incentive to attack the head area in taekwondo did not increase the incidence of injuries in youth athletes. It can be concluded that the proper use of protective measures (head and mouth guards) in combination with the rules established for health protection (higher competencies of referees and more weight divisions in competitions) effectively reduces the occurrence of injuries in combat sports. In all Olympic combat sports, the injury incidence should be regularly assessed using the Injury Incidence Rate (IIR) per 1000 min exposures (MEs). Nonetheless, further studies are needed to monitor how established rules (e.g., prohibited behaviour) affect the IIRs.

Relationship Between Level of Knowledge with Behavior Using Personal Protective Equipment among Laboratory Workers at Al-Ihsan Hospital, Bandung, West Java

Background: Personal protective equipment (PPE) is mandatory equipment for workers to use while working in accordance with the hazards and risks that are being faced. This behavior of using PPE itself aims to isolate the workers’ bodies from hazards and risks of occupational accidents. Based on the results of observations, laboratory workers of Al-Ihsan Hospital Bandung still often ignored the use of PPE which may inflict the risk of the occurrence of occupational accidents. This study aims to analyze the relationship between the level of knowledge and the behavior of using PPE among laboratory workers of Al-Ihsan Hospital Bandung, West Java. Subjects and Method: It was a quantitative study with a cross-sectional study design conducted at Al-Ihsan Regional General Hospital Bandung from June to September 2022. The sample used was 43 laboratory workers. The dependent variable was the behavior of using personal protective equipment (PPE). The independent variable was the level of knowledge. Data collection was carried out using an online questionnaire. The data were analyzed using the Chi-Square test. Results: The level of knowledge relates to the use of PPE. Well-informed workers increased the behavior of using PPE by 60.0 times compared to workers with a low level of knowledge and it was statistically significant (OR= 60.0; 95% CI= 8.98 to 400.8; p<0.001). Conclusion: The level of knowledge is significantly related to the behavior of using PPE. Keywords: behavior of using PPE, level of knowledge, and laboratory workers

GENERAL RULES FOR SAFE WORK WITH BIOLOGICAL AGENTS

Problem statement. The work was carried out on the identification and distribution by groups of various types of emergency situations that are possible in laboratories when performing procedures with various biological agents. The need to observe clearly regulated rules for safe work with various biological objects in laboratory institutions is proved. The purpose of the article. Determine the rules for safe work with various biological agents in laboratory conditions of different security levels. Method. Analytical methods, generalizing approaches to information presented in regulatory documents, literary and other information sources. Results. Existing and previously developed rules for safe work and techniques for appropriate laboratory work with biological objects are studied. The main signs of work risks according to the international classification of microorganisms are investigated. The characteristics of each hazard group are studied and examples of microbial species assigned to a particular risk group are given. The classification characteristics for four types of microbiological laboratories according to a number of features are given. It was established that the level of laboratories’ biological safety depends on the risk group of microorganisms. It is recognized that compliance with the rules of safe work with various biological agents in laboratory conditions is ensured by the use of necessary and mandatory equipment for a certain level of the laboratory. It is argued that the possibility of implementing biological safety rules in laboratories of different levels is based on the assessment of biological risks in certain conditions of a given laboratory institution. A step-by-step procedure for assessing biological risks in a certain laboratory has been developed, which is also presented in the form of a block diagram. Scientific novelty. Scientific and normative information on the rules of safe work with biological agents in laboratory conditions is analyzed and summarized. A defined sequence of actions for biological risk assessment in certain laboratory settings is proposed. Practical value. The practical possibility and necessity of managing biological risks in laboratory conditions of different biological safety levels is substantiated.

MONITORING THE USE OF PERSONAL PROTECTIVE EQUIPMENT ON EMPLOYERS’ HEALTH AND SAFETY

Personal Protective Equipment (PPE) is a tool that has the ability to protect a person whose function is to isolate part or all of the body from potential hazards in the workplace. This PPE consists of mandatory equipment used by workers in accordance with work hazards and risks used to maintain the safety of workers as well as those around them. In developing countries such as Timor-Leste, the issue of occupational health and safety still seems to be something that has not received the maximum portion of attention. The aim is to know and understand the use of Personal Protective Equipment for the Occupational Health and Safety of Employees of the Auto Vision Aimutin Company, Dili. This research is qualitative research with an analytical descriptive approach that serves to describe or provide an overview of the object under study through data or samples that have been collected as they are without analyzing and making conclusions that apply to the public. The use of personal protective equipment (PPE) is very important for the health and safety of workers, while those who do not use personal protective equipment are at high risk of contracting disease in the work environment. The results of respondents' answers about occupational health and safety, occupational health, work safety, and personal protective equipment (PPE) are the majority of respondents answered strongly agree with the percentage value (100%), while to agree and strongly disagree respondents did not provide answers with a percentage value (0%).

Emergency Response and Management for Mountain Marathon Cross-Country Events

The cases of mountain marathon accidents in the past five years at home and abroad are combined with the domino theory of accident causation theory to analyze mountain cross-country marathon events. Conclusion: Equipment problems are the main cause of accidents, athletes' strain response is the decisive factor leading to accidents, and a sound rescue system is an important guarantee to avoid accidents; hidden danger investigation includes emergency training for emergencies, inspection of athletes' mandatory equipment, and inspection of guarantee measures; prevention of accidents requires enhanced awareness of risk prevention, more integrated development and implementation of policy requirements; experience learning includes education and training, assurance mechanisms, safety measures, epidemic prevention and control, emergency plans and communication systems; prevention of emergencies includes improving prevention mechanisms, holding outdoor safety education and training seminars, and pressing for accountability mechanisms.

Research on Priority-based Flexible Job Shop Scheduling Algorithm

Research on the Flexible Job Shop Scheduling (FJSP) problem in the manufacturing process of aircraft engines has been carried out. It is found that there are real requirements such as order mandatory nodes and equipment selection in the current job scheduling process. Order mandatory node means that some important orders must be delivered on time at a certain point in time, which often affects the quality of workshop scheduling results. In addition, equipment selection is also an important factor affecting the quality of job shop scheduling results. On this basis, an order priority calculation method with manual intervention is designed. Experiments show that the proposed shop job scheduling algorithm effectively improves the quality of job shop scheduling results.

Preparation of Additol Antiseptic and Disinfectant Solution

Background Antiseptics and disinfectants are mandatory equipment to maintain hygienic environment in hospitals and other health care settings which includes sanitizers preservatives and sporisites. Additol is a preparation in which the main chemical constituents are Terpineol castor oil basil oil propylene glycol and small quantity of liquid caramel made to sufficient quantity of one litre.Objective Castor oil and Sodium hydroxide gives the soap solution and followed by different analytical tests like saponification tests and all the values are validated and these are considered under the jurisdiction of FDA testing guidelines done for the activity and application of disinfectants. Currently during this pandemic it is used in medical settings to stop the spread of viruses.Methodology Castor oil and Sodium hydroxide NaOH were used in the preparation of soap solution. Terpineol oil basil oil propylene glycol and liquid caramel were further used in the preparation.Results The results were in good agreement and were performed under the testing guidelines. Tests were carried out to determine the antimicrobial activity and the obtained results were enclosed by standard limits. By following the standard procedure under the FDA testing guidelines prepared product Additol was compared with marketed product Dettol using Riedel-Walker Co-efficient test and the procured values were within the range.Conclusion The proposed Additol 1000 ml was evaluated for the disinfectant activity following standard procedure. The proposed disinfectant exhibited good disinfectant activity against the test microorganisms.

An Approach to Ship Behavior Prediction Based on AIS and RNN Optimization Model

AIS (Automatic Identification System) is a mandatory navigational equipment on board according to SOLAS (Safety of Life at Sea) convention. It is an automatic tracking system that uses VHF (Very High Frequency) transponders on ships and is used by VTS (Vessel Traffic Services) for monitor vessel movements. Existing AIS data has some principle defects due to radio propagation. This paper provides an approach to predict ship behavior with AIS data. In order to solve the problem that traditional ship behavior prediction needs to establish complex ship motion model, a new ship behavior prediction method based on LSTM (Long Short-Term Memory, LSTM) neural network model of machine learning is proposed. LSTM is the optimization model of RNN (Recurrent Neural Networks). Unlike standard feedback neural networks, LSTM has feedback connections. It can not only process single data points, but also entire sequences of data. These prominent features just match the characteristics of AIS data. The LSTM neural network prediction model is established and the shore is used. Based on the real data of AIS (Automatic Identification System) which ships engaged in the waters of South China Sea, the time series of ship behavior characteristics are extracted to train the model and validate the data. The training data is grouped by MMSI (Maritime Mobile Service Identity) and ensure the equal interval requirements of the ship's navigation behavior sequence data. This paper presents 4 figures with the parameter course, speed, position and the loss curve of LSTM training and testing. The results show that the model has a high accuracy and avoids the complicated process of ship motion modeling. The predicted results can improve the supervision of VTS (Vessel Traffic Services) and play a high practical application value in early warning of ship collision, SAR (Search and Rescue) operation and safety-related issues.

New approaches to accounting petroleum and petroleum products in Ukraine

This paper analyzes the measures to increase the accuracy and reliability of accounting of petroleum and petroleum products in Ukraine on the basis of the mandatory equipment of excise petroleum products warehouses with level meter-counters and flow meter-counters.For this purpose, the excise warehouses for the petroleum and petroleum products are equipped with level meters-counters and flow meter-counters with the transfer of information in automatic mode to the State fiscal service of Ukraine. The phased procedure for the introduction of automatic data transfer from excise warehouses is envisaged. In this case, the level meter-counter means a level meter, which measures the level, temperature and density and calculates, according to the strapping table of the storage tank entered into the memory of the level meter, the volume of petroleum and petroleum product, reduced to a temperature of 15 °C.In accordance with current regulatory documents, the maximum permissible error of the level meter should be ± 2 mm for petroleum products and ± 3 mm for petroleum. The maximum permissible error for the flow meter-counter should be ± 0.25 %. At present, quite a lot of types of level meters are undergoing a conformity assessment with the technical regulations of legally regulated measuring instruments with the aim of using them as level meter-counters.The important question is the error with which the level meter-counter determines the volume of petroleum and petroleum products in the storage tank and the allowable discrepancy between the results of volume measurement using the level meter-counter and flow meter-counter. The corresponding formulas for calculating these quantities are given.Measurement methods and methods for calculating permissible imbalance need to be used.The stated approach of operational control of accounting should be applied to other energy resources — in particular, to control the caloric content of natural gas.

Design and manufacturing of shin pads with multi-material additive manufactured features for football players: A comparison with commercial shin pads

Shin pads are part of the mandatory equipment footballers must wear so as to prevent lesions. Most players wear commercially available shin pads made from a variety of common materials (polypropylene or polyethylene) and high-resistance materials (glass fibre, carbon fibre or Kevlar) using traditional manufacturing techniques. Additive manufacturing was used years ago to deliver customised rigid shin pads, but they did not offer any significant advantage in terms of materials or design compared to traditional shin pads. This project analyses a novel approach to the design and manufacture of shin pads for football players that combines existing digitisation tools, lattice structures and a multi-material additive manufacturing device. A total of 24 different additive manufacturing geometries were evaluated using a customised rig where a 1-kg impactor was released from several heights (100–400 mm). The impact acceleration, the transmitted force to the leg and penetration were calculated. Results were compared against two commercially available shin pads. Results show that two of the additive manufacturing specimens tested at the highest drop height had lower impact accelerations than commercial shin pads. They had an acceleration reduction between 42% and 68% with respect to the commercial shin pads. Regarding the penetration, the improvement achieved with additive manufacturing specimens ranged from 13% to 32%, while the attenuation and the contact times were similar.

Simulation of vehicle motion during tests performed in driving improvement centers

One of the tasks of the driving technique improvement center (ODTJ) is learning the correct behavior of the driver after disturbing the movement of the vehicle before entering the so-called "sliding plate". This disorder is made using the "dynamic plate". "Sliding plate" and "dynamic plate" are mandatory equipment of ODTJ. The article presents the model of the vehicle and the ground with a separate, periodically moving, "dynamic plate" with high adhesion of the contact surface with the wheels of the car. Examples of simulation results showing the scale of motion disorder of the vehicle to which the trained driver has to react are presented. Due to the limited volume of the article, the author refers the reader to more comprehensive, more detailed own publications presenting various aspects of the application of the model presented in the work.

Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting

PurposeMusculoskeletal disorders are considered as a major issue affecting the health and well-being of active duty police. Discomfort from wearing mandatory equipment and sitting for long periods of time in fleet vehicles are workload factors linked to musculoskeletal disorders in police. This study aims to determine the prevalence of multi-site musculoskeletal pain among Swedish police and to explore the possible association to discomfort experience when wearing mandatory equipment and sitting for long periods in fleet vehicles.MethodsIn this cross-sectional study responses from 4185 police were collected through a self-administered online survey including questions about physical work environment, mandatory equipment and musculoskeletal pain. Multi-site pain was determined through summing pain sites from four body regions. Binomial logistic regression was performed to explore the association between multi-site musculoskeletal pain: (1) discomfort from wearing mandatory equipment and (2) sitting for long periods in fleet vehicles.ResultsThe prevalence of multi-site musculoskeletal pain at least 1 day per week within the previous 3 months was 41.3%. A statistically significant association between discomfort from wearing mandatory equipment and multi-site musculoskeletal pain was found; duty belt [OR 5.42 (95% CI 4.56–6.43)] as well as body armour [OR 2.69 (95% CI 2.11–3.42)]. Sitting for long periods in fleet vehicles was not significantly associated to multi-site musculoskeletal pain.ConclusionMulti-site musculoskeletal pain is a considerable problem among Swedish police and modifying mandatory equipment to decrease discomfort is suggested as a potential means of decreasing the musculoskeletal pain experienced by many police officers.

Parental Knowledge and Attitudes Toward Dental Trauma and Prevention in Handball and Basketball Athletes in Rijeka, Croatia

The aim of this study was to investigate parental knowledge and attitudes about emergency treatment of avulsed teeth, the potential of using mouth guards during children’s sports, and the importance of education on this subject. Method and materials. This study was conducted on a sample size of 127 parents of athletes 8-15 years old, who were all members of handball and basketball teams in Rijeka, Croatia. Results. Approximately 68% of parents had not received education about dental injuries and were not informed about it. A small proportion of the children wore mouth guards, regardless of whether their parents were educated in terms of dental trauma or not. In the analysis of emergency procedure method used on avulsed tooth, no statistically significant difference was found between those who were previously educated about dental trauma and those who were not. Conclusion. Mouth guards should definitely become part of the mandatory equipment in sports, and this awareness should be raised in athletes as well as their parents. It is necessary to educate the public about emergency procedures in the event of dental injury.

Peripheral nerve block needle defect.

Sir, Many unusual findings related to regional anaesthesia equipment have been reported.[1,2] We recently encountered a manufacturing defect in a regional block needle that has not been described to date. A 65 year old, ASA-3, patient was scheduled for right ankle wound debridement. Ultrasound guided anterior sciatic and femoral block with a 21 gauge, 100 mm insulated peripheral block needle (Stimuplex®, A100, B Braun, Melsungen, Germany) was planned. In our operating theatre, the regional anaesthesia block area (RABA) is dedicated for the regional procedures. RABA is equipped with drugs, ultrasound machine, monitoring and nursing assistant. After consenting and checking for the laterality, patient was positioned and site pre-scanned. The linear array ultrasound probe position was marked with a non-erasable marker and subsequently operator scrubbed. Preparation included cleaning the site, drawing drugs and priming the tube and the block needle with ropivacaine 0.5%. The needle is normally covered with a protective open-ended plastic sheath which is removed just before needle insertion. In this case, after all the preparation including skin infiltration with 1% lignocaine and probe fixation, procedurist attempted to withdraw or remove the outer sheath. We could notice that the outer sheath was totally embedded within the hub, and we were unable to remove even on applying considerable pulling force [Figure 1]. Procedure was continued with another needle. Figure 1 Normal (a) and faulty (b) peripheral block needles. Solid arrowhead showing the embedded sheath within the hub B Braun Division, Singapore did confirm this malfunction after close examination of the equipment sent to them and reported it as an isolated incident. Like many other anaesthesiologists, we take it for granted that regional anaesthesia tools are fool-proof. Although there were no harmful consequences of this incident, this emphasises mandatory pre-procedural equipment check.

Analysis of medical equipment management in relation to the mandatory medical equipment safety manager (MESM) in Japan.

Half a decade has passed since the fifth revision of the medical law and mandatory appointment of a medical equipment safety manager (MESM) in hospitals in Japan. During this period, circumstances have changed regarding maintenance of medical equipment (ME). We conducted a survey to examine these changes and the current situation in ME management. Maintenance of ME and related work were found to have increased in many hospitals, but the number of clinical engineering technologists (CETs) has only slightly increased. The appointed MESM was a CET or physician in most hospitals. In hospitals where physicians were appointed as the MESM, 81% had operation managers. Many respondents commented that it was difficult for one person to cover all the tasks required by the MESM, due to a lack of knowledge, too much work, or other reasons. This suggests the importance of an operation manager for ME to work under the MESM.

Medical Events During the 2009 Los Angeles County Station Fire: Lessons for Wildfire EMS Planning

Background. Little is known about the types of injuries and medical problems encountered by fire department personnel during suppression of large campaign-type wildland fires. Such information could help to plan for response to medical incidents during future wildfires. Objective. To describe the injuries and medical problems experienced by firefighters during the 2009 Los Angeles County Station Fire. Methods. This was a retrospective analysis of case records of patients treated during the Los Angeles County Station Fire. Data were abstracted from two sources: the incident command medical tracking sheet and prehospital patient care reports (PCRs). Results. The sample included 183 patient contacts, of which PCRs were available for 65. For the remaining 118 patients, data were abstracted from the incident command medical tracking sheet. The most common chief complaint was extremity injury, accounting for 44 patient contacts (24% of all patients), with smoke inhalation second, at 32 patient contacts (17%). Of the 65 patients with PCRs, 31 (52%) were treated with oxygen, 26 (40%) had intravenous (IV) lines started, and 15 (23%) received an IV fluid bolus. Half of the patients were transported to an emergency department (ED); the remainder were treated on scene or self-transported to a non–acute care facility. Conclusions. Most firefighter injuries and illnesses encountered during the Los Angeles Station Fire were minor. The prevalence of injuries observed should be taken into consideration in creation of protocols and mandatory equipment lists for fireline paramedics. Furthermore, advanced training for paramedics in the diagnosis and treatment of minor medical conditions may be useful.

전자해도 통합공급서비스 체계구축 연구

전자해도시스템(ECDIS)에서 사용되는 공인 디지털해도인 전자해도는, 최근 2018년까지 국제해사인명안전협약(SOLAS) 선박에 대한 의무탑재가 결정됨에 따라 많은 선박에서 사용되고 있다. 또한, 전자해도는 국제수로기구(IHO)의 간행규정에 따라 각국 수로국이나 공인된 기관에서 간행되므로 공인된 해양지리정보로서 항해목적 이외에도 해양의 다양한 분야에서 사용되고 있다. 그러나, 기본적으로 전자해도는 공인된 ECDIS 장비에서 사용되도록 공급체계가 제시되어 있으며, 또한, IHO의 전자해도 보안표준인 S-63을 적용하여 제공되는 경우가 많으므로 비 항해용 목적의 전자해도 수요에는 효과적으로 대응하지 못하고 있다. 본 논문에서는 기존의 ECDIS에서 사용되는 항해목적의 수요와 비 항해용 수요를 통합적으로 대응할 수 있는 전자해도 통합공급서비스체계에 대한 방안을 제시하며, 제시된 방안을 검증할 수 있는 통합공급시스템의 구현결과를 제시한다. Electronic Navigational Charts(ENCs) are a database for the use of supporting the safety of navigation in marie voyage embedded within the navigational information in the Electronic Chart Display & Information System(ECDIS). Recently IMO made a decision on the mandatory equipment resolution of ECDIS for the international SOLAS vessels until 2018. With this regulation intention together the spontaneous uses from the wide range of marine applications are accelerating the increasing demand for ENCs at both of the navigational purpose and the non-navigational purpose. But there seems to be not enough guidelines or systematic approach for the service of the non navigational purpose. This paper deals with ENCs distribution issues. We present a integrated solution for the ENCs service of both user domains and also demonstrate the implemented results.

Stress Hormone Responses to an Ultraendurance Race in the Cold

Physical stress (exercise and/or environmental) activates the sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenocortical (HPA) axes. The combination of ultraendurance exercise in the cold presents a unique summated stress to the body. The purpose of this study was to assess the stress hormone response in runners, cyclists, and skiers participating in a 161-km ultraendurance race on a snow-packed course in the Alaskan wilderness. Forty-four athletes (20 runners, 17 cyclists, 7 skiers) competed on the same course of snow-machine trails and ice roads with each athlete carrying 7 kg of mandatory equipment. Pre-race weight and blood samples were collected 2 days prior to the race start. Post-race measurements were made within 15 minutes of race finish. Hematocrit was measured, and blood samples were analyzed for levels of norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol. Runners lost significant weight (-1.74 kg +/- 1.29) pre-race to post-race. Hematocrit was maintained, and plasma volume increased minimally. Norepinephrine increased significantly pre-race (279.9 pg/mL +/- 356.9) to post-race (691.7 pg/mL +/- 422.6) with no difference among divisions. Epinephrine did not change significantly during the race. Adrenocorticotropic hormone (2.40 pg/mL +/- 2.40 to 19.04 pg/mL +/- 45.38) increased significantly with no difference among divisions. Cortisol increased significantly pre-race (12.03 microg/dL +/- 5.66) to post-race (26.69 microg/dL +/- 5.77), and post-race cortisol was significantly higher in runners vs skiers. These data suggest activation of both the SAM and HPA axes from an ultraendurance race in the cold and reveal the degree of stress hormone responses to this exhausting bout of exercise.

Forcing Isolation: Medicare’s “In the Home” Coverage Standard for Wheelchairs

Older adults and people with physical disabilities can get Medicare coverage for mobility devices, like wheelchairs, walkers, and scooters, which are necessary for use in their homes. However they cannot get coverage for mobility devices that are solely for functioning outside their home. Since the institution of Medicare's coverage standards for mobility devices, and other kinds of durable medical equipment, nearly four decades ago, advances have been made in three critical areas: improvements in design of mobility devices that allow people to participate more fully in their communities; widespread societal recognition that with appropriate accommodations many limitations on functioning can and should be lifted; and recent court decisions requiring that individuals with disabilities be provided with the necessary supports to live as independently as possible in their communities. The current interpretation of Medicare's coverage standards for mobility devices does not reflect these advances. The Centers for Medicare and Medicaid Services' (CMS) interpretation of Medicare's coverage standard prevents people from getting needed medical equipment to function within their communities. By contemporary medical and legal standards, the [CMS's] interpretation is unreasonable and quite likely unlawful. The Medicare statute neither specifies that durable medical equipment is exclusively for use in the patient's home nor bars consideration of an equipment's use outside the home. There is no indication of Congressional intent to support this limitation of coverage. CMS has both the authority and the responsibility to interpret the Medicare statute so as to be consistent with historical developments in law, technology and social mores. United States Supreme Court precedent holds that agencies are "charged with the administration of [a] statute in light of everyday realities." Everyday realities have changed since Medicare was launched in 1965. Laws such as the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990 and the Ticket to Work and Work Improvements Incentives Act of 1999 reflect a broad, bipartisan commitment to increasing community integration of people with disabilities. This commitment is evident in judicial decisions, including Olmstead v. L.C. ex rel. Zimring, and executive orders, such as President George W. Bush's New Freedom Initiative, a set of proposals to promote opportunities for Americans with disabilities to learn and develop skills, engage in productive work, make choices about their daily lives, and participate fully in their communities. Developing political and legal standards are consistent with medical opinion: the costs of isolation for people with disabilities can include poorer health outcomes and higher systematic health costs. Also, scientific evidence indicates that people who get inappropriate mobility devices given their needs develop secondary medical conditions. In light of technological advances that today make appropriate equipment available and community integration possible, CMS has a responsibility to update its interpretation of the Medicare statute. While CMS must rightly be concerned with costs associated with a more modern interpretation of Medicare's coverage policy, other insurers have found that an appropriate standard has not led to an explosion in the provision of more expensive mobility devices. Specifically, the brief recommends that the Centers for Medicare and Medicaid Services: (1) correct its Medicare coverage policy to cover medically appropriate mobility devices that help maintain or improve functioning for people in the environments they are likely to encounter in their daily routines (both inside and outside of the home), and (2) guard against unnecessary expenses for Medicare by incorporating mandatory equipment evaluations to ensure that people receive equipment that matches their needs. While durable medical equipment encompasses a wide array of assistive devices, this brief will focus on wheeled mobility items, recognizing that this analysis will have varying applications to other durable medical equipment as well.

U.S. DEATHS & INJURIES ASSOCIATED WITH WEIGHT TRAINING

To monitor trends and to heighten public and sport medical personnel awareness, we tracked weight training deaths and injuries for 1998, 1999, 2000, and 2001 by using the National Electronic Injury Surveillance System (NEISS) and US Consumer Product Safety Commission (US CPSC) Death Certificate, Accident Investigation, and Reported Incident files. Weight training accounted for an estimated 60039 hospital-reported injuries in 1998, 65347 injuries in 1999, 68054 injuries in 2000, and 74656 injuries in 2001. In 1998, there were 9 deaths in 304 days or an average of 1 death every 34 days. Ages of the victims ranged from 3 to 59 yr. All deaths involved males, most occurred in the home (78%) with the bench press or other supine exercise (67%) implicated. We are sad to report that these trends appear to continue into the new decade. Since January 1999, there have been 16 deaths associated with resistance equipment. Most victims (15/16 or 94%) were males, with ages ranging from 4 to 70 yr. At least 75% of deaths were associated with free weights and at least 50% with the bench press. Our goals as sports medicine specialists should be to eliminate these senseless fatalities and to minimize the incidence and severity of all resistance training injuries. Unquestionably, widespread education, mandatory equipment fatality warning labels, spotting, and an emphasis on technique rather than resistance, will help us achieve these goals.