Past Injury Research Articles

Acute Kidney Injury in a COVID-19 Lung Transplant Recipient

Dear Editor, A 63-year-old man was referred to our hospital for extracorporeal membrane oxygenation (ECMO) following a severe COVID-19 infection 4 months back. He was put on V-V ECMO and continued on the same for a month. He was evaluated and found to have extensive pulmonary fibrosis. He was considered for a lung transplantation and after appropriate medical evaluation and repeated negative severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) reverse real-time polymerase chain reaction tests, he underwent a deceased donor transplantation 2 months back. He had no comorbidities, and pretransplant evaluation did not reveal any significant cardiac, liver or renal abnormalities. His creatine phosphokinase (CPK) at the time of transplantation was checked and was found to be normal. The posttransplant course was uneventful and he was off ventilatory support from the 14th posttransplant day. Posttransplant serum creatinine was 0.8 mg/dl, and his urinalysis did not reveal any abnormality. His initial tacrolimus levels were on the lower side (8.7 ng/ml), and accordingly, his tacrolimus dose was increased. The repeat level was 11.9 ng/ml (target 12–15 ng/ml in first 6 months) 6 weeks’ posttransplantation, his urine output started to decrease and his creatinine started to rise. A nephrology consultation was sought and evaluation revealed the presence of new-onset proteinuria. There was no evidence of urinary tract infection. Because of worsening renal functions (serum creatinine – 2.1 mg/dl and blood urea – 210 mg/dl) and reducing urine output, he was advised dialysis. He did not appear to be dehydrated, and his inferior vena cava diameter was 1.8 cm and not collapsible. The high urea was considered because of his steroids (20 mg/day and protein-rich parenteral nutrition. A provisional diagnosis of acute tubular necrosis (ATN) with the underlying glomerular disease was considered. As there was no improvement in his renal functions, he underwent a renal biopsy. His histopathological examination of the biopsy showed normal viable glomeruli with scattered tubules with denuded lining. There was no interstitial inflammation and tubular atrophy [Figure 1a]. Some tubules showed casts which stained positive for myoglobin [Figure 1b]. The electron microscopy showed podocyte loss (>30%) and significant subendothelial basement membrane rarefaction [Figure 1c]. No new therapy was advised as he was on triple immunosuppression, which was felt to be appropriate for the glomerular pathology. After another 2 weeks of dialysis, he made slow renal recovery. He was discharged off dialysis after another week. His predischarge creatinine was 0.8 mg/dl.Figure 1: Histopathological examination of the biopsy show features of acute tubular necrosis (a). Myoglobin tubular casts were noted in immunohistochemistry (b). Electron microscopy revealed podocyte injury with significant basement rarefaction (c)Acute kidney injury (AKI) is common post lung transplantation.[1] It is anticipated that the incidence of AKI will be a major concern in severe COVID-19-infected patients who undergo lung transplantation as SARS-COV-2 infection has a propensity to involve kidneys.[2] AKI, in our case, appears to be multifactorial. Our patient had underlying ATN, which we believe was because of the hemodynamic instability secondary to an emergency transplant in a critically sick individual. What was unusual in our case was the co-existence of myoglobin casts and the electron microscopic evidence of basement membrane pathology. Rhabdomyolysis is known to happen in patients with COVID-19 infection[3] and occasionally in patients on ECMO. As the CPK in the patient was consistently normal from the time of transplantation, it is speculated that the myoglobin casts depict past injury secondary to COVID-19 infection. The third component was the evidence of glomerular injury, which cannot be explained by ATN. Recent evidence also suggests that glomerular disease develops 4–6 weeks following COVID-19 infection.[4,5] The glomerular involvement in our patient is also a sequelae of COVID-19 infection pretransplant. The most common finding in COVID-19-induced glomerular disease is focal segmental glomerulosclerosis (FSGS).[6] Our patient had podocytopathy, but the pathology was not consistent with FSGS. We believe the biopsy manifestations of underlying glomerular involvement seem to have been modified by posttransplant immunosuppression. Our case highlights unique pathomechanisms of AKI in a COVID-19 lung transplant recipient. Declaration of patient consent The authors certify that patient consent has been taken for participation in the study and for publication of clinical details and images. Patients understand that the names, initials would not be published, and all standard protocols will be followed to conceal their identity. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

LESÕES NA ARTICULAÇÃO DO JOELHO EM JOVENS JOGADORES DE BASQUETEBOL

ABSTRACT Introduction Basketball is a popular sport globally, and as the development of college basketball develops, basketball injuries also tend to increase. The knee has the highest injuries and problems incidence, reducing the athlete’s ability and shortening their professional career. Objective Explore the causes and characteristics of knee joint injuries in basketball players, comparing their different levels, performances, and positions. Methods 600 college basketball players were studied. Current and past injuries were collected. A questionnaire on lifestyle, behavior, and habits was also applied, and their levels of physical ability and knowledge were also evaluated. Statistical methods were employed to investigate the characteristics and causes of knee joint injuries in young athletes. Results Among knee joint injuries of adolescent basketball players, there were more medial collateral ligament injuries and meniscal injuries. The probabilities are 34.1% and 24.3%, respectively. Patellar strain and cruciate ligament injury accounted for 12.1% and 19.5%, respectively, and the probability of fracture injury was 2.4%. Conclusion The knee joint is one of the most vulnerable joints in basketball. The consequences of its injury can bring an athletic career down and have a considerable impact on athletes’ physical and mental health. Evidence Level II; Therapeutic Studies – Investigating the results.

Abstract PR009: An epigenetic memory of inflammation controls context-dependent lineage plasticity in the pancreas

Abstract Inflammation is essential to the disruption of tissue homeostasis, and, in the pancreas, can destabilize the identity of terminally differentiated acinar cells. A longstanding question has been whether a history of past injuries instructs subsequent homeostatic responses to future stimuli – despite being distantly separated in time. Thus, we employ here Mist1-CreERT2; LSL-tdTomato lineage-tracing mice to investigate the long-term effects of a transient inflammatory episode on pancreatic tissue homeostasis. We delineate the chromatin dynamics that accompany the cycle of metaplasia and regeneration following pancreatitis, and reveal that the pancreatic acinar cell compartment durably retains specific inflammation-induced epigenetic changes even 18-weeks after exposure to the original inflammatory stimulus. We observe that despite histologic resolution of pancreatitis, acinar cells fail to return to their molecular baseline after several months, representing an incomplete cell fate decision. Motif analysis demonstrates the enrichment of AP-1/Fra1 motifs at these persistently accessible memory regions—a transcriptional effector activated downstream of the Ras/MAPK pathway. This epigenetic memory controls lineage plasticity, with diminished metaplasia in response to a second inflammatory insult but increased tumorigenesis with an oncogenic Kras mutation. We demonstrate that pancreatic acinar cells exhibit rapid malignant transformation upon re-challenge with oncogenic stress via inflammatory memory recall, with robust reactivation of genes associated with differentially accessible memory regions. Together, our findings define the dynamics and recall of an epigenetic memory of inflammation that impacts cell fate decisions in a context-dependent manner. Citation Format: David J. Falvo, Adrien Grimont, Paul Zumbo, Julie L. Yang, Alexa Osterhoudt, Grace Pan, Andre F. Rendeiro, John E. Wilkinson, Friederike Dündar, Olivier Elemento, Rhonda K. Yantiss, Doron Betel, Richard Koch, Rohit Chandwani. An epigenetic memory of inflammation controls context-dependent lineage plasticity in the pancreas [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr PR009.

Living in a Silver Zone: Residents’ perceptions of area-wide traffic calming measures in Singapore

Traffic calming has been introduced in many cities in a bid to create more age-friendly and sustainable communities. This study uses Q methodology to understand the perspectives and experiences of residents after almost a decade since the first implementation of traffic calming measures in neighbourhoods in Singapore. In particular, we focused on the Silver Zone programme, which involves the introduction of senior-friendly road safety features in areas with a high proportion of senior residents and where there have been past road traffic injury involving seniors. With 26 participants, we identified three perspectives and termed them the Road Safety Enthusiast, Inconvenienced Users, and Implementation Critics. While their perspectives of the traffic calming measures were different, we found that all three groups broadly supported the objectives of Silver Zones. The participants were able to identify that the benefits of traffic calming go beyond protecting vulnerable populations to enhancing the liveability and overall traffic safety of their neighbourhood and community. However, the benefits and inconveniences of these measures were felt differently across these groups, which are areas for planners and policymakers to address to increase the support for traffic calming in neighbourhoods. The efficacy of Q methodology for mobility and planning related research is also supported and further discussed in the article.

Characterising groin pain in rink hockey: Function and five-second squeeze in Spanish players

ObjectivesTo assess the relationship between history of past season groin pain and current pain during the five-second squeeze test (5SST) with groin function and adductor strength in rink hockey players. DesignCross-sectional. SettingFirst (Ok Liga), Second (Plata) and third division (Bronce) clubs. Participants: Sixty-eight female and 183 male hockey players. Main outcome measuresSeasonal prevalence of groin pain (time/non-time-loss). Adductor strength and pain during the 5SST. Function was evaluated with the Hip and Groin Outcome Score (HAGOS). ResultsSeasonal time-loss groin pain prevalence was 21%. Male players had 3.5 higher odds of having had an episode of time-loss groin pain during the previous season compared to female players. The adductor relative strength was no different between players with and without previous season groin injury (p = 0.53-0.55), while the HAGOS results differed between groups, with past season groin injury players obtaining lower values in all subscales. HAGOS scores differed between the 5SST pain intensity groups (p < 0.01). ConclusionsMale players had higher odds of having had a groin injury in the previous season compared to female players. Players with pain during 5SST and previous season groin injury reported functional deficits, while strength remains identical to their healthy counterparts.

Epidemiology of Sports-Related Clavicle Fractures in the United States: Injuries From 2015 to 2019.

Background:Clavicle fractures are common orthopaedic injuries that frequently occur during sports and recreational activity.Purpose:To (1) determine the incidence rate of sports-related clavicle fractures among patients evaluated in emergency departments in the United States over a 5-year period, (2) determine the most common sports and risks associated with clavicle fractures, and (3) update the literature by comparing past and present injury trends.Study Design:Descriptive epidemiology study.Methods:The National Electronic Injury Surveillance System (NEISS) database was queried for patients evaluated with clavicle fractures in US emergency departments from 2015 to 2019. The authors evaluated the data by age, sex, race, and sport/recreational activity. Injuries were characterized based on sports-specific mechanism of injury. Using the NEISS weighted multiplier, the authors estimated annual incidence rates based on US Census data. Contingency table comparisons of categorical variables (ie, age groups vs sex distributions) were analyzed using either chi-square or Fisher exact tests as appropriate for the population size, while continuous variable comparisons were performed using 1-way analysis of variance statistical testing.Results:A total of 2386 athletic-related clavicle fractures were evaluated at participating emergency departments, translating to 304,211 clavicle fractures, with an annual per-year injury rate of 18.72 clavicle fractures per 100,000 persons at risk (95% CI, 15.28-23.67). Male athletes had disproportionately higher injury rates than female athletes (P < .001) for every year of the study and demonstrated a higher incidence of fractures compared with female athletes (injury proportion ratio, 5.54). Patients aged 10 to 19 years accounted for the highest overall incidence of injury (64.5%). The annual incidence rate of athletic-related clavicle fractures was not significantly different during the study period (P = .24). The most common mechanisms of injury were participation in football (26.87%), soccer (15.76%), snowboarding (5.03%), bicycling (3.77%), wrestling (3.65%), and snow skiing (3.52%).Conclusion:Study findings indicated that clavicle fractures sustained during sports and recreational activity disproportionately affect male athletes. Adolescent populations (10-19 years of age) had the highest overall incidence of injury, and the most common activities associated with clavicle fractures were football and soccer.

Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: A nested case-control study.

BackgroundInjury, prevalent and potentially associated with prescription opioid use among older adults, has been implicated as a warning sign of serious opioid-related adverse events (ORAEs) including opioid misuse, dependence, and poisoning, but this association has not been empirically tested. The study aims to examine the association between incident injury after prescription opioid initiation and subsequent risk of ORAEs and to assess whether the association differs by recency of injury among older patients.Methods and findingsThis nested case-control study was conducted within a cohort of 126,752 individuals aged 65 years or older selected from a 5% sample of Medicare beneficiaries in the United States between 2011 and 2018. Cohort participants were newly prescribed opioid users with chronic noncancer pain who had no injury or ORAEs in the year before opioid initiation, had 30 days or more of observation, and had at least 1 additional opioid prescription dispensed during follow-up. We identified ORAE cases as patients who had an inpatient or outpatient encounter with diagnosis codes for opioid misuse, dependence, or poisoning. During a mean follow-up of 1.8 years, we identified 2,734 patients who were newly diagnosed with ORAEs and 10,936 controls matched on the year of cohort entry date and a disease risk score (DRS), a summary score derived from the probability of an ORAE outcome based on covariates measured prior to cohort entry and in the absence of injury. Multivariate conditional logistic regression was used to estimate ORAE risk associated with any and recency of injury, defined based on the primary diagnosis code of inpatient and outpatient encounters. Among the cases and controls, 68.0% (n = 1,859 for cases and n = 7,436 for controls) were women and the mean (SD) age was 74.5 (6.9) years. Overall, 54.0% (n = 1,475) of cases and 46.0% (n = 1,259) of controls experienced incident injury after opioid initiation. Patients with (versus without) injury after opioid therapy had higher risk of ORAEs after adjustment for time-varying confounders, including diagnosis of tobacco or alcohol use disorder, drug use disorder, chronic pain diagnosis, mental health disorder, pain-related comorbidities, frailty index, emergency department visit, skilled nursing facility stay, anticonvulsant use, and patterns of prescription opioid use (adjusted odds ratio [aOR] = 1.4; 95% confidence interval (CI) 1.2 to 1.5; P < 0.001). Increased risk of ORAEs was associated with current (≤30 days) injury (aOR = 2.8; 95% CI 2.3 to 3.4; P < 0.001), whereas risk of ORAEs was not significantly associated with recent (31 to 90 days; aOR = 0.93; 95% CI 0.73 to 1.17; P = 0.48), past (91 to 180 days; aOR = 1.08; 95% CI 0.88 to 1.33; P = 0.51), and remote (181 to 365 days; aOR = 0.88; 95% CI 0.73 to 1.1; P = 0.18) injury preceding the incident diagnosis of ORAE or matched date. Patients with injury and prescription opioid use versus those with neither in the month before the ORAE or matched date were at greater risk of ORAEs (aOR = 5.0; 95% CI 4.1 to 6.1; P < 0.001). Major limitations are that the study findings can only be generalized to older Medicare fee-for-service beneficiaries and that unknown or unmeasured confounders have the potential to bias the observed association toward or away from the null.ConclusionsIn this study, we observed that incident diagnosis of injury following opioid initiation was associated with subsequent increased risk of ORAEs, and the risk was only significant among patients with injury in the month before the index date. Regular monitoring for injury may help identify older opioid users at high risk for ORAEs.

Cumulative Effect of Head Injuries on Nonmotor Outcomes in Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative movement disorder that is a result of dopamine depletion in the basal ganglia. Individuals with a PD diagnosis experience motor symptoms (e.g., tremors) and nonmotor symptoms (e.g., cognitive decline). Previous studies suggest that progression of cognitive dysfunction in other neurologic populations can be predicted by cumulative head injuries. The study examined the association between lifelong number of head injuries and nonmotor outcomes (cognitive complaints, depression, and quality of life). Participants consisted of 3,483 individuals with PD diagnoses who were enrolled in the Fox Insight study. Participants completed a self-report questionnaire to quantify the number of head injuries experienced throughout life. Participants also completed measures of nonmotor outcomes (cognitive complaints, depression, and quality of life) every 6 months over a 3-year period. Cognitive complaints were more common among those experiencing more head injuries. Further, more severe depression and greater difficulties in quality of life were reported among individuals experiencing a greater number of head injuries. Additional analyses revealed the effect between cognitive complaints and number of head injuries was driven by individuals who experienced five or more head injuries in their lifetime. Among individuals with PD, a patient report of past head injuries may have prognostic implications for important nonmotor outcomes. Report of multiple head injuries may be particularly concerning.

A Measure of Burnout in Current NCAA Student-Athletes.

IntroductionThe prevalence of athletes who specialize in sports has increased in recent years. Substantial literature on youth sports has linked early sport specialization to negative consequences, such as burnout and injury. However, empirical evidence comparing rates of burnout and specialization in NCAA athletes is limited. The purpose of this study was to survey current NCAA Division I student-athletes to compare levels of burnout to sex, year of NCAA eligibility, and age at the beginning of sport specialization.MethodsA self-reported survey was distributed to student-athletes at two NCAA Division I institutions, which included demographics, sport specialization history, injury history, and the Athlete Burnout Questionnaire. Results from the three measures of the Athlete Burnout Questionnaire (reduced sense of accomplishment, exhaustion, sport devaluation) were compared to sex, year of NCAA eligibility, age of beginning sport specialization, and injury history.ResultsA total of 267 athletes (95 males and 172 females) completed the survey. Of those, 156 (58.4%) were in their first or second year of NCAA eligibility, and 111 (41.6%) were in their third, fourth, or fifth year. Of the total, 121 (46.4%) reported specializing before the age of 15, and 140 (53.6%) specialized at age 16 or older. Females reported significantly higher levels of exhaustion than males (Difference of means (M) = 0.43, 95% confidence interval (CI) = [0.20, 0.66], p < 0.01). Athletes in their third, fourth, or fifth year of eligibility reported significantly higher levels of sport devaluation (M = 0.27, 95% CI = [0.05, 0.48], p < 0.05) than athletes in their first or second year. Athletes who specialized before age 15 did not report significantly higher levels of burnout than athletes who specialized at age 16 or later. In total, 203 athletes (77.2%) reported experiencing any injury. Athletes who reported a history of experiencing any injury demonstrated significantly higher feelings of reduced sense of accomplishment than athletes with no injury history (Difference of means (M) = 0.24, 95% confidence interval (CI) = [0.03, 0.45], p < 0.05).ConclusionsAthletes were more likely to experience elevated levels of burnout if they reported female sex, older NCAA eligibility, or a past injury history. However, athletes were not more likely to experience increased burnout based on age of beginning specialization. The results demonstrated a need to address burnout in athletes following injury and to be aware that females and older athletes are more prone to burnout.

A case of intraoperative observation of maxillary artery aneurysm

The maxillary artery aneurysm occurs rarely, only a few cases were described in the foreign literature where the aneurysm were associated mainly with the past head injury. The behavior of the aneurysm is largely unknown: both spontaneous resolution and growth of the aneurysm, resulting in rupture, have been reported.&#x0D; We observed an aneurysm of the maxillary artery in the maxillary sinus as an intraoperative finding, with the following bleeding and embolization of the bleeding vessel.&#x0D; Due to the growing number of endovideoscopic operations on the axillary system, it was proposed to increase the volume of preoperative examination to prevent the intraoperative bleeding.

Prevalence of musculoskeletal injuries in Thai classical dancers

ABSTRACT Thai classical dance has earned recognition across the world, however, attention on the health of dancers has not been well implemented. This study aimed to report on the prevalence of musculoskeletal injuries in Thai classical dancers. The descriptive cross-sectional survey study was implemented. A total of 356 (amateur = 221, professional = 135) Thai classical dancers participated (male = 111 and female = 245). The questionnaire was applied to harvest the key information. The results presented that amateurs (39.84%) had a higher rate of injury than professional dancers (11.48%), and males (60.36%) had a higher rate of past injury than females (49.80%). The most common past injuries of both amateur and professional dancers were: knee (22.62%, 12.59%), ankle (12.67%, 9.63%), and foot (12.2%, 8.15%), respectively. The number of past injury sites per person was significant differences between males and females (p < 0.04). Present injury sites in both amateur and professional dancers were: knee (16.06%, 25.68%), ankle (9.84%, 9.46%), and lower back (8.29%, 9.46%), respectively. In conclusion, the lower extremity injury is commonly presented in both amateur and professional dancers. Clinicians and dance educators might use these injury results in clinic and educate Thai classical dancers for safety and prevention.

Profil objawów nerwicowych u pacjentów dziennego oddziału leczenia zaburzeń nerwicowych z historią urazów głowy

The aim of the study was to assess the relationship between the occurrence of brain damage and symptoms of neurotic disorders, reported by patients of the psychotherapeutic day hospital for neurotic and personality disorders before starting treatment. Analysis of the cooccurrence of neurotic symptoms with previous head or brain tissue damage. The trauma was reported in a structured interview (Life Questionnaire) completed before treatment in the day hospital for neurotic disorders. Illustrated with OR coefficients (odds ratios), the performed regression analyzes showed statistically significant correlations between brain damage (caused by brain trauma, stroke, etc.) and symptoms listed in the symptom checklist KO"0". In a group of 2,582 women and 1,347 men, some of respondents reported (in the self-completed Life Questionnaire) a previous head or brain injury. Men reported a history of trauma much more often than women (20.2% vs. 12.2%; p < 0.0005). Patients who had a history of head trauma obtained a significantly higher value of the global severity of neurotic symptoms (OWK) in the symptom checklist KO "0" than patients without head trauma. This applied to both the male and female groups. Regression analyzes showed a significant relationship between head injuries and the group of anxiety and somatoform symptoms. In both groups (men and women), ‛paraneurological', dissociative, derealization, and anxiety symptoms occurred more frequently. Men more often reported difficulties in controlling the expression of emotions, muscle cramps and tension, obsessive-compulsive symptoms, skin and allergic symptoms, and symptoms of depressive disorders. Women more often reported vomiting when feeling nervous. Patients with a history of head injuries have a higher global severity of neurotic disorders symptoms than people without such history. Men experience head injuries more often than women, and the risk of developing symptoms of neurotic disorders is higher in men. It seems that patients with head injuries are a special group when it comes to reporting some psychopathological symptoms, especially in the group of men.

Impacts of past occupational injury and long-duration compensated work disability on future hospital admissions.

ObjectivesTo investigate changes in the prevalence and nature of hospital admissions towards the end of long-duration workers’ compensation claims (&gt;2 years), and afterwards. To examine differences in hospitalisation when workers’ compensation claims end due to either a 260-week duration limit, or otherwise, and comparisons with hospitalisations of a community comparator. ApproachA retrospective cohort study examined 2475 workers, termed the s39 group, whose workers’ compensation ceased due to a 260-week limit in 2017/2018 under s39(1) of the Workers’ Compensation Act New South Wales 2012 legislative amendments (Australia). Comparator groups were injured workers with long-duration claims whose compensation ceased independently of s39 (termed the injured control group, N=3626) and a community group (N=8485). Workers’ compensation records were linked to national social security payments, and hospital admissions. Outcomes describe the prevalence and diagnostic categories of hospital admissions 12 months before, and after, the cessation of workers’ compensation stopped payments. ResultsMusculoskeletal health conditions were common diagnoses in overnight hospitalisations for injured workers. Single-day hospital care for mental health disorders were more common for injured workers (17% of same-day admissions) than for members of a community control (3% of same-day admissions) across two years. Exiting the workers’ compensation scheme is associated with significantly fewer annual hospital admissions for the injured control group (OR 0.76), but not for the s39 group (OR 1.01). Injured workers with long-duration compensated work disability were admitted to hospital more often than the community comparator group during the year after workers’ compensation stops (s39 group: OR 1.55, injured control group: OR 1.30). Across all study groups, hospital admission was more common for people receiving disability social security benefits and older age groups. ConclusionPolicy change in the New South Wales workers’ compensation system introduced a 260-week limit on compensation, leaving workers with an elevated need for hospital care after their compensation ended. Welfare policies that disrupt key determinants of health require dedicated inter-agency provisions to support the elevated health needs of those affected.

Diving Lessons

Diving Lessons

Monitoring Variables Influence on Random Forest Models to Forecast Injuries in Short-Track Speed Skating.

Injuries limit the athletes' ability to participate fully in their training and competitive process. They are detrimental to performance, affecting the athletes psychologically while limiting physiological adaptations and long-term development. This study aims to present a framework for developing random forest classifier models, forecasting injuries in the upcoming 1 to 7 days, to assist the performance support staff in reducing injuries and maximizing performance within the Canadian National Female Short-Track Speed Skating Program. Forty different variables monitored daily over two seasons (2018–2019 and 2019–2020) were used to develop two sets of forecasting models. One includes only training load variables (TL), and a second (ALL) combines a wide array of monitored variables (neuromuscular function, heart rate variability, training load, psychological wellbeing, past injury type, and location). The sensitivity (ALL: 0.35 ± 0.19, TL: 0.23 ± 0.03), specificity (ALL: 0.81 ± 0.05, TL: 0.74 ± 0.03) and Matthews Correlation Coefficients (MCC) (ALL: 0.13 ± 0.05, TL: −0.02 ± 0.02) were computed. Paired T-test on the MCC revealed statistically significant (p < 0.01) and large positive effects (Cohen d > 1) for the ALL forecasting models' MCC over every forecasting window (1 to 7 days). These models were highly determined by the athletes' training completion, lower limb and trunk/lumbar injury history, as well as sFatigue, a training load marker. The TL forecasting models' MCC suggests they do not bring any added value to forecast injuries. Combining a wide array of monitored variables and quantifying the injury etiology conceptual components significantly improve the injury forecasting performance of random forest models. The ALL forecasting models' performances are promising, especially on one time windows of one or two days, with sensitivities and specificities being respectively above 0.5 and 0.7. They could add value to the decision-making process for the support staff in order to assist the Canadian National Female Team Short-Track Speed Skating program in reducing the number of incomplete training days, which could potentially increase performance. On longer forecasting time windows, ALL forecasting models' sensitivity and MCC decrease gradually. Further work is needed to determine if such models could be useful for forecasting injuries over three days or longer.

Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers.

Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers. Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y-1, prior to age 12 y (late specialization if after age 12 y). Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups. Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

Surviving Fifty Years With Shrapnel Within the Brain

AimsTraumatic brain injury during the war by shrapnel or bullet is lethal and life-threatening. The mortality rate from traumatic brain injury is more than 90%. Mrs. N (70) of Bangladesh is an exceptional and one of the luckiest women of the world. She is a war victim and has been living with shrapnel within her brain for the last 50 years.MethodsAccording to the patient attendant, half a century ago, during the Liberation War of Bangladesh, one shell accidentally exploded in their backyard. Unfortunately, a few pieces of shrapnel penetrated her arm, leg and right side of the head. She lost her consciousness and immediately treated at war hospital as per level best. She forgets details of her treatment and has no treatment records. Last 50 years, she has been surviving with movement difficulties, weaknesses of the upper and lower limbs and occasional convulsions. Her sufferings have intensified day by day. Last few years she has been experiencing headaches, dizziness, vomiting and forgetfulness. Two months back, she drank some insecticide mistakenly. She also suffering insomnia and she often cried out from deep sleep. She complains about hearing unknown voices. The voices were talking about her. She also started to suspect her family members. She claims that her family members were conspiring to kill her. She has history of convulsions three times in the last 50 years, which were generalized and tonic clonic in nature. She didn't take any medication for convulsion. As her suspicion, irrelevant talk and oddity in behavior worsened, her family members took her to me for treatment. Considering her past traumatic brain injury, an X-ray skull was advised. Surprisingly, it showed a metallic foreign body (shrapnel) within her skull. Furthermore, a CT scan of the brain was done, and it showed there was an irregular bony gap at right parietal area, a shrapnel at right frontal area with extensive encephalomalacic Porencephaly communicating with lateral ventricle. Her thyroid and liver function are normal. She is non-diabetic, non-hypertensive. She was advised to take risperidone 2 mg daily at night. With this low dose antipsychotic medication her psychosis controlled.ResultsSurviving with shrapnel within the brain followed by traumatic brain injury is very much rare. Shrapnel gradually damages the brain parenchyma and creates a large porencephaly.ConclusionTraumatic brain injury by bullet or shrapnel is always fatal. It is very much rare in medical to survive fifty years with shrapnel within the brain after shrapnel injury.

Events Across the Life Course Contribute to Higher Mobility Impairment Rates in Rural U.S.

PurposeThis paper investigates how life events such as injuries, health insurance coverage, geography, and occupation contribute to mobility disability rates over time. Findings can inform policies and practices to address factors that may contribute to disability in rural and urban areas.MethodsWe utilized 27 waves of the National Longitudinal Survey of Youth (NLSY) data from 1979 to 2016 to explore how past injury, occupation, health insurance coverage, and rurality predicted mobility impairment at ages 40 and 50 using regression analysis.FindingsRural respondents reported significantly higher rates of mobility impairment at age 40 and age 50 relative to people living in urban areas, and were more likely to report injury, work in high exertion occupations, and experience several pain-related health conditions. Using logistic regression and controlling for race and education, we found that people had higher odds of experiencing mobility impairment at age 40 if they reported a broken bone in the last 10 years, reported ever being knocked unconscious, had any workplace injury from 1988 to 2000, or lived in a rural area. People reported lower odds of mobility impairment if they had more consistent health insurance coverage over time. Further analysis showed that people consistently uninsured over time were 91% more likely to report mobility impairment at age 40 than those consistently insured.ConclusionA better understanding of environmental factors associated with disability such as access to insurance, risk exposures, resources, and other place-based behaviors can inform additional strategies for reducing the severity and duration of mobility disability.

‘A man on a watchtower’: Malleson and the British military mission to Turkistan, 1918–20

It is not often that one comes across a former British intelligence chief venting his spleen in public about past injuries done to him by his government and, in doing so, revealing recent intelligence operations. One such instructive example is that of Major-General Sir Wilfrid Malleson who, on 24 January 1922, in a lecture to the Central Asian Society, castigated the British government of India for failing to recognise the admittedly impressive services of the personnel of the British military mission to Turkestan from 1918-20, which had been under his command. In his righteous fury, Malleson revealed to a large extent British military and intelligence operations in the region, particularly as they affected Afghanistan in the critical years of 1919-20, covering as they did the Third Afghan War and its aftermath. It is proposed in this article to concentrate on an examination of this subject since it has been comparatively neglected and has much to tell us about the nature of British intelligence in this period and place.

Memory of Conflicts and Perceived Threat as Relevant Mediators of Interreligious Conflicts

The present study investigated to what extent memory of conflict and perceived threat explain the relation between religiosity and supporting interreligious conflicts between Muslims and Christians in Indonesia. We employed data from the survey of the interreligious conflicts in 2017, involving 2026 adults from five hotspot regions: Aceh Singkil, South Lampung, Bekasi, Poso, and Kupang. Our confirmatory factor analysis and measurement invariance demonstrated that all employed scales were valid and reliable across religious groups. Our structural equation modelling showed that while the memory of conflicts was only positively related to supporting lawful protests, the perceived threat was shown to be strongly related to supporting both lawful and violent protests. This shows that memory of past physical injuries is not highly susceptible to exclusive behaviours against the religious outgroup. However, it is the individuals’ evaluation of the religious outgroup as a result of past conflicts which encourages exclusionary behaviours against them. These findings provide empirical insights into the importance of the aftermath of interreligious conflicts and how they can be used to avoid future clashes.