Previous Level Of Performance Research Articles

Current Analysis of Women Athletes with Pelvic Pain

Accurate diagnosis and effective management of pelvic pain in women have become more challenging now that the number of women athletes and the number of diagnostic possibilities are increasing. We conducted a prospective study of women athletes with pelvic pain seen during a 2-yr period within a large well-defined clinical practice to clarify some of the current causes and treatment possibilities. One hundred fourteen females, 14% of the total male/female cohort, were referred for treatment of suspected musculoskeletal injury. On the basis of history and physical and radiological examinations, 74 (64.9% of females) turned out to have injuries of the hip (group A) and/or soft tissues surrounding the hip (group B), and 40 (35.1%) had other sometimes more threatening diagnoses. In groups A and B, 40 (90.1%) of 44 patients who chose surgery achieved previous performance levels within 1 yr compared with only 4 (13.8%) of 29 who did not have surgery. Factors such as sport type, competitive status, and age did not affect the outcomes. Most diagnoses in group C, e.g., inflammatory bowel disease, reflex sympathetic dystrophy, and malignancy, usually eclipsed the potential musculoskeletal diagnoses in terms of long-term importance. In this series of patients, most pelvic pain in women athletes was identifiable and treatable. Most had benign musculoskeletal causes, and surgery played an important role in treatment of those causes. Still, we found a large number of other causes that required longer specialized care. Health care professionals seeing such patients need to be alert to the new concepts of pelvic injury and the various roles for surgery and the broad list of other considerations.

Outcome after Lacerations of the Superficial and Deep Digital Flexor Tendons, Suspensory Ligament and/or Distal Sesamoidean Ligaments in 106 Horses

To report outcome after the surgical treatment of lacerations of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and/or distal sesamoidean ligaments (DSL) in horses. Case series. Horses (n=106) with lacerations of the SDFT, DDFT, SL, and/or DSL. Medical records (1988-2002) were reviewed for signalment, limb and tendon/ligament involvement (location and extent of injury, tendon sheath involvement), method of repair, and outcome. The median age of horses was 7 years and the follow-up time ranged from 1 to 10 years. Fifty-five percent of horses returned to their previous level of performance, 27% to a lower level, and 18% were euthanatized. Multivariate statistical analysis demonstrated that the number of structures transected had the most significant influence on outcome. No significant association was detected between outcome and tendon sheath involvement, tendon suturing, casting, or limb affected. Fetlock hyperextension was the most significant complication. A high survival rate can be expected after SDFT, DDFT, SL, and/or DSL lacerations in horses, but only 55% of affected horses returned to their previous activity level. The number of structures affected was the major factor determining whether horses returned to an equal level of performance.

Drug use and sport—A commentary on: Injury, pain and prescription opioid use among former National Football League football players by Cottler et al.

The accompanying paper by Cottler et al. reports on findings from a telephone survey study that examined opioid analgesic use and misuse by U.S. professional football players. The study shows high rates of misuse of these medications, and provides an opportunity to consider the intersection between sports and drug use. While in recent years there has been increasing focus upon the use of performance enhancing drugs (e.g., steroids) in athletes, the present report provides valuable information about a relatively unexplored but important topic: opioid analgesic misuse by athletes. The data provided show that misuse of opioids in this population is cause for concern, suggest that study of other groups of athletes should be undertaken, and that further assessment of opioid use in football players is also needed. The study also provides an opportunity to conceptualize drug (and non-drug) use in athletes, as a means to either return athletic functioning to a previous level of performance, or to enhance functioning. Discussions of drug use in sports need to appreciate the complexity of such use, which can be indicated and appropriate under certain circumstances, but which can also be inappropriate and problematic under others—for example, for drugs such as opioid analgesics.

Idiopathic aseptic pericardial effusion with cardiac tamponade in a horse

SummaryThis report describes the successful treatment of pericardial effusion and cardiac tamponade in a 10‐year‐old Hanoverian gelding. Pericarditis and pericardial effusion are uncommon conditions in horses. Although many potential causes for the effusion have been described most cases are classified as idiopathic. The most valuable diagnostic procedure for the detection of pericardial effusion is echocardiography. Pericardiocentesis and drainage of the fluid were carried out in this case. At one year follow‐up there were no clinical signs of recurrence and the horse has returned to his previous level of athletic performance.

Closed reduction of scapulohumeral joint luxation in an Icelandic horse after general anaesthesia

This report describes the clinical, ultrasonographic and radiographic findings in an 8-year-old Icelandic mare with unilateral shoulder luxation after general anaesthesia. Reduction of the luxated humerus was performed in a closed fashion using a calving jack under general anaesthesia. The horse recovered well and ultimately returned to its previous level of performance.

Unilateral periorchitis with a secondary peritonitis in a Standardbred stallion

SummaryA 6‐year‐old Standardbred stallion presented for evaluation of progressive diffuse scrotal swelling of 5 days' duration. Physical examination was within normal limits apart from pitting ventral oedema and severely enlarged fluid filled scrotum. Rectal examination did not reveal any abnormalities in the palpable intestinal tract, spleen, kidneys or internal inguinal rings. Testicular ultrasound examination showed evidence of abnormal right testicular parenchyma that was displaced proximally by a heteroechoic region of possible abscessation. The left testis was surrounded by a large amount of hypoechoic fluid. Abdominocentesis was performed and was indicative of peritonitis. Broad‐spectrum antimicrobials and analgesics were administered preoperatively and a bilateral open orchidectomy with closure of the external inguinal ring in addition to scrotal ablation was performed. Post operative peritoneal lavage was performed once a day for 3 days. There were no complications associated with recovery or within the immediate post operative period. The horse was released to the care of his owners 5 days following surgery and has returned to his previous racing performance level.

Ulnar collateral ligament injuries of the elbow in professional football quarterbacks

Ulnar collateral ligament (UCL) injuries of the elbow can cause significant pain and disability in the overhead thrower. Most studies in the literature have focused on baseball players and demonstrated that surgical reconstruction is the most reliable way to allow these athletes to return to their previous level of performance. Little is known about whether or not surgical reconstruction is necessary for other types of elite throwing athletes. We hypothesize that professional football quarterbacks with UCL injuries of the elbow can return to competitive play after nonoperative management. The NFL Injury Surveillance System (NFLISS) was reviewed for any UCL injuries of the elbow in quarterbacks from 1994 to 2008, including the type and mechanism of injury, player demographics, method of treatment, and time to return to play. A total of 10 cases of UCL injuries in quarterbacks were identified starting in 1994. Nine cases were treated nonoperatively and the mean return to play was 26.4 days. UCL injuries of the elbow are uncommon injuries in professional quarterbacks. This group of overhead athletes can be successfully treated nonoperatively, in contrast to baseball players, who more commonly need surgical reconstruction to return to competitive play. The difference between the 2 groups of overhead athletes is most likely secondary to biomechanics and demand.

Activities of daily living after hip fracture: profile and rate of recovery during 2 years of follow-up

In this study 509 hip fracture patients were followed-up during 24 months measuring their recuperation in activities of daily living. The different activities measured had both different profile and probability of recovery. Recovery of pre-fracture functional level is a goal of hip fracture treatment. The objective of this study was to measure recovery of previous functional level for ambulation and for the activities of daily living during the 24 months after osteoporotic hip fracture. This is a longitudinal prospective study of the patients admitted to the orthopaedics department of a university hospital for hip fracture and followed up by a geriatrician during three years (2003-2005). Demographic, clinical, functional and treatment data were collected during hospitalisation. Telephone follow-up was made at 3, 6, 12 and 24 months. Data were analysed by survival analysis applying the Kaplan-Meier estimator. Five hundred and nine patients were included. The mean age was 84.5 (SD 6.3) years. The activities with lower probability of recovery to the previous level at 24 months were climbing stairs, chair/bed transfers, ambulation, dressing, bathing and use of toilet (between 67.5% and 76% recovery). The activities with higher probability of recovery were grooming, feeding and bladder and bowel control (between 86.3% and 95.4%). Recovery of previous performance level for ambulation, chair/bed transfers, use of toilet, feeding, grooming and bladder control occurred primarily during the first 6 months, whereas recovery of bathing, dressing and climbing stairs occurred mainly in the first 12 months after the fracture. The activities with lower likelihood of recovery were ambulation, chair/bed transfers, climbing stairs, use of toilet, bathing and dressing. Time of recovery varied by activity; bathing, dressing and climbing stairs were the activities with the longest recovery time.

Computer- and Video-Based Instruction of Food-Preparation Skills: Acquisition, Generalization, and Maintenance

The purpose of this study was to evaluate the effects of a computer-based video instruction (CBVI) program to teach life skills. Three middle school-aged students with intellectual disabilities were taught how to make a sandwich, use a microwave, and set the table with a CBVI software package. A multiple probe across behaviors design was used to evaluate for a functional relation between the software and skill acquisition. All students increased the percentage of steps completed in the correct order after receiving CBVI. During maintenance probes, the performance of all students deteriorated; after a single review session with CBVI, all students regained previous levels of performance, tentatively indicating a role of CBVI as a tool for reviewing previously mastered material. Results are discussed in terms of the use of CBVI for providing students sufficient learning trials on tasks that require the use of consumable products (e.g., food).

Complete and partial hoof wall resection for keratoma removal: post operative complications and final outcome in 26 horses (1994-2004)

There are no data on the frequency of post operative complications following keratoma removal, such as recurrence, hoof wall instability and excessive granulation tissue formation, or their relation to the method of surgical removal. To identify important factors in the outcome for horses undergoing surgical removal of a keratoma and compare the post operative complications encountered following keratoma removal by complete hoof wall resection (CR) and partial hoof wall resection (PR). Horses undergoing PR would have fewer post operative complications and would return to work more quickly than those undergoing CR. A retrospective review of medical records from one equine hospital identified 26 horses that underwent removal of a keratoma by CR or PR. Clinical, radiological and surgical findings and outcome were analysed. Common clinical signs included lameness and the presence of a subsolar abscess. Fourteen horses underwent CR and 12 PR. The complication rate following CR (71%) was significantly lower than that following PR (25%) (P<0.01). Complications encountered included excess granulation tissue formation, hoof crack formation and keratoma recurrence at the surgical site. The time taken to return to full work post operatively was significantly shorter in horses undergoing PR compared to CR (P<0.01). All horses, except one, returned to their previous exercise level. PR resulted in fewer post operative complications and a more rapid return to athletic activity than CR. Although the overall complication rate for CR was higher than for PR, the overall prognosis for return to soundness and the previous performance level is very good.

Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint. Part 2: Treatment and outcome

There are currently few long-term follow-up data relating to recovery from injury of a collateral ligament (CL) of the distal interphalangeal (DIP) joint and limited information about the effect of associated osseous injury on prognosis. To describe long-term follow-up results for horses with CL injury, with and without associated osseous injury; and to determine the effect of extracorporeal shock wave therapy (ECSWT) or radial pressure wave therapy (RPWT) on outcome. Prognosis for return to performance for horses with CL-related osseous injury would be worse than for horses with CL injury alone. Magnetic resonance images from 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence of osseous abnormality associated with the ligament origin or insertion and the middle and distal phalanges. Horses were assigned to groups according to the combination of their injuries. Type of treatment was recorded and follow-up information obtained. Thirty-two horses with additional sources of lameness were excluded from analysis of outcome. Follow-up data were available for 182 horses, 55 of which had follow-up information for up to 2 years after presentation. Twenty-seven percent of horses with CL injury alone and 34% of horses with CL related osseous injury returned to their previous performance level. Prognosis for a combination of injuries to multiple soft tissue and osseous structures within the hoof capsule was substantially worse. There was no effect of ECSWT or RPWT on outcome. The presence of mild to moderate CL related osseous injury does not appear to influence prognosis compared with CL injury alone. Further studies of a larger number of horses are necessary in order to ascertain if specific types of osseous pathology influence return to performance levels.

Diversified business groups and corporate restructuring in China

PurposeThis paper aims to explore the roles different ownership structures, the joint effect of related and unrelated diversification strategies, and previous performance levels have on the restructuring strategies of such firms.Design/methodology/approachAnnual reports of publicly traded firms in the two Chinese stock exchanges are used to collect data. Multiple regression and ANOVA analysis are used to examine the impact of ownership structure types, match between diversification strategies, and previous performance on the change of business scopes of the sample business groups.FindingsCompared to other ownership types, government owned business groups tend to increase their business scope during asset restructuring, while private business groups tend to decrease their scopes through divestitures and spinoffs. Poor previous performance is also found to be negatively related to change in business scopes. The “match” between related and unrelated diversification strategies of the business groups leads to increase in business scopes, while “mismatch” between these two strategies tends to lead to decrease in business scopes.Practical implicationsThis study provides some recommendations to managers and public policy makers in emerging economies. There is a need to monitor the changing institutional environment a firm operates in. It is up to the managers of business groups to determine the degree of market imperfections they are facing and the need to compensate with internal market mechanism and social exchange mechanism within the group structure. As China opens its door further to private ownership and foreign ownership, the pressure to increase efficiency and effectiveness along with the continuous improvement of the institutional environment will require that managers adopt strategies that can enhance the competitiveness of the firms, whether it is through further diversification or scope reduction.Originality/valueThis research deepens our understanding of restructuring strategies of Chinese business groups, by linking factors such as ownership structure, diversification strategies, and past performance to scope changes in these groups. It can broaden our understanding of corporate restructuring in transitional economies, such as China and India.

Pyloric stenoses in horses: a seven case reports

The seven cases presented here were diagnosed at the Equine Clinic, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic between the years 2002 and 2008. The age range of affected horses was from 10 months to 10 years and included four Thoroughbreds and three warm blooded horses. The horses showed different clinical signs – recurrent or acute colic, poor appetite, frequent recumbency and poor performance. Physical examination revealed diverse results in each horse. Results of gastroscopic examination showed severe nonglandular mucosa ulceration and pathological changes along the pylorus in all horses. Two horses showed distal esophagitis. The duodenum was visible and endoscopically unchanged in two horses. Treatment was applied to four horses with different results. Follow up: Two horses are alive and they have partially or fully returned to their previous performance level. Five horses were euthanised because of clinical worsening and/or unsuccessful treatment. Four horses were examined &lt;I&gt;post mortem&lt;/I&gt;. The final diagnosis of pyloric stenosis was made by gastroscopy in six horses. In the seventh horse it was confirmed by necropsy. Gastric or gastroduodenal ulceration was revealed as the cause of pyloric stenosis in five horses. In two horses the origins of pyloric changes were uncertain.

Arthroscopic Removal of Palmar/Plantar Osteochondral Fragments from the Proximal Interphalangeal Joint in Four Horses

To describe anatomic considerations and arthroscopic technique in horses for arthroscopic removal of palmar/plantar osteochondral fragments from the proximal interphalangeal (PIP) joint. Retrospective study. Adult horses (n=4) with osteochondral fragments of the palmar/plantar PIP joint. Arthroscopic removal of palmar/plantar osteochondral fragments within the PIP joint was performed with horses in dorsal recumbency under general anesthesia. Medical records of affected horses were reviewed to determine history; physical, lameness, and radiological findings; surgical technique; complications and outcome. Two horses had lameness localized to the PIP joint. Two other horses had lameness suspected, but not confirmed to the pastern region. One of these horses had a history of intermittent lameness, but was not lame on admission. All horses had radiographic evidence of palmar/plantar osteochondral fragmentation within the PIP joint. Fragmentation was located abaxially in 2 horses in the hind limb and axially in 2 horses in the left forelimb. Osteochondral fragments were successfully removed via a palmar/plantar arthroscopic approach in all horses. Three horses returned to previous levels of athletic performance; 1 horse was used for trail riding instead of reining. Arthroscopy of the palmar/plantar pouch of the PIP joint allowed limited assessment of the joint and removal of osteochondral fragments. Arthroscopy of the palmar/plantar PIP joint pouch for assessment and removal of osteochondral fragments is possible and should be considered when lameness is localized to this joint.

Application of the Anatomic Double-Bundle Reconstruction Concept to Revision and Augmentation Anterior Cruciate Ligament Surgeries

Shen, Wei MD, PhD1; Forsythe, Brian MD1; Ingham, Sheila McNeill MD1; Honkamp, Nicholas J. MD1; Fu, Freddie H. MD1 Author Information

Ultrasound‐Guided Balloon Thrombectomy for Treatment of Aorto‐Iliac‐Femoral Thrombosis in a Horse

Ultrasound‐Guided Balloon Thrombectomy for Treatment of Aorto‐Iliac‐Femoral Thrombosis in a Horse

Effect of Trade Openness and Foreign Direct Investment on Industry Performance in Ghana

This paper analyzes the macroeconomic implications of trade openness and foreign direct investment (FDI) on industrial performance in Ghana. The paper argues that in Ghana industrial performance is affected adversely by trade openness through a number of mechanisms including monetary policy, fiscal policy, and FDI. The methodological approach consists of analyzing a set of macroeconometric models using quarterly data for the period 1983(1)-2006(4) under general-to-specific parsimonious conditions. Unrestricted Cointegrating and Vector Error-Correction Models were estimated to examine the static and dynamic long-run effects as well as the short-run dynamics of the system and the speed of adjustment to the long-run equilibrium. The findings indicate that industrial performance is largely impeded by trade openness, high lending rate of commercial banks and, to a lesser extent, corporate tax. The main positive determinants of industrial performance are raw material availability, previous level of economic performance, industrial wage, and a moderate rate of inflation. It is, therefore, recommended that effective policies should be directed at stabilizing the macroeconomy to reduce the operational risks of banks which would reflect in lower lending rates, making the agricultural sector more vibrant for increased supply of raw materials to the industrial sector, and paying attractive industrial wages to workers. It is also recommended that policymakers should formulate and implement prudent policies that would appropriately harness domestic capital to finance industrial activities rather than over-relying on FDI (that does not have significant long-run impact on industrial performance in Ghana.

Evaluation of foot pain in the standing horse by magnetic resonance imaging

The records of 41 horses with previously undiagnosed foot pain that had been examined by standing magnetic resonance imaging were reviewed and follow-up information was obtained from their owners two...

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study

We aimed to estimate the proportions of colorectal cancer cases that might be prevented by sigmoidoscopy compared with colonoscopy among women and men. In a population-based case control study conducted in Germany, 540 cases with a first diagnosis of primary colorectal cancer and 614 controls matched for age, sex, and county of residence were recruited. A detailed lifetime history of endoscopic examinations of the large bowel was obtained by standardized personal interviews, validated by medical records, and compared between cases and controls, paying particular attention to location of colorectal cancer and sex differences. Overall, 39%, 77%, and 64% of proximal, distal, and total colorectal cancer cases were estimated to be preventable by colonoscopy. The estimated proportion of total colorectal cancer cases preventable by sigmoidoscopy was 45% among both women and men, assuming that sigmoidoscopy reaches the junction of the descending and sigmoid colon only and findings of distal polyps are not followed by colonoscopy. Assuming that sigmoidoscopy reaches the splenic flexure and colonoscopy is done after detection of distal polyps, estimated proportions of total colorectal cancer preventable by sigmoidoscopy increase to 50% and 55% (73% and 91% of total colorectal cancer preventable by primary colonoscopy) among women and men, respectively. We conclude that colonoscopy provides strong protection against colorectal cancer among both women and men. The proportion of this protection achieved by sigmoidoscopy with follow-up colonoscopy in case of distal polyps may be larger than anticipated. Among men, this regimen may be almost as effective as colonoscopy, at least at previous performance levels of colonoscopy.

Endoscopic Resection of Dorsal Spinous Processes and Interspinous Ligament in Ten Horses

To describe endoscopic surgical subtotal resection of the dorsal spinous processes (DSP) and interspinous ligament in horses. Descriptive clinical study. Adult horses (n=10) with back pain and impinging dorsal spinous processes Diseased portions of DSP and interspinous ligament were resected by endoscopic surgery, using Destandau Endospine to create a surgical space and provide triangulation for the endoscope, suction cannula, and surgical instruments. Medical records of 10 horses with pain attributable to DSP pathology treated by endoscopic resection of DSP were reviewed to determine intra- and postoperative complications and outcome. Affected portions of DSP were successfully resected with minimal hemorrhage. Limited periosteal reaction was noticed after 3 months in 2 horses. Nine horses had no complications and returned to full work within 8 weeks; 1 developed a subcutaneous abscess, which was successfully managed, and returned to work after 3 months. Surgical resection improved presenting clinical signs and owner's complaint although 2 horses did not return to previous performance levels. Resection of DSP and interspinous ligament can be successfully performed endoscopically in horses. Hemorrhage was minimal but reduced visibility. Complications were minimal and most horses returned to work by 8 weeks. Endoscopic resection of DSP is a safe and reliable surgical procedure in horses.