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ObjectiveTo describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games.MethodsA total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems.ResultsThere were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)).ConclusionsIn a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games.

ObjectiveTo describe the epidemiology of illness at the Sochi 2014 Winter Paralympic Games.MethodsA total of 547 athletes from 45 countries were monitored daily for 12 days over the Sochi 2014 Winter Paralympic Games (6564 athlete days). Illness data were obtained daily from teams without their own medical support (13 teams, 37 athletes) and teams with their own medical support (32 teams, 510 athletes) through electronic data capturing systems.ResultsThe total number of illnesses reported was 123, with an illness incidence rate (IR) of 18.7 per 1000 athlete days (95% CI 15.1% to 23.2%). The highest IR was reported for wheelchair curling (IR of 20.0 (95% CI 10.1% to 39.6%)). Illnesses in the respiratory system (IR of 5.6 (95% CI 3.8% to 8.0%)), eye and adnexa (IR of 2.7 (95% CI 1.7% to 4.4%)) and digestive system (IR of 2.4 (95% CI 1.4% to 4.2%)) were the most common. Older athletes (35–63 years) had a significantly higher IR than younger athletes (14–25 years, p=0.049).ConclusionsThe results of this study indicate that Paralympic athletes report higher illness incidence rates compared to Olympic athletes at similar competitions. The highest rates of illness were reported for the respiratory and digestive systems, eye and adnexa, respectively. Thus, the results of this study form a basis for the identification of physiological systems at higher risk of illness, which can in turn inform illness prevention and management programmes with eventual policy change to promote athlete safety in future editions of the Winter Paralympic Games.

Despite all these challenges, most preventive frameworks, return to play protocols, pre-participation programmes and athlete health consensus guidelines in sports remain unsuitable to the unique needs of Para athletes. [...]the knowledge about Para athletes’ health is scarce within the sports and exercise community, and many athletes do not have the same support structures as non-disabled athletes.3 Para athletes live with an impairment as a result of a confirmed medical diagnosis and are often at risk of secondary health conditions that could have an impact both on their daily activities and participation in sport. [...]there is a pressing need to enhance their well-being at both primary, secondary and tertiary health levels. [...]cultural considerations must not be overlooked, as health, sports and disabilities are viewed differently across the world. Interpersonal level: the importance of support teams and peers The need to improve knowledge regarding athlete health promotion to persons (coaches, medical staff, training staff, parents and peers) working with the Para athlete has previously been emphasised.3 These persons may have the ability to prevent health incidents both directly and indirectly, and it has been suggested that adequate interpersonal support and communication may reduce stressors for the individual athlete.11 To enhance communication and improve individual athletes’ health, regular athlete health monitoring programmes involving direct interpersonal communication between the athlete, coach and athlete health team are strongly recommended, as emphasised by the participants in our recent study.8 Our hypothesis is that such measures are important among Para athletes since athletes may face barriers related to medical support, health insurance, finance and accessibility. [...]facilitation of peer support in athlete health promotion throughout the life course, for example for young athletes, pregnant athletes and athletes retiring, seems to be an underutilised model.

A remote sediment classification technique based on attenuation measurements from Chirp sub-bottom profiler data is described. This differs from previously published work in that attenuation measurements are obtained for each stratigraphic unit within a complex, thinly interbedded sedimentary sequence. Compressional wave attenuation measurements are obtained for a wide variety of lithologies, including muds, silts, sands, clayey sands, silty clays and gravel lags, with grain sizes ranging from 8 Phi to -4 Phi. In addition, attenuation measurements from sub-bottom profiler data were calibrated against laboratory acoustic measurements of vibracores and seabed samples from corresponding geographic locations, under simulated in-situ conditions using a Pulse Tube method. We adapt an instantaneous frequency matching method using a causal attenuation filter to model the decay of the Chirp transmitted waveform. From this modelling, a relationship between t* (a causal attenuation operator) and change in instantaneous frequency is established. The Hilbert transform is used to extract instantaneous frequency information from Chirp seismic, which is used to derive attenuation information for selected individual stratigraphic layers imaged by the sub-bottom profiler. This paper draws attention to the limitations in comparing attenuation measurements derived from Chirp sub-bottom profiler data against previously published literature on experimental attenuation measurements, which are limited by the wide variance of these data, and the difficulty in finding a meaningful best fit to these data. This demonstrates the importance of calibrating remote sediment classification observations using complimentary acoustic analysis of seabed samples to generate a site-specific geoacoustic database. A positive correlation between laboratory and sub-bottom profiler attenuation measurements was obtained, with a correlation coefficient of 0.885. Poorly sorted gravels with a mixed lithic and biogenic pebble component are characterised by very high attenuation with values of Q from 4 to 19. These sediments are considerably coarser-grained than those typically described in previously published experimental studies.[PUBLICATION ABSTRACT]

The PATCH project was an intersectoral initiative between health, social and education services in Lanarkshire, Scotland which provided support at home from two experienced children's nurses for parents of children with complex disability. The project was funded by the Scottish Executive Health Department Innovations Fund for Children's Services for two years from April 2000. This article reports results of an external independent evaluation of parents' and agency members' perceptions of the PATCH service. Audiorecorded interviews were obtained from members of eight families and eight agencies. Issues related to the two key aspects of support addressed in the project, carer training and partnership working, are presented. The skilled approach to training adopted was successful in creating a network of carers, both lay and professional, which resulted in improved respite and rest for parents. Effective partnership working resulted in improved communication, the development of an innovative child record, effective help in crises and improved service co-ordination. Together, the training and partnership elements of the PATCH service addressed practical, emotional and social dif. culties experienced by families. The freedom to work flexibly and to approach agencies directly and the ability to cut across established organizational structures were significant factors in improving support for families. A number of key aspects of nursing expertise and possible outcome indicators for such a service are presented.

Background Understanding the patient safety literature has been compromised by the inconsistent use of language. Objectives To identify key concepts of relevance to the International Patient Safety Classification (ICPS) proposed by the World Alliance For Patient Safety of the World Health Organization (WHO), and agree on definitions and preferred terms. Methods Six principles were agreed upon—that the concepts and terms should: be applicable across the full spectrum of healthcare; be consistent with concepts from other WHO Classifications; have meanings as close as possible to those in colloquial use; convey the appropriate meanings with respect to patient safety; be brief and clear, without unnecessary or redundant qualifiers; be fit-for-purpose for the ICPS. Results Definitions and preferred terms were agreed for 48 concepts of relevance to the ICPS; these were described and the relationships between them and the ICPS were outlined. Conclusions The consistent use of key concepts, definitions and preferred terms should pave the way for better understanding, for comparisons between facilities and jurisdictions, and for trends to be tracked over time. Changes and improvements, translation into other languages and alignment with other sets of patient safety definitions will be necessary. This work represents the start of an ongoing process of progressively improving a common international understanding of terms and concepts relevant to patient safety.