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Background: Professional football teams that rank high on the log at the end of the season generally have fewer injuries than teams that rank lower on the log. This highlights the importance of implementing injury prevention measures, not only to protect player welfare and ensure their longevity in the sport, but also to improve the performance of the team. The association between a low incidence of injury and superior performance during a season may be even more relevant in sports with a higher incidence of injury than football, such as rugby union.  Discussion: To examine this association in the South African Currie Cup rugby union competition, time-loss (≥ 1 day training/match play missed) injury data and final position in the competition was examined over five-seasons. Teams who ranked in 1st position had significantly lower average injury rates than teams who ranked in last position [48 injuries per 1 000 player hours (95% C.I 20 to 76) vs 130 injuries per 1 000 player hours (95% C.I 79 to 180)]. More specifically, the team with the lowest injury rate in each season ranked in 1st or 2nd position. This team performance aspect of injury prevention should be highlighted more. In particular, this should be used to assist with communicating the importance of injury prevention programmes to stakeholders directly involved with budgetary allocations in the team. 

Background Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p  < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p  < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance.

BackgroundParaesophageal hernia repairs (PEHRs) have high rates of radiographic recurrence, with some patients requiring repeat operation. This study characterizes patients who underwent PEHR to identify the factors associated with postoperative symptom improvement and radiographic recurrence. We furthermore use propensity score matching to compare patients undergoing initial and reoperative PEHR to identify the factors predictive of recurrence or need for reoperation.MethodsAfter IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified. Patient characteristics, preoperative imaging, operative findings, and postoperative outcomes were recorded. A computational generalization of inverse propensity score weight was then used to construct populations of initial and redo PEHR patients with similar covariate distributions.ResultsA total of 244 patients underwent PEHR (78.7% female, mean age 65.4 ± 12.3 years). Most repairs were performed with crural closure (81.4%) and fundoplication (71.7%) with 14.2% utilizing mesh. Postoperatively, 76.5% of patients had subjective symptom improvement and of 157 patients with postoperative imaging, 52.9% had evidence of radiographic recurrence at a mean follow-up of 10.4 ± 13.6 months. Only 4.9% of patients required a redo operation. Hernia type, crural closure, fundoplication, and mesh usage were not predictors of radiographic recurrence or symptom improvement (P > 0.05). Propensity weight score analysis of 50 redo PEHRs compared to a matched cohort of 194 initial operations revealed lower rates of postoperative symptom improvement (P < 0.05) but no differences in need for revision, complication rates, ED visits, or readmissions.ConclusionsMost PEHR patients have symptomatic improvement with minimal complications and reoperations despite frequent radiographic recurrence. Hernia type, crural closure, fundoplication, and mesh usage were not significantly associated with recurrence or symptom improvement. Compared to initial PEHR, reoperative PEHRs had lower rates of symptom improvement but similar rates of recurrence, complications, and need for reoperation.

The merger of two dense stellar remnants including at least one neutron star is predicted to produce gravitational waves (GWs) and short-duration gamma ray bursts 1 , 2 . In the process, neutron-rich material is ejected from the system and heavy elements are synthesized by r-process nucleosynthesis 1 , 3 . The radioactive decay of these heavy elements produces additional transient radiation termed kilonova or macronova 4 – 10 . We report the detection of linear optical polarization, P  = (0.50 ± 0.07)%, 1.46 days after detection of the GWs from GW 170817—a double neutron star merger associated with an optical macronova counterpart and a short gamma ray burst 11 – 14 . The optical emission from a macronova is expected to be characterized by a blue, rapidly decaying component and a red, more slowly evolving component due to material rich in heavy elements—the lanthanides 15 . The polarization measurement was made when the macronova was still in its blue phase, during which there was an important contribution from a lanthanide-free outflow. The low degree of polarization is consistent with intrinsically unpolarized emission scattered by galactic dust, suggesting a symmetric geometry of the emitting region and low inclination of the merger system. Stringent upper limits to the polarization degree from 2.45–9.48 days post-burst are consistent with the lanthanides-rich macronova interpretation. A double neutron star merger gave rise to the gravitational-wave event GW 170817, with counterpart electromagnetic radiation in the optical and gamma-ray spectra. Polarization measurements of the optical emission reveal a lanthanide-rich macronova.

The aim of this research was to evaluate the influence of microstructure on hydrogen permeation of weld and API X52 base metal under cathodic protection. The microstructures analyzed were of the API X52, as received, quenched, and annealed, and the welded zone. The test was performed in base metal (BM), quenched base metal (QBM), annealed base metal (ABM), and weld metal (WM). Hydrogen permeation flows were evaluated using electrochemical tests in a Devanathan cell. The potentiodynamic polarization curves were carried out to evaluate the corrosion resistance of each microstructure. All tests were carried out in synthetic soil solutions NS4 and NS4 + sodium thiosulfate at 25°C. The sodium thiosulfate was used to simulate sulfate reduction bacteria (SRB). Through polarization, assays established that the microstructure does not influence the corrosion resistance. The permeation tests showed that weld metal had lower hydrogen flow than base metal as received, quenched, and annealed.

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.

IntroductionPaediatric complete heart blocks are predominantly congenital with cases often diagnosed in utero, at birth or usually within the first 1 month of life. This is secondary to immune mediated injury of the conduction system due to transplacental passage of maternal anti-SSA/Ro-SSB/La antibodies. Childhood AV (atrioventricular) block is one which is diagnosed between 1 month and 18 years of age, which could be due to maternal antibodies, congenital heart defect, iatrogenic or due to underlying genetic causes. Idiopathic complete heart block of childhood is a rare entity with scarce case reports.Case ReportWe report a case of 13 month old previously fit boy diagnosed with idiopathic complete AV block. He was admitted at 13 months of age with an episode of febrile convulsion secondary to throat infection. He was noted to have a low heart rate of around 50 beats per minute. There was no family history of cardiac problems or need for pacemakers. An ECG (electrocardiogram) done showed evidence of complete heart block with QTc of 500 ms. He was otherwise hemodynamically stable with normal blood parameters. His echocardiography showed mild dilatation of both ventricles with overall good function & structurally normal arrangements. His blood tests showed normal thyroid function, kidney function, iron levels, vitamin D levels, creatine kinase levels and auto-antibody screen. The anti Ro-La antibodies were negative in both the child and his mother. The genetic screening for inherited causes of complete heart block was also negative. He remains stable with close monitoring by the cardiac team with no evidence of arrhythmia or current need for pacemaker at 2 years of age. He has a sibling who was also screened and investigations were normal.DiscussionThis case currently falls in the idiopathic AV block of childhood of which there are only scarce case reports worldwide. We currently do not know about the etiology or clinical course of these cases. Future genetic studies might reveal an underlying genetic cause in these cases. Further similar case reports and linear studies would help us to forecast clinical prognosis in these cases.

Chronic obstructive pulmonary disease (COPD) is a common cause of acute medical hospital admission, and the prevalence of undiagnosed COPD in the community is high. The impact of undiagnosed COPD on presentation to secondary care services is not currently known. We therefore set out to characterise patients at first admission with an acute exacerbation of COPD, and to identify potential areas for improvement in earlier diagnosis and further management. A retrospective case review of patients first admitted to a district teaching hospital with an acute exacerbation of COPD over a 1-year period was carried out. Forty-one patients with a first admission with an acute exacerbation of COPD were identified, 14 (34%) of whom had not been previously diagnosed and were diagnosed with COPD as a result of the admission. At presentation, this group of patients had severe disease, with mean (SD) FEV1 1.02 (0.32) L, and a respiratory acidosis in eight (20%) patients, even though this was their first admission for an acute exacerbation of COPD. Missed potential opportunities to intervene in community and inpatient management were identified, including earlier diagnosis, pre-hospital corticosteroid therapy, inpatient respiratory team input, provision of smoking cessation advice and consideration of pulmonary rehabilitation. Patients with a first hospital admission with an acute exacerbation of COPD frequently have severe disease at presentation. Despite having severe disease, a diagnosis of COPD had not been made in the community prior to admission in one-third of patients. Future work should be directed at earlier identification of patients who are symptomatic from COPD and ensuring that the interventions of proven benefit in COPD are systematically offered to patients in both primary and secondary care.