Women's rugby league injury claims and costs in New Zealand.

AIM: There is scarce information on rugby league injuries in female players. This paper provides an overview of the epidemiology of women's rugby league injuries requiring medical treatment and associated costs in New Zealand. METHOD: New Zealand Accident Compensation Corporation injury data for the period 1999-2007 were searched for rugby league injury cases occurring in females. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs. RESULTS: There were 320 moderate to serious injury claims recorded for females participating in rugby league activities over the study period. There was a mean (SD) of 37.9 (9.5) injury claims per year. The mean cost per year for the study period was $196 514 ($99,133) (£76,066 (£38,374)) with half of the injury claims occurring in New Zealand Maori. Concussion/brain injuries accounted for 3.8% of total female moderate to serious injury claims but accounted for 5.4% of female injury costs ($84,399 (£32,688)) with the highest mean cost per claim ($7033 (£2724)). The lower limb accounted for 65% of the total female injury claims and 58.7% of total injury costs ($922,296 (£356,968)). The mean cost per claim was higher for the lower limb ($4434 (£1714)) than the upper ($3331 (£1288)) limb. Clerks recorded 16.3% of the total injury claims, 20.3% of total injury costs ($319,474 (£123,211)) and had the highest mean cost per claim ($6144 (£2370)). The 25-29 age group recorded 31.9% of injury claims and 33.8% of injury costs. The 35-39 age group recorded the highest mean cost per claim ($6200 (£2392)) but only 10.9% of total claims and 13.8% of total costs. DISCUSSION: When compared with other studies in rugby league injuries, it appears that females incur substantially fewer injuries (5.7%) than males (94.3%). Although no participation data by sex are available, it is likely that participation percentages are reflected in the injury percentages. The high frequency (65%) and cost proportion (58.7%) for lower limb injuries was higher in females than in male rugby league players (previously reported as 42.4% of the injury claims and 31.5% of the total injury claim costs for the lower limb). CONCLUSIONS: Injury prevention programmes for women's rugby league should focus on the 25-29 age group and address ways to prevent concussion and lower limb injuries.

Epidemiology of cervical spine abnormalities in asymptomatic adult professional rugby union players using static and dynamic MRI protocols: 2002 to 2006.

OBJECTIVE: In this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated. DESIGN: Prospective observational study. SETTING: French professional rugby union clubs, between 2002 and 2006. PARTICIPANTS: 206 elite male adult players. INTERVENTION: Static sagittal T2 and axial T2* fast spin echo (FSE), and dynamic sagittal single-shot FSE weighted MRI scans of the C2-C7 region were examined for the presence of abnormalities. Participants' spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol. MAIN OUTCOME MEASUREMENTS: The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised. RESULTS: Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged>21 years, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment. CONCLUSIONS: Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, it can assist in preventing spinal injury.

Rugby league injuries in New Zealand: a review of 8 years of Accident Compensation Corporation injury entitlement claims and costs.

AIM: This paper provides an overview of the epidemiology of rugby league injuries and associated costs in New Zealand requiring medical treatment. METHOD: New Zealand national Accident Compensation Corporation injury data for the period 1999 to 2007 were searched for rugby league injury cases. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs. RESULTS: A total of 5941 injury entitlement claims were recorded over the study period with a significant decrease observed in the injury rate between the 1999-2000 and 2002-2003 reporting years. The total cost of the injuries for the study period was $42,822,048 (equivalent to pound15,916,072). The mean (SD) number of injury entitlement claims per year was 743 (271) and yearly cost was $5,352,760 (pound1,989,880) ($2,485,535 (pound923,994)). The knee was the most commonly reported injury site (225 per 1000 entitlement claims; $8,750,147 (pound3,252,020)) and soft tissue injuries were the most common injury types (474 per 1000 entitlement claims; $17,324,214 (pound6,438,599)). Accounting for only 1.8% of total injury entitlement claims, concussion/brain injuries accounted for 6.3% of injury entitlement costs and had the highest mean cost per claim ($25 347 (pound9420)). The upper and lower arm recorded the highest mean injury site claim cost of $43,096 (pound16,016) per claim. The 25-29 age group recorded 27.7% of total injury entitlement claims and 29.6% of total injury entitlement costs, which was slightly more than the 20-24 age group (27.3% claims; 24.7% costs). Nearly 15% of total moderate to serious injury entitlement claims and 20% of total costs were recorded from participants 35 years or older. DISCUSSION: This study identified that the knee was the most common injury site and soft tissue injuries were the most common injury type requiring medical treatment, which is consistent with other international studies on rugby league epidemiology. This study also highlights that the rate of injury and the average age of injured rugby league players increased over time. The high cost of concussion/brain injuries is a cause for concern as it reflects the severity of the injuries. CONCLUSION: Injury prevention programmes for rugby league should focus on reducing the risk of concussion/brain injury and knee and soft tissue injury, and should target participants in the 20-30 years old age range. More longitudinal epidemiological studies with specific details on injury mechanisms and participation data are warranted to further identify the injury circumstances surrounding participation in rugby league activities.

Determining rigid body transformation parameters from ill-conditioned spatial marker co-ordinates.

The three-dimensional location of a body-fixed axis system is described by position and orientation parameters that can be calculated knowing local and global coordinates of three or more body-fixed markers. However, marker distribution can become ill-conditioned when marker placement is symmetrical with respect to the mean of the markers. As symmetry and ill-conditioning increases, random errors in marker locations can affect the stability of orientation parameters as a result of the mathematical approach adopted. The present study investigates the methods of Veldpaus et al. [1988; Journal of Biomechanics 21, 45], Challis [1995; Biomechanics 28, 733] and Andriacchi et al. [1998; Journal of Biomedical Engineering 120, 743] for obtaining segment orientation parameters when segment markers ranged from well-defined to highly ill-conditioned depending on the symmetry of segment markers. A novel fourth approach is also presented that enabled comparisons of the root mean square error of reconstructed marker coordinates to verify that an optimal solution was obtained. No single method produced optimal results for all axis orientation parameters when reconstructing movement trials. The best performed was the method of Veldpaus et al. [1988; Journal of Biomechanics 21, 45] based on consistent results and ease of implementation. The fourth approach presented provided a reliable method in all but the highly ill-conditioned markers, however implementation was computationally difficult. The method of Challis [1995; Biomechanics 28, 733] was only suited to well-conditioned marker sets which avoided markers lying in a single plane with symmetries in marker distribution relative to the mean. The method of Andriacchi et al. [1998; Journal of Biomedical Engineering 120, 743] produced, at best, orientation parameters that approximated the results obtained by least squares methods.

Dynamic coordinate data for describing muscle-tendon paths: a mathematical approach.

When modelling the musculoskeletal system over a range of joint angles the use of fixed points to describe muscle-tendon paths has inherent limitations. These result in fewer deflection points and the use of effective insertions to accommodate both relative marker movement and avoid muscle paths contacting bony structures. Model performance is dependent on the joint angle relative to the anatomical position where the muscle-tendon paths were defined. The present study proposes a scheme for the implementation of dynamic coordinates for describing muscle-tendon paths. For each muscle-tendon element a plane is defined in which the muscle-tendon complex acts when crossing a given joint. The muscle-tendon plane is dependent on 3D segment orientations and describes one degree of freedom, while the remaining two degrees of freedom are described by polar coordinates and locate the dynamic point in the muscle-tendon plane. The dynamic approach is implemented on four muscles of the lower limb in modelled and simulated joint movements and offers a significant improvement on previous approaches based on fixed deflection points. The scheme accommodates compound 3D rotations about joint axes, is not computationally difficult or require large data sets, and does not impose limitations on the number of points that may be defined along a muscle-tendon path.

Proteolysis of human hemoglobin by schistosome cathepsin D.

Schistosomes feed on human blood. They employ proteases to degrade hemoglobin from ingested erythrocytes, using the residues released for amino acid metabolism. However, the identity and the role of the participating protease(s) are unclear and controversial. Confocal microscopy localized schistosomal cathepsin D to the parasite gastrodermis, and revealed elevated protease expression in females. At sub-cellular level, cathepsin D was localized to superficial digestive vacuoles of the gut and to cisternae of the gastrodermal rough endoplasmic reticulum. Schistosome cathepsin D, expressed in insect cells, autoactivated at pH 3.6 to a approximately 40 kDa form that cleaved the substrates o-aminobenzoyl-Ile-Glu-Phe-nitroPhe-Arg-leu-NH(2) and hemoglobin. The NH(2)-terminal residues of mature cathepsin D of Schistosoma japonicum and Schistosoma mansoni were Asn1 and Gly1, respectively, revealing that the proregion peptide was comprised of 35 residues. The proteases cleaved hemoglobin at pH 2.5--4.6, releasing numerous fragments. S. Japonicum cathepsin D cleaved at 13 sites, S. mansoni cathepsin D at 15 sites. Early cleavage sites were alpha Phe33-Leu34 and beta Phe41-Phe42, while others included alpha Leu109-Ala-110 and beta Leu14-Trp15, demonstrating a preference for bulky hydrophobic residues at P1 and P1'. Most of the schistosomal cathepsin D cleavage sites were discrete from those of human cathepsin D. The gastrodermal location, elevated expression in females, acidic pH optima, similar substrate preferences in two species, and the discrete substrate preferences compared with human cathepsin D together provide compelling support for the hypothesis that schistosomal cathepsin D plays an integral role in hemoglobin proteolysis, and might be selectively targeted by drugs based on protease inhibition.

A pharmacological and biochemical investigation of the venom from the platypus (Ornithorhynchus anatinus).

In this study several activities of the venom of Ornithorhynchus anatinus have been investigated. Whole venom induced local oedema after subplantar injection and produced relaxation of the rat uterus in vitro. The relaxant activity was partially purified by gel permeation HPLC and subsequent analyses by SDS-PAGE revealed that this activity was associated with a 4200 mol. wt peptide. The N-terminal partial sequence of this peptide exhibited substantial identity with human and porcine C-type natriuretic peptide (CNP). Three other major proteins isolated from the venom had mol. wts of 140,000, 55,000 and 16,000. None was found to have any sequence homology with proteins listed in the SwissProt database. The 140,000 mol. wt protein exhibited hyaluronidase activity but the nature of the 55,000 and 16,000 mol. wt proteins remains to be determined. Platypus venom also exhibits protease activity, although the concentration of proteolytic enzymes was too low to be visualised by SDS-PAGE using Coomassie staining.

The natriuretic peptide (ovCNP-39) from platypus (Ornithorhynchus anatinus) venom relaxes the isolated rat uterus and promotes oedema and mast cell histamine release.

In this study we characterise the ability of a C-type natriuretic peptide from platypus (Ornithorhynchus anatinus) venom (ovCNP-39) to relax the rat uterus in vitro and we investigate the possibility that ovCNP-39 contributes to the acute effects of envenomation, which include oedema, pain and erythema. We have found that both ovCNP-39 and the endogenous C-type natriuretic peptide, CNP-22, produce oedema in the rat paw and release histamine from rat peritoneal mast cells. Two synthetic peptides, ovCNP-39(1-17) and ovCNP-39(18-39), corresponding to the N- and C-termini, respectively, are equipotent histamine releasers, suggesting that ovCNP-39 and other natriuretic peptides do not act through conventional natriuretic peptide receptors on mast cells.

Biomechanics of rugby union scrummaging. Technical and safety issues.

In the game of ruby union, the scrum epitomises the physical nature of the game. It is both a powerful offensive skill, affording a base for attacking play, and a defensive skill in denying the opposition clean possession. However, the scrum has also been implicated in a large proportion of serious spinal injuries in rugby union. The majority of injuries are found to occur at engagement where the forces experienced by front-row players (more than two-thirds of a tonne shared across the front-row) can exceed the structural limits of the cervical spine. These large forces are a consequence of the speed of engagement and the weight (and number) of players involved in the scrum. This highlights not only the need for physical preparation of all forwards but particularly player restraint at engagement, and justifies the 'crouch-pause-engage' sequence recently introduced to 'depower' the scrum. As the hooker is the player exposed to the greatest loads throughout the scrum and subsequently most at risk, he should determine the timing of engagement of the 2 front-rows. Stability of the scrum is an indication of front-row players' ability to utilise their strength to transmit the force to their opponents as well as the push of second-row and back-row players behind them in the scrum. This appears to be independent of the size of players. Equally, it reflects the risk of chronic degeneration of the musculoskeletal system through repeated exposure to these large stresses. However, not only are older and more experienced players better able to generate and transmit these forces, they are also able to maintain the integrity of the scrum. A large proportion of individual players' efforts to generate force is lost in their coordinated effort in a normal scrum. It is assumed these forces are dissipated through players re-orientating their bodies in the scrum situation as well as to less efficient shear forces and to the elastic and compressive tissues in the body. It again reinforces the importance of physical preparation for all forwards to better withstand the large forces involved in scrummaging. Despite negative publicity surrounding the risk of serious spinal injury in rugby union, limited research has been conducted to examine either the mechanisms of injury or techniques implicated in causing injury. Biomechanical information can provide systematic bases for modifying existing techniques and assessing the physical capacities necessary to efficiently and safely play in the serum. This will both improve performance of game skills and minimise the potential for injury.

Shoe-surface interaction and the reduction of injury in rugby union.

While it is quite clear that footwear can provide protection against lower limb injury in running and some court sports, the literature related to footwear design and injury prevention in most sports played on natural turf is limited. Nowhere is this more apparent than in the design of footwear for rugby union and rugby league. Therefore, in this article, information from other sporting codes will be applied to the design and performance characteristics of footwear and surfaces in an attempt to understand the causes of equipment-related injuries in rugby. A complete understanding of the complex interactions between the leg, foot, footwear and the surface has not yet been achieved and as a consequence, precise footwear design criteria to minimise injury, while not compromising the performance aspects of shoe design, have yet to be established. The variable surface conditions experienced by players makes it difficult to provide recommendations as to the ideal footwear for all (or any) conditions. Equally, the ground reaction loads experienced by each player (and playing position) vary sufficiently to make generalisations difficult. Also the foot-fall pattern during weight-bearing is highly individualised and further prohibits making general recommendations about selecting footwear for rugby.

Summation of segmental velocities in the golf swing.

The downswing phase in golf was represented as a double pendulum pivoted at the shoulder joint and hinged at the wrist. The motion of such a pendulum was used to derive a series of equations which were used to describe the instantaneous values of several of the component features of the downswing. Results of this analysis showed that an initial delay in the uncocking of the wrist would allow (a) acceleration of the arm to reach a greater value and (b) the acceleration of the club to be summed with the existing maximum angular acceleration of the proximal segment.

Conjugate imagery in the automated reproduction of three dimensional coordinates from two dimensional coordinate data.

The three-dimensional video analysis of human motion commonly utilises automated image processing and digitisation processes to produce real-time unidentified two-dimensional coordinate data of segmental markers. In what can be a time-consuming process the two-dimensional data are then identified and tracked to produce three-dimensional coordinates. This paper presents an approach to the automated reproduction of three-dimensional coordinates from two-dimensional coordinates data. Conjugate imaging techniques were utilised in the development of four criterion measures for determining the validity of conjugate (corresponding) image points. An algorithm based on the criterion measures was then developed for the automated reproduction of three dimensional coordinates from camera image coordinate data. The algorithm was tested with a 55 point marker system viewed in four video cameras (digitisation error approx. 0.2%, lab point separation > or = 6 cm). The success of the algorithm was dependent on the closeness of markers, the accuracy of the photogrammetric system, and the number of markers visible in two camera images. The present research has developed techniques based on conjugate imagery for the automated reproduction of three-dimensional coordinates from two-dimensional data, and provided a bases for further development of automated three-dimensional tracking.

Selective flocculation of nucleic acids, lipids, and colloidal particles from a yeast cell homogenate by polyethyleneimine, and its scale-up.

Nucleic acids, lipid, and colloidal particulate material can be selectively flocculated from a yeast cell homogenate by the cationic polymer polyethyleneimine (PEI). Flocculation can occur from a crude homogenate, a homogenate clarified centrifugally, or by the prior use of sodium tetraborate (borax). Flocculation from a homogenate previously clarified by the use of borax is best suited for large-scale operation. The supernatant obtained following centrifugation is effectively free of nucleic acid, lipid, and particulate material with essentially 100% soluble enzyme recovery. Enzyme specific activity increases by approximately 45% compared to a zero PEI control.

Impact of atrazine-bearing agricultural tile drainage discharge on planktonic drift of a natural stream.

Preliminary results are reported from a co-operative study between Agriculture Canada and Environment Canada on environmental impacts of atrazine measured in a field stream receiving agricultural drainage. Systematically, tile drained plots of known crop rotation, area, flow and pesticides use were used in the study. A maximum tile drainage concentration of 13.9 microg liter(-1) atrazine was measured while the maximum measured stream concentration was 1.89 microg liter(-1). Phytoplankton and zooplankton samples were collected on a bi-monthly basis during the growing season. The study indicated possible negative impacts of low concentrations of atrazine on planktonic drift populations, when natural stream flow was reduced, resulting in a lower dilution capacity. A 20 m section of the stream was affected by the tile drainage waters as measured by the resident biological community. Both atrazine and ambient environmental conditions were felt to be contributing to the measured results. No negative impacts on planktonic drift populations were evident beyond 50 m downstream of the tile drainage and stream confluence.

A C-type natriuretic peptide from the venom of the platypus (Ornithorhynchus anatinus): structure and pharmacology.

A peptide which relaxes rat uterine smooth muscle and exhibits homology with the mammalian C-type natriuretic peptide (CNP) has previously been identified in platypus (Ornithorhynchus anatinus) venom from its partial N-terminal amino acid sequence. In this study we describe the purification, detailed structure, synthesis and pharmacological characteristics of this peptide, which has been designated ovCNP-39 (Ornithorhynchus venom C-type natriuretic peptide). Elucidation of the 39-residue amino acid sequence confirms the homology with mammalian CNPs. These peptides produce hypotension in vivo and relax smooth muscle in vitro, but are poorly characterised in terms of physiological function. ovCNP-39 is equipotent with human/rat/porcine CNP-22 in eliciting cyclic guanosine 5'-monophosphate (cGMP) elevation in cultured vascular smooth muscle cells, suggesting that, like CNP, it acts through the ANPB natriuretic peptide receptor subtype. The direct elevation of cGMP in vascular smooth muscle by ovCNP-39 may underlie the vasodilatory effects of platypus envenomation.

Reproducibility of knee laxity assessment results using the dynamic cruciate tester.

The purpose of the study was to examine reproducibility of knee laxity measurements obtained using the Dynamic Cruciate Tester (DCT) from day-to-day, set-to-set, and trial-to-trial. In Part I, peak anterior tibial translation (ATT) was assessed for 1 anterior cruciate ligament (ACL) deficient and 16 control subjects during two sets of three active trials (maximal isometric quadriceps contractions) and three passive trials (240 N load) conducted over four consecutive days. In Part II, peak ATT was recorded for 12 chronic ACL deficient subjects during one set of five active and five passive trials within one day. Results were analysed using mixed repeated measures ANOVA designs with intraclass reliability coefficients (ICC) calculated from the ANOVA results. There were no significant differences in the mean peak ATT results among the four tests days or between the two test sets conducted within a day, with ICC ranging from R1 = 0.939 to 0.980. It was concluded peak ATT measurements obtained using the DCT were reproducible from day-to-day and set-to-set. A significant main effect of trial was found on both active (F(2,32) = 13.93; p < 0.001) and passive (F(2,32) = 57.21; p < 0.001) peak ATT results. It was therefore recommended a full pretrial should be conducted before knee laxity assessment using the DCT to ensure reproducible results.

The nature and circumstances of tackle injuries in rugby union.

This study describes the nature and circumstances of injury occurring in rugby union tackles (33% of 569 injury events) using data from the Rugby Injury and Performance Project (RIPP) and provides supplementary information on the nature of tackles involving injury from analysis of videotape of tackle injury events. The most common tackle injuries in the RIPP data were sprains/strains (41%) followed by haematomas/bruising (26%). The most frequently injured body sites were the head/neck/face (22%) and the knee (17%). The ball carrier and tackler were injured in tackles in similar proportions in both RIPP and New Zealand Rugby Football Union (NZRFU) video tackle incidents. Both players were most often in motion in the tackle at the time of injury with approximately 70% of injuries occurring when the injured player was running or diving/falling to the ground. Tackle injury was most often caused by impact with another player rather than impact with the ground. The use of protective padding may reduce the risk of impact injury. The majority of tackle injuries were associated with stopping tackles to the trunk which were from the front (63%), rather than from the side or behind. Thus consideration should be given to coaching strategies or to rule changes which reduce the likelihood or prohibit front-on tackles.

Iatrogenic contact dermatitis to proparacaine: an ophthalmic topical anesthetic.

Allergic contact dermatitis to a topical ophthalmic anesthetic, proparacaine, is reported in a patient with refractory glaucoma. His ophthalmologist routinely used a preparation containing this anesthetic, which is an uncommon sensitizer, for measuring the patient's intraocular pressure. That the patient did not apply the medication himself resulted in added difficulty in discovering the iatrogenically induced contact allergy. Avoidance of this anesthetic resulted in resolution of the patient's recurrent bouts of periocular dermatitis and conjunctivitis. The importance of testing patients suspected of having contact allergy to all medications to which they are exposed is emphasized.

Lumbosacral loads in bedmaking.

The purpose of this study was to determine whether the introduction of larger and heavier beds which were lower to the floor increased the physical stress on employees responsible for room cleaning and bedmaking in the hospitality industry. More specifically, this study assessed the effect of bed size (single, double and king) and bed height (460 and 560 mm) on dynamic and static estimates of L5/S1 compression force and static L5/S1 shear force for six simulated components of the overall bedmaking task. Results confirmed the view that static models severely underestimate the loads on the lumbar spine under inertial lifting conditions, and also indicated that: (i) tasks with the greatest hand loads were not necessarily associated with the greatest spinal loads due to differences in the way each task was performed; (ii) L5/S1 loads produced during bedmaking may exceed recommended safe lifting limits for certain task-size height combinations; and (iii) the use of larger and heavier beds in the hospitality industry imposes increased loads on the lumbar spine. The investigation of alternative work practices designed to minimise loads on the lumbar spine is recommended.

Training habits and injuries of masters' level football players: a preliminary report.

OBJECTIVE: To profile training habits and injuries in football players participating in a national Masters tournament. METHODS: A cross-sectional retrospective study design was used to survey male football players attending the 2008 New Zealand Masters Games. Information regarding player demographics, football injuries, football related training, and risk factors for injury were collected. RESULTS: 199 Players were recruited, with a median age of 44 yrs (range 35-73) and a median football playing history of 15 yrs (range 0-66). Irrespective of age, 112 (84%) players included a warm-up and 104 (78%) included a stretching regime in their regular training programme. In the 12 months prior to the tournament, 128 football related injuries were reported by 93 players (64 injuries/100 players or 46 injured players/100 players). The most frequently injured region was the lower limb; specifically the lower leg (n=23), ankle (n=18), hamstring (n=17), knee (n=15), and Achilles tendon (n=15). CONCLUSION: This study provides a preliminary insight into the training habits and injury profiles of Masters football players. Despite all players including some form of injury prevention strategy in their training, a significant number of players experienced an injury in the 12 months prior to the tournament.