South African professional Super Rugby players' lived experiences of career-related traumatic injuries: A descriptive phenomenological analysis.

Background: Historically, non-career-ending traumatic rugby injury (TRI) has been viewed from a predominantly biological perspective. However, dimensional perspectives, such as the biopsychosocial model, have highlighted the need to incorporate psychosocial understandings of TRI into treatment plans. Aim: To describe the lived experiences of a cohort of traumatically injured South African Super Rugby players in order to add to the body of literature on the subject of TRI experience. Methods: The employment of a qualitative, descriptive phenomenological method was used to achieve the research outcome. Discussion: Common descriptive themes indicated that TRI seems to exist within three stages: the initial, emotional and subsequent reactions to the traumatic injury. Sub-themes described within each stage included attempts at remaining positive and appraising the severity of the injury during onset, fear responses and concomitant feelings of loss related to foregone career opportunities during the emotional reactions stage, the employment of coping mechanisms, and relying on specific support structures during subsequent reactions. Two novel experiences revealed within this study and not reported in the international literature included the injured players' reliance on compartmentalisation and positive religious belief structures as coping strategies. All themes were reduced to descriptive phenomenological essences that describe a lifeworld or biopsychosocial experience of TRI. Conclusion: Themes drawn from this study can be applied in the future design and implementation of expanded studies and psychological interventions aimed at assisting traumatically injured rugby players during their recovery process. The identified themes affirm aspects from the international literature while highlighting some uniquely South African outcomes.

Addressing negative psychosocial factors linked to severe injury in professional rugby players: An introduction to a group psychotherapy approach.

Background: Negative psychosocial sequelae of severe rugby injury (SRI) in professional rugby players are well documented. Unaddressed, these issues can leave players vulnerable to persistent common mental disorders (CMD) and negatively affect injury recovery processes. Objective: To introduce a psychotherapeutic group intervention aimed at addressing negative psychosocial sequelae linked to SRI in professional rugby player cohorts. Methods: Literature aimed at clarifying the potential efficacy of an integrative group therapy model, the Recovery Mastery Group (RMG), is discussed after which component parts of the intervention are presented. Case illustration: A case illustration is presented comprising examples of how the RMG framework addressed psychosocial recovery issues in a professional South African rugby team during 2019. Conclusion: The proposed Recovery Mastery Group (RMG) is presented as a cost- and time- effective psychotherapeutic intervention that integrates well-researched psychotherapeutic techniques. The RMG appears able to address multiple facets of psychosocial injury recovery, while possibly offering protection from the onset of CMD. This introduction to the RMG can be a forerunner of similar research across larger cohorts, in different team sports, to determine wider therapeutic intervention efficacy.

A Validated Tropical-Extratropical Flood Hazard Assessment for New York Harbor.

Recent studies of flood risk at New York Harbor (NYH) have shown disparate results for the 100-year storm tide, providing an uncertain foundation for the flood mitigation response after Hurricane Sandy. Here, we present a flood hazard assessment that improves confidence in our understanding of the region's present-day potential for flooding, by separately including the contribution of tropical cyclones (TCs) and extratropical cyclones (ETCs), and validating our modeling study at multiple stages against historical observations. The TC assessment is based on a climatology of 606 synthetic storms developed from a statistical-stochastic model of North Atlantic TCs. The ETC assessment is based on simulations of historical storms with many random tide scenarios. Synthetic TC landfall rates and the final TC and ETC flood exceedance curves are all shown to be consistent with curves computed using historical data, within 95% confidence ranges. Combining the ETC and TC results together, the 100-year return period storm tide at NYH is 2.70 m (2.51-2.92 at 95% confidence), and Hurricane Sandy's storm tide of 3.38 m was a 260-year (170-420) storm tide. Deeper analyses of historical flood reports from estimated Category-3 hurricanes in 1788 and 1821 lead to new estimates and reduced uncertainties for their floods, and show that Sandy's storm tide was the largest at NYH back to at least 1700. The flood exceedance curves for ETCs and TCs have sharply different slopes due to their differing meteorology and frequency, warranting separate treatment in hazard assessments.

Crystal structure of a Pumilio homology domain.

Puf proteins regulate translation and mRNA stability by binding sequences in their target RNAs through the Pumilio homology domain (PUM-HD), which is characterized by eight tandem copies of a 36 amino acid motif, the PUM repeat. We have solved the structure of the PUM-HD from human Pumilio1 at 1.9 A resolution. The structure reveals that the eight PUM repeats correspond to eight copies of a single, repeated structural motif. The PUM repeats pack together to form a right-handed superhelix that approximates a half doughnut. The distribution of side chains on the inner and outer faces of this half doughnut suggests that the inner face of the PUM-HD binds RNA while the outer face interacts with proteins such as Nanos, Brain Tumor, and cytoplasmic polyadenylation element binding protein.

Structural basis for recognition of AU-rich element RNA by the HuD protein.

Hu proteins bind to adenosine-uridine (AU)-rich elements (AREs) in the 3' untranslated regions of many short-lived mRNAs, thereby stabilizing them. Here we report the crystal structures of the first two RNA recognition motif (RRM) domains of the HuD protein in complex with an 11-nucleotide fragment of a class I ARE (the c-fos ARE; to 1.8 A), and with an 11-nucleotide fragment of a class II ARE (the tumor necrosis factor alpha ARE; to 2.3 A). These structures reveal a consensus RNA recognition sequence that suggests a preference for pyrimidine-rich sequences and a requirement for a central uracil residue in the clustered AUUUA repeats found in class II AREs. Comparison to structures of other RRM domain-nucleic acid complexes reveals two base recognition pockets in all the structures that interact with bases using residues in conserved ribonucleoprotein motifs and at the C-terminal ends of RRM domains. Different conformations of nucleic acid can be bound by RRM domains by using different combinations of base recognition pockets and multiple RRM domains.

Nerve trunk pain: physical diagnosis and treatment.

The management of peripheral neuropathic pain or nerve trunk pain relies upon accurate differential diagnosis. In part neurogenic pain has been attributed to increased activity in, as well as to abnormal processing of non-nociceptive input from, the nervi nervorum. For neurogenic pain to be identified as the dominant feature of a painful condition there should be evidence of increased nerve trunk mechanosensitivity from all aspects of the physical examination procedure. Consistent dysfunction should be identified on key active and passive movements, neural tissue provocation tests as well as nerve trunk palpation. A local cause for the neurogenic pain disorder should also be identified if the condition is to be treated by manual therapy. A treatment approach is presented which has been shown to have efficacy in the relief of pain and restoration of function in cervicobrachial pain disorders where there is evidence according to the outlined examination protocol of nerve trunk pain.

Sonic hedgehog protein signals not as a hydrolytic enzyme but as an apparent ligand for patched.

The amino-terminal signaling domain of the Sonic hedgehog secreted protein (Shh-N), which derives from the Shh precursor through an autoprocessing reaction mediated by the carboxyl-terminal domain, executes multiple functions in embryonic tissue patterning, including induction of ventral and suppression of dorsal cell types in the developing neural tube. An apparent catalytic site within Shh-N is suggested by structural homology to a bacterial carboxypeptidase. We demonstrate here that alteration of residues presumed to be critical for a hydrolytic activity does not cause a loss of inductive activity, thus ruling out catalysis by Shh-N as a requirement for signaling. We favor the alternative, that Shh-N functions primarily as a ligand for the putative receptor Patched (Ptc). This possibility is supported by new evidence for direct binding of Shh-N to Ptc and by a strong correlation between the affinity of Ptc-binding and the signaling potency of Shh-N protein variants carrying alterations of conserved residues in a particular region of the protein surface. These results together suggest that direct Shh-N binding to Ptc is a critical event in transduction of the Shh-N signal.

Crystal structure of a Hedgehog autoprocessing domain: homology between Hedgehog and self-splicing proteins.

The approximately 25 kDa carboxy-terminal domain of Drosophila Hedgehog protein (Hh-C) possesses an autoprocessing activity that results in an intramolecular cleavage of full-length Hedgehog protein and covalent attachment of a cholesterol moiety to the newly generated amino-terminal fragment. We have identified a 17 kDa fragment of Hh-C (Hh-C17) active in the initiation of autoprocessing and report here its crystal structure. The Hh-C17 structure comprises two homologous subdomains that appear to have arisen from tandem duplication of a primordial gene. Residues in the Hh-C17 active site have been identified, and their role in Hedgehog autoprocessing probed by site-directed mutagenesis. Aspects of sequence, structure, and reaction mechanism are conserved between Hh-C17 and the self-splicing regions of inteins, permitting reconstruction of a plausible evolutionary history of Hh-C and the inteins.

A potential catalytic site revealed by the 1.7-A crystal structure of the amino-terminal signalling domain of Sonic hedgehog.

Within the past few years, members of the hedgehog (hh) family of secreted signalling proteins have emerged as the primary signals generated by certain embryonic patterning centres. In vertebrate embryos, for example, sonic hedgehog expression in the notochord appears to be responsible for the local and long-range induction of ventral cell types within the neural tube and somites (reviewed in refs 1, 2). Protein products encoded by hh family members are synthesized as precursors that undergo autoprocessing to generate an amino-terminal domain that appears to be responsible for both local and long-range signalling activities, and a carboxy-terminal domain that contains the autoprocessing activity. As part of an effort to understand how hh family members participate in cell-to-cell signalling, we have determined and report here the crystal structure at 1.7 A of the amino-terminal domain of murine Sonic hedgehog (Shh-N). The structure revealed a tetrahedrally coordinated zinc ion that appears to be structurally analogous to the zinc coordination sites of zinc hydrolases, such as thermolysin and carboxypeptidase A. This previously unsuspected catalytic site represents a distinct activity from the autoprocessing activity that resides in the carboxy-terminal domain.

Schistosoma mansoni: molecular cloning and sequencing of the 200-kDa chemotherapeutic target antigen.

Praziquantel is the drug of choice for human schistosomiasis. The efficacy of this drug is impaired in immune-deficient mice. However, transfer to B cell-depleted mice of a monoclonal antibody that recognizes a 200-kDa GPI-anchored glycoprotein of S. mansoni restores the effectiveness of praziquantel. In order to characterize this target antigen, we have isolated and sequenced cDNA clones encoding the 200-kDa protein. Three overlapping cDNA clones contained the complete nucleotide sequence. The sequences of five tryptic peptides from the native 200-kDa protein could be matched with regions in the amino acid sequence deduced from the nucleotide sequence of the isolated clones. This deduced amino acid sequence differed from sequences available in six databases. Praziquantel exposes epitopes on the worm surface that are normally not exposed, and we have shown by immunofluorescent staining that the fusion protein encoded by one of our cDNA clones expresses epitopes that are exposed on the surface of praziquantel-treated worms.

Birth defects surveillance: Jefferson County, Alabama, and Uppsala County, Sweden.

Birth defects in live-born infants were documented for 2 years in Jefferson County, Alabama (USA)--1986 and 1987--and in Uppsala County, Sweden--1985 and 1986. A total of 27,561 live births (9,179 white male, 8,728 white female, 4,883 black male, and 4,771 black female infants) occurred in Jefferson County; 6,896 live births (3,535 male and 3,361 female) were recorded in Uppsala County. These newborns were studied to establish a database of birth defects for the two small geographic areas and to study similarities and differences. Rates of hip dislocation, heart malformations, and clubfoot were high in Swedish infants. Similar frequencies of spina bifida and polydactyly were noted in Alabama whites and Swedish infants. Regional registries offer a systematic approach to detection of clustering of specific birth defects, identification of families for further study, location of patients with unique needs, and enhanced coordination of health services, including genetic counseling.

Characterization of the calcitonin/CGRP gene in Williams syndrome.

We have investigated the possibility of mutations in the calcitonin/calcitonin gene related peptide (CGRP) gene in children with Williams syndrome. Involvement of the calcitonin/CGRP gene in Williams syndrome is postulated on the basis that Williams syndrome children often have infantile hypercalcemia and deficient expression of calcitonin, a hormone that lowers serum calcium levels. To test the hypothesis that mutations in the calcitonin/CGRP gene might be responsible for the reduced calcitonin levels, we examined the calcitonin/CGRP gene structure in Williams syndrome children. Analysis of white blood cell DNA by Southern blot hybridizations in 5 individuals did not show any detectable large deletions or rearrangements in the calcitonin/CGRP gene locus. The possibility of small deletions or point mutations within the exon encoding the mature calcitonin hormone is unlikely based on ribonuclease protection assays with patient DNA amplified by the polymerase chain reaction (PCR) technique. These findings suggest that the calcitonin deficiency might be due either to mutations elsewhere in the gene or to defects in the cellular machinery needed for calcitonin synthesis and/or secretion.

Injuries and illnesses aboard research vessels of the University National Oceanographic Laboratory System.

The University National Oceanographic System operates a fleet of vessels to carry out its scientific projects. Illnesses and injuries at sea are handled by first responders aboard the vessels in consultation with land-based physicians at a telecommunications response center in the United States. During the period 1985 to 1987, 122 cases among regular and scientific crew required medical consultation by telecommunications. Of these, 31% were injuries, 34% were medical cases (infected), 12% were sexually transmitted diseases, and 23% were medical cases (noninfected). Evacuation from the vessel, vessel diversion, or repatriation of the patient was required for 20% of all cases; of these, 48% were for injuries, 36% for noninfected medical illnesses, and 16% for infected medical cases. Rates of illness and injury were calculated using the crew days at sea as a denominator.

Basic elements of maritime health care.

The goal is to do everything possible to facilitate the captain-patient relationship so that the patient receives the best care possible. As the MTRC consults on medical problems at sea, a data base is generated relative to specific medical problems, preferred treatment modalities, medical facilities available in various ports around the world, availability and safety of evacuation services, and epidemiologic and occupational medicine data. This cumulative body of information can be relayed to all companies on an industry-wide basis. The data can be used to generate recommendations for the contents of a ship's medicine chest (including those supplies that are necessary and those that are not necessary). A secondary benefit of this system is that the medical staff in the MTRC knows in advance the ship's medicine chest inventory. Thus, valuable time is not lost asking the captain to check on the availability of a medication or supply. An MTRC is ideally situated to discern occupational patterns of disease that might be related to a certain port of call or a certain rating aboard ship. This information can be shared with company officials and seafarers who otherwise might not have ready access to it. The availability of a central storage site for medical records is important because of the high degree of mobility of the patient population. The medical record should be easily accessible to medical professionals, with the consent of the patient. An MTRC is a logical respository for medical records because around-the-clock availability of the medical record is particularly important for the medical staff when advising treatment for the patient at sea.(ABSTRACT TRUNCATED AT 250 WORDS)