Sport-related concussion return-to-play practices of medical team staff in elite football in the United Kingdom.

INTRODUCTION: This study explored sport-related concussion (SRC) return-to-play (RTP) behaviours and attitudes of medical team staff working in elite football in the United Kingdom. Usage and awareness of The Football Association (FA) guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. Additionally, confidence in managing RTP post-SRC, perceived player under-reporting of symptoms, use of enhanced RTP pathways, and coaching pressure on RTP were investigated. METHODS: A cross-sectional questionnaire study was distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. RESULTS: A total of 112 responses were gathered. High awareness rates of the FA guidelines were found (96%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 80% of respondents with 93% feeling very confident or confident in managing the RTP of a player with a SRC. 60% rarely or never experienced coaching pressure around player RTP, and 24% felt players always or very often under-reported symptoms to expedite their return. 90% had a moderate to high confidence in the Sport Concussion Assessment Tool-5 (SCAT-5) as a RTP decision tool, and 66% always or very often used an enhanced RTP pathway. CONCLUSION: Confidence in managing player RTP post SRC and use of enhanced RTP pathways were high, as was confidence in the SCAT-5 as a RTP decision tool. Respondents raised concerns around player under-reporting of symptoms to accelerate RTP post-SRC, and perceived coaching pressure around decision making.

Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study.

OBJECTIVES: To explore sport-related concussion (SRC) awareness, behaviours, and attitudes of medical team staff working in elite football in the United Kingdom. Including usage and awareness of the FA concussion guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. METHODS: Cross-sectional questionnaire study distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. RESULTS: 120 responses were gathered. High awareness rates of the FA guidelines were found (97%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 78%. Of those, 99% collected SCAT5 with low rates of other neuro-psychometric testing (17%). Confidence of pitch-side SRC recognition was high (93% feeling very confident or confident). Introduction of a 'concussion' substitute was seen as strongly positive for player welfare (85% strongly agreeing or agreeing). CONCLUSIONS: Awareness of FA concussion guidelines, and collection of SCAT5 baseline testing was high. Player and coaching staff concussion education rates were low, as was the use of neuro-psychometric testing beyond the use of the SCAT5. There was strong support the introduction of a 'concussion' substitute being a positive thing for player welfare.

Rare case of adult-onset phalangeal microgeodic syndrome of the feet.

Phalangeal microgeodic syndrome (PMS) is a rare condition typically affecting children and is characterised by painful digits precipitated by cold temperatures. In medical literature, cases appear to be clustered in Japan. Adult-onset PMS is particularly rare and although imaging features are characteristic, it may go undiagnosed, as it is not commonly encountered. We present, to our knowledge, the fifth reported case in the literature of adult PMS, the second to affect the feet rather than hands, and the first in a Caucasian adult patient. This case report aims to raise awareness of this likely underdiagnosed condition to allow optimal management and avoidance of unnecessary diagnostic procedures.

Understanding the plasticity of the alpha/beta hydrolase fold: lid swapping on the Candida antarctica lipase B results in chimeras with interesting biocatalytic properties.

The best of both worlds. Long molecular dynamics (MD) simulations of Candida antarctica lipase B (CALB) confirmed the function of helix alpha5 as a lid structure. Replacement of the helix with corresponding lid regions from CALB homologues from Neurospora crassa and Gibberella zeae resulted in new CALB chimeras with novel biocatalytic properties. The figure shows a snapshot from the MD simulation. The Candida antarctica lipase B (CALB) has found very extensive use in biocatalysis reactions. Long molecular dynamics simulations of CALB in explicit aqueous solvent confirmed the high mobility of the regions lining the channel that leads into the active site, in particular, of helices alpha5 and alpha10. The simulation also confirmed the function of helix alpha5 as a lid of the lipase. Replacing it with corresponding lid regions from the CALB homologues from Neurospora crassa and Gibberella zeae resulted in two new CALB mutants. Characterization of these revealed several interesting properties, including increased hydrolytic activity on simple esters, specifically substrates with C(alpha) branching on the carboxylic side, and much increased enantioselectivity in hydrolysis of racemic ethyl 2-phenylpropanoate (E>50), which is a common structure of the profen drug family.

GPs' knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England.

BACKGROUND: Physical activity (PA) brief advice in health care is effective at getting individuals active. It has been suggested that one in four people would be more active if advised by a GP or nurse, but as many as 72% of GPs do not discuss the benefits of physical activity with patients. AIM: To assess the knowledge, use, and confidence in national PA and Chief Medical Officer (CMO) health guidelines and tools among GPs in England. DESIGN AND SETTING: Online questionnaire-based survey of self-selecting GPs in England that took place over a 10-day period in March 2016. METHOD: The questionnaire consisted of six multiple-choice questions and was available on the Doctors.net.uk (DNUK) homepage. Quotas were used to ensure good regional representation. RESULTS: The final analysis included 1013 responses. Only 20% of responders were broadly or very familiar with the national PA guidelines. In all, 70% of GPs were aware of the General Practice Physical Activity Questionnaire (GPPAQ), but 26% were not familiar with any PA assessment tools, and 55% reported that they had not undertaken any training with respect to encouraging PA. CONCLUSION: The majority of GPs in England (80%) are unfamiliar with the national PA guidelines. Awareness of the recommended tool for assessment, GPPAQ, is higher than use by GPs. This may be because it is used by other clinical staff, for example, as part of the NHS Health Check programme. Although brief advice in isolation by GPs on PA will only be a part of the behaviour change journey, it is an important prompt, especially if repeated as part of routine practice. This study highlights the need for significant improvement in knowledge, skills, and confidence to maximise the potential for PA advice in GP consultations.

Diagnosis and management of intersection syndrome as a cause of overuse wrist pain.

Wrist pain due to repetitive motion or overuse is a common presentation in primary care. This case reports the rare condition of intersection syndrome as the cause of the wrist pain in an amateur tennis player. This is a non-infectious, inflammatory process that occurs where tendons in the first extensor compartment intersect the tendons in the second extensor compartment. Suitable history and examination provided the diagnosis, which was confirmed by MRI. Management consisted of early involvement of the multidisciplinary team, patient education, workplace and sporting adaptations, rest, analgesia, reduction of load, protection and immobilisation of the affected joint followed by a period of rehabilitation.

Evaluation of the potential of fungal and plant laccases for active-packaging applications.

Laccases from Trametes versicolor (TvL), Myceliophthora thermophila (MtL), and Rhus vernicifera (RvL) were investigated with regard to their potential utilization as oxygen scavengers in active packages containing food susceptible to oxidation reactions. The substrate selectivity of the laccases was investigated with a set of 17 reducing substrates, mainly phenolic compounds. The temperature dependence of reactions performed at low temperatures (4-31 °C) was studied. Furthermore, the laccases were subjected to immobilization in a latex/clay matrix and drying procedures performed at temperatures up to 105 °C. The results show that it is possible to immobilize the laccases with retained activity after dispersion coating, drying at 75-105 °C, and subsequent storage of the enzyme-containing films at 4 °C. TvL and, to some extent, MtL were promiscuous with regard to their reducing substrate, in the sense that the difference in activity with the 17 substrates tested was relatively small. RvL, on the other hand, showed high selectivity, primarily toward substrates resembling its natural substrate urushiol. When tested at 7 °C, all three laccases retained >20% of the activity they had at 25 °C, which suggests that it would be possible to utilize the laccases also in refrigerated food packages. Coating and drying resulted in a remaining enzymatic activity ranging from 18 to 53%, depending on the drying conditions used. The results indicate that laccases are useful for active-packaging applications and that the selectivity for reducing substrates is an important characteristic of laccases from different sources.