Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C-spine rule.

PURPOSE: Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. Finally, we introduced the modified Canadian C-spine rule. METHODS: A prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model. RESULTS: Data from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71-0.81)], 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively. CONCLUSIONS: The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments.

Developing a national road traffic safety education program in Iran.

BACKGROUND: Education is a pivot included Decade of Action for Road Safety initiative, which has reduced deaths caused by accidents in developed countries. Given the circumstances of each country, a proper education program is necessary. Thus, the aim of this study was to develop the National Road Traffic Safety Education Program (NRTSEP) and reduce Road Traffic Injuries (RTIs). METHODS: This study used a qualitative approach and was conducted in Iran. Data were obtained through sixteen semi-structured in-depth interviews from indifferent road safety and health promotion field experts as well as eleven focus group discussion (FGD) sessions conducted with participants from general population. Inductive qualitative content analysis was used to converge and compare themes through data. The initial pattern of the program was developed and subsequently, the designed program was validated and finalized by two-step Delphi method for the consensus of expert opinion. RESULTS: The following six main themes emerged from the analysis: target groups, program content, educational methods, instructors, resources and evaluation. The target group consisted of children, youth, parents, teachers, elderly, motorcyclists, cyclists, pedestrians, drivers, driver license applicants, instructors and administrators of driving schools, and specific groups such as the disabled, managers at different levels, and policymakers. The content of the program consisted of 27 items, including traffic laws and regulations, first aid, and medical emergencies. Educational practices and authorities were determined based on the target group and educational content. The most important resources of the program were human force and other cases, which can be managed in case of a lead agency. In the evaluation dimension, the cases such as mortality rate, hospitalization, behavioral changes, and other cases can be considered. CONCLUSIONS: The designed program should be implemented for all target groups for road safety promotion. The proper content was provided with proper educational methods and instructors for the target groups. A lead agency is needed to provide the resources and funding to run the program.

The effect of intravenous tranexamic acid on preventing the progress of cerebral hemorrhage in patients with brain traumatic injuries compared to placebo: A randomized clinical trial.

Background: Head trauma is one of the common reasons for patient attendance in the emergency ward. This study investigated the effect of tranexamic acid as a cheap, easily available antifibrinolytic drug on reducing the progress of cerebral hemorrhage compared to placebo. Methods: This double-blind controlled clinical trial was performed on 120 traumatized patients presenting to the emergency room of Shahid Rahnemoon hospital during 2014-2015, Yazd, Iran. Those patients who met the inclusion criteria were randomly allocated into 2 groups. Group A received tranexamic acid, while group B received placebo parenterally. Finally, 56 patients in Group A and 44 in Group B were analyzed. The patients underwent brain CT scan and were followed up for ICU stay in days. Also, the number of patients who died during the first 7 days of hospitalization was recorded. The data were analyzed with SPSS20 using independent samples t test and chi-square test. Results: The mean age of the patients was 41±20.27 years. Also, 20 patients (20%) were female and 80 were male (80%). There was no significant difference between the drug group and placebo group in the rate of hemorrhage volume progress (p=0.824). Regarding patients' ICU stay, the ICU stay of the tranexamic acid group decreased significantly compared to the placebo group (p=0.001). No significant difference was found between the intervention group and placebo group in the mortality rate of patients during the first 7 days of hospitalization (p=0.236). Conclusion: Tranexamic acid has no effect on reducing cerebral hemorrhage volume in patients. Although this drug was not effective in reducing mortality rate in patients, it decreased their ICU stay.

The Efficacy of Propofol vs. Subcutaneous Sumatriptan for Treatment of Acute Migraine Headaches in the Emergency Department: A Double-Blinded Clinical Trial.

BACKGROUND: In this double-blinded, randomized trial, we hypothesized that propofol is as effective as sumatriptan in treating acute migraine headaches, with better control of nausea and vomiting, and fewer side effects. METHODS: Ninety cases of acute migraine attack admitted to the emergency department were randomly allocated into two treatment groups: (1) 6 mg of sumatriptan subcutaneously or (2) propofol injected intravenously in 30 to 40 mg boluses, followed by 10 to 20 mg intermittent bolus doses to sedate the patients to Ramsey score of 3 to 4. Headache severity was assessed using an 11-point visual analog scale before treatment and 30 minutes, 1 hour, and 2 hours after treatment. Accompanying symptoms, improvement in headache, and the need for anti-emetic therapy were also assessed. RESULTS: A total of 91 patients were enrolled in this study. One patient in the sumatriptan group was excluded due to severe chest tightness, and 90 patients were included in the final analysis. Pain intensity was significantly lower in the propofol group 30 minutes after treatment (P = 0.001); however, after 1 and 2 hours, there were no significant differences between the groups. The need for anti-emetic therapy and the recurrence of symptoms were significantly lower in the propofol group (P = 0.045 and P = 0.001, respectively). CONCLUSION: Propofol is equally suitable as sumatriptan for the acute treatment of migraine headaches in an emergency department setting. Moreover, the use of propofol avoids some of the adverse side effects of sumatriptan while providing better control of nausea and vomiting.

Diagnostic and Prognostic Values of S100B versus Neuron Specific Enolase for Traumatic Brain Injury; a Systematic Review and Meta-analysis.

Introduction: Traumataic brain injury (TBI) represents a significant global health burden. This systematic review delves into the comparison of S100B and Neuron-Specific Enolase (NSE) regarding their diagnostic and prognostic accuracy in TBI within the adult population. Methods: Conducted on October 21, 2023, the search identified 24 studies encompassing 6454 adult patients. QUADAS-2 and QUAPAS tools were employed to assess the risk of bias. The analyses aimed to evaluate the diagnostic and prognostic performance of S100B and NSE based on sensitivity, specificity, and area under the curve (AUC). The outcomes were detecting intracranial injury, mortality, and unfavorable outcome. Results: Pooled data analysis tended towards favoring S100B for diagnostic and prognostic purposes. S100B exhibited a diagnostic AUC of 0.74 (95% confidence interval (CI): 0.70-0.78), sensitivity of 80% (95% CI: 63%-90%), and specificity of 59% (95% CI: 45%-72%), outperforming NSE with an AUC of 0.66 (95% CI: 0.61-0.70), sensitivity of 74% (95% CI: 53%-88%), and specificity of 46% (95% CI: 24%-69%). Notably, both biomarkers demonstrated enhanced diagnostic value when blood samples were collected within 12 hours post-injury. The analyses also revealed the excellent diagnostic ability of S100B with a sensitivity of 99% (95% CI: 4%-100%) and a specificity of 76% (95% CI: 51%-91%) in mild TBI patients (AUC = 0.89 [0.86-0.91]). In predicting mortality, S100B showed a sensitivity of 90% (95% CI: 65%-98%) and specificity of 61% (95% CI: 39%-79%), slightly surpassing NSE's performance with a sensitivity of 88% (95% CI: 76%-95%) and specificity of 56% (95% CI: 47%-65%). For predicting unfavorable outcomes, S100B exhibited a sensitivity of 83% (95% CI: 74%-90%) and specificity of 51% (95% CI: 30%-72%), while NSE had a sensitivity of 80% (95% CI: 64%-90%) and specificity of 59% (95% CI: 46%-71%). Conclusion: Although neither biomarker has shown promising diagnostic performance in detecting abnormal computed tomography (CT) findings, they have displayed acceptable outcome prediction capabilities, particularly with regard to mortality.

The most important medicinal plants affecting sperm and testosterone production: a systematic review.

OBJECTIVE: Infertility, defined as the inability to conceive after one year of intercourse without the use of contraception, affects 15% of couples. Many factors, such as genitourinary tract infections, endocrine disorders, immunological factors and drug-related injuries, affect the male reproductive system and cause infertility. Due to men's fear of infertility, it is very important to pay attention to medicinal plants that are effective in male fertility. Therefore, the aim of this study was to evaluate the medicinal plants that affect sperm and testosterone production in men. METHODS: In this review, we used the following search terms, consisting of herbal medicine, traditional medicine, traditional therapies, sperm, testosterone, testicles and Iran were used to retrieve the relevant articles published in the journals indexed in the Information Sciences Institute, Science Direct, PubMed, Scopus, PubMed Central and Scientific Information Databases. We searched and used papers published between 2000 and 2020. Then, we analyzed the eligible papers. We collected and analyzed 35 papers from the databases. We selected only the articles about herbs that affect sperm and testosterone production. RESULTS: Based on the results, herbs Apium graveolens, Cinnamomum camphora, Cornus mas, Satureja khuzestanica, Withania somnifera, Fumaria parviflora, zingiber officinale, cinnamomum zeylanicum and Phoenix dactylifera are used in the male reproductive system. CONCLUSIONS: Plants can probably be useful in increasing fertility due to their antioxidant power and low side effects.

Lower extremity kinematic coupling during single and double leg landing and gait in female junior athletes with dynamic knee valgus.

BACKGROUND: Dynamic knee valgus (DKV) is a common lower extremity movement disorder among females. This study aimed to investigate kinematic couplings between lower extremity joints in female junior athletes with DKV during single and double-leg landing and gait. METHODS: Twenty-six physically active female junior athletes (10-14 years old) with DKV were recruited. Kinematic couplings between rearfoot, tibia, knee, and hip were extracted using eight Vicon motion capture cameras and two force plates. Zero-lag cross-correlation coefficient and vector coding were used to calculate kinematic couplings between joints during physical tasks. Paired t-test and Wilcoxon tests were run to find significant couplings between joint motions and coupling strengths. Bonferroni posthoc was used to determine significance with α ≤ 0.05. RESULTS: The results showed that the strongest kinematic relationship existed between rearfoot eversion/inversion and tibial internal/external rotation during all three tasks. Correlations of the rearfoot supination/pronation with tibial rotations, knee, and hip motions in sagittal, frontal, and transverse planes were very strong to strong during double-leg landing and moderate to weak during gait. A weak correlation was observed between rearfoot supination/pronation and hip adduction/abduction during single-leg landing. CONCLUSIONS: Coupling relationships between rearfoot, knee, and hip vary by the task intensity and alignment profiles in female juniors with DKV.

A League-Wide Evaluation of Factors Influencing Match Activity Profile in Elite Australian Football.

Introduction: Accurate interpretation of activity profile data requires an understanding of the variables influencing player movement during matches. Methods: Over 65,000 stints (player rotations) from all 207 matches of the 2018 Australian Football League (AFL) season were evaluated. The relative activity profile including total distance per minute (TD), high-speed running distance per minute (HSR) and Player LoadTM per minute (PL) was determined for each stint and analysed against a range of match-related, player-related and environment-related predictor variables using multivariate linear mixed modelling. Effect size statistics along with the uncertainty in the estimates (95% confidence interval) were used to interpret the findings. Results: The smallest important effects on TD, HSR, and PL were calculated as 1.5%, 5.5%, and 2.4%, respectively. Stint duration had small to moderate negative effects on TD (-6%), PL (-7.7%), and HSR (-13%), while recovery duration between stints had a small positive effect on HSR (+7%). There were moderate reductions in TD (-8%), HSR (-23%), and PL (-9.6%) in the last quarter compared to the first quarter of matches, while similar reductions existed in subsequent stints compared to the first stint in each quarter. Moderate to large differences of up to 9% in TD, 48% in HSR and 12% in PL existed between positions. The TD of less experienced players was slightly higher than their more experienced counterparts (2-3%). A 5% increase in body mass was associated with a small reduction in HSR (-5.5%). There were small reductions in TD (-2%), HSR (-10%), and PL (-3%) during the Finals Series compared to the Premiership Season. Moderate levels of rainfall during matches and higher apparent temperatures had small negative effects on TD (-2%) and HSR (-6 and -9%). The number of days break between matches, score margin, match outcome, ground hardness, ground size, and traveling for the current or the previous match had trivial effects on the activity profile. Conclusion: Player position and stage of the match (quarter) had the largest effects on match activity profile while stint duration, recovery duration, stint timing, professional experience, body mass, stage of the season, and weather conditions also had substantial effects.

Electrocardiographic Changes Following Acute Hydralazine Overdose.

Hydralazine is an FDA-approved antihypertensive agent which has been utilized for years either alone or in combination with other medications especially the beta-blockers. Hydralazine works as a direct-acting vasodilator, thereby exerting a decrease in vascular resistance and increase in intravascular volume. When overdosed, hydralazine applies its toxic effects by extending its pharmacological action, which produces hypotension, syncope, tachycardia, and nausea. However, studies and case reports of acute hydralazine toxicity and its effects on electrocardiographic changes are rare, and most of the medical literature have only highlighted its immunological side effects. In this report, we are presenting a case of acute hydralazine overdose in a young woman who ended up in CCU due to remarkably abnormal electrocardiogram and unstable hemodynamics followed by myocardial infarction.

The Effect of Hyoscine on Pain, Tenderness, and Rebound Tenderness in Patients with Appendicitis: Quasi-Interventional Study.

OBJECTIVE: To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis. METHODS: In this single-group, prospective interventional study (before-after) according to inclusion and exclusion criteria, 70 patients with pain in the right lower abdomen and typical symptoms of appendicitis were evaluated and after surgery, diagnostic accuracy was examined by pathologic results. The pain was evaluated before and after administration of hyoscine by numerical and verbal examination. Tenderness and rebound tenderness were also determined. RESULTS: The mean age of patients was 26.81±7.66. Totally, 42 patients (60%) had reduction in pain, 50 patients (71% percent) had reduction in tenderness, and 39 (55%) had reduction in rebound tenderness after treatment with the drug. A statistically significant reduction of pain and tenderness, rebound tenderness was observed in all of men after administration of hyoscine (p<0.001) but in women, the reduction of severity of tender results was only significant (p=0.002). Data analysis in women and men together showed the significant reduction of pain, tenderness, and rebound tenderness (p<0.001). CONCLUSION: According to the results, hyoscine can reduce pain, tenderness, and rebound tenderness. So, it seems that hyoscine is a good candidate for patients with appendicitis. IRCT REGISTRATION NUMBER: IRCT2015111825123N1.

The Individual and Combined Effects of Multiple Factors on the Risk of Soft Tissue Non-contact Injuries in Elite Team Sport Athletes.

Aim: Relationships between athlete monitoring-derived variables and injury risk have been investigated predominantly in isolation. The aim of this study was to evaluate the individual and combined effects of multiple factors on the risk of soft-tissue non-contact injuries in elite team sport athletes. Methods: Fifty-five elite Australian footballers were prospectively monitored over two consecutive seasons. Internal and external training load was quantified using the session rating of perceived exertion and GPS/accelerometry, respectively. Cumulative load and acute-to-chronic workload ratios were derived using rolling averages and exponentially weighted moving averages. History of injuries in the current and previous seasons was recorded along with professional experience, weekly musculoskeletal screening, and subjective wellness scores for individual athletes. Individual and combined effects of these variables on injury risk were evaluated with generalized linear mixed models. Results: High cumulative loads and acute-to-chronic workload ratios were associated with increased risk of injuries. The effects for measures derived using exponentially weighted moving averages were greater than those for rolling averages. History of a recent injury, long-term experience at professional level, and substantial reductions in a selection of musculoskeletal screening and subjective wellness scores were associated with increased risk. The effects of high cumulative loads were underestimated by ~20% before adjusting for previous injuries, whereas the effects of high acute-to-chronic workload ratios were overestimated by 10-15%. Injury-prone players, identified via player identity in the mixed model, were at > 5 times higher risk of injuries compared to robust players (hazard ratio 5.4, 90% confidence limits 3.6-12) despite adjusting for training load and previous injuries. Combinations of multiple risk factors were associated with extremely large increases in risk; for example, a hazard ratio of 22 (9.7-52) was observed for the combination of high acute load, recent history of a leg injury, and a substantial reduction in the adductor squeeze test score. Conclusion: On the basis of our findings with an elite team of Australian footballers, the information from athlete monitoring practices in team sports should be interpreted collectively and used as a part of the injury prevention decision-making process along with consideration of individual differences in risk.

Normal Variability of Weekly Musculoskeletal Screening Scores and the Influence of Training Load across an Australian Football League Season.

Aim: The sit and reach test (S&R), dorsiflexion lunge test (DLT), and adductor squeeze test (AST) are commonly used in weekly musculoskeletal screening for athlete monitoring and injury prevention purposes. The aim of this study was to determine the normal week to week variability of the test scores, individual differences in variability, and the effects of training load on the scores. Methods: Forty-four elite Australian rules footballers from one club completed the weekly screening tests on day 2 or 3 post-main training (pre-season) or post-match (in-season) over a 10 month season. Ratings of perceived exertion and session duration for all training sessions were used to derive various measures of training load via both simple summations and exponentially weighted moving averages. Data were analyzed via linear and quadratic mixed modeling and interpreted using magnitude-based inference. Results: Substantial small to moderate variability was found for the tests at both season phases; for example over the in-season, the normal variability ±90% confidence limits were as follows: S&R ±1.01 cm, ±0.12; DLT ±0.48 cm, ±0.06; AST ±7.4%, ±0.6%. Small individual differences in variability existed for the S&R and AST (factor standard deviations between 1.31 and 1.66). All measures of training load had trivial effects on the screening scores. Conclusion: A change in a test score larger than the normal variability is required to be considered a true change. Athlete monitoring and flagging systems need to account for the individual differences in variability. The tests are not sensitive to internal training load when conducted 2 or 3 days post-training or post-match, and the scores should be interpreted cautiously when used as measures of recovery.

Frequencies of HLA-A, B and DRB1 alleles in a large normal population living in the city of Mashhad, Northeastern Iran.

OBJECTIVES: The population in Iran is a genetic admixture of the ancestral Aryan and other populations neighboring Iran. Different ethnic groups in Iran show wide regional distributions for many human leukocyte antigen (HLA) alleles. Therefore, it is necessary and sensible to study the differences in HLA allele distribution in different area. We studied the HLA class I and II allele frequencies in a large unrelated healthy Iranian population from Mashhad in the Northeast region. MATERIALS AND METHODS: Five hundred unrelated healthy adult individuals borne and living in Mashhad, Northeast of Iran, were genotyped for HLA-A, B and HLA-DRB1 alleles using PCR with low resolution sequence specific primers (SSP-PCR) technique. RESULTS: A total of 14 HLA-A, 24 HLA-B and 10 HLA-DRB1 alleles were spread throughout the studied population with distinct allele frequencies. At the HLA-A locus, HLA-A*02 was found to be the most frequent allele, with a frequency of 20.9%. The most common HLA-B alleles was B*35 (16.4%). The two most common observed alleles in HLA class II alleles were DRB1*15 (20.0%) followed by DRB1*13 (16.2%). CONCLUSION: This study is the first on the HLA class I and II allele frequencies in Northeastern Iranian population living in Mashhad. Distribution of HLA-A and B loci showed some similarities with those of other Iranians. Some difference in HLA-DRB1 polymorphisms however was observed. Considering the highly mixed population of Mashhad, the finding was not unexpected.

Effects of Training Load and Leg Dominance on Achilles and Patellar Tendon Structure.

PURPOSE: Detrimental changes in tendon structure increase the risk of tendinopathies. The aim of this study was to investigate the influence of individual internal and external training loads and leg dominance on changes in the Achilles and patellar tendon structure. METHODS: The internal structure of the Achilles and patellar tendons of both limbs of 26 elite Australian footballers was assessed using ultrasound tissue characterization at the beginning and the end of an 18-wk preseason. Linear-regression analysis was used to estimate the effects of training load on changes in the proportion of aligned and intact tendon bundles for each side. Standardization and magnitude-based inferences were used to interpret the findings. RESULTS: Possibly to very likely small increases in the proportion of aligned and intact tendon bundles occurred in the dominant Achilles (initial value 81.1%; change, ±90% confidence limits 1.6%, ±1.0%), nondominant Achilles (80.8%; 0.9%, ±1.0%), dominant patellar (75.8%; 1.5%, ±1.5%), and nondominant patellar (76.8%; 2.7%, ±1.4%) tendons. Measures of training load had inconsistent effects on changes in tendon structure; eg, there were possibly to likely small positive effects on the structure of the nondominant Achilles tendon, likely small negative effects on the dominant Achilles tendon, and predominantly no clear effects on the patellar tendons. CONCLUSION: The small and inconsistent effects of training load are indicative of the role of recovery between tendon-overloading (training) sessions and the multivariate nature of the tendon response to load, with leg dominance a possible influencing factor.

Proposal of a Global Training Load Measure Predicting Match Performance in an Elite Team Sport.

Aim: The use of external and internal load is an important aspect of monitoring systems in team sport. The aim of this study was to validate a novel measure of training load by quantifying the training-performance relationship of elite Australian footballers. Methods: The primary training measure of each of 36 players was weekly load derived from a weighted combination of Global Positioning System (GPS) data and perceived wellness over a 24-week season. Smoothed loads representing an exponentially weighted rolling average were derived with decay time constants of 1.5, 2, 3, and 4 weeks. Differential loads representing rate of change in load were generated in similar fashion. Other derived measures of training included monotony, strain and acute:chronic ratio. Performance was a proprietary score derived from match performance indicators. Effects of a 1 SD within-player change below and above the mean of each training measure were quantified with a quadratic mixed model for each position (defenders, forwards, midfielders, and rucks). Effects were interpreted using standardization and magnitude-based inferences. Results: Performance was generally highest near the mean or ~1 SD below the mean of each training measure, and 1 SD increases in the following measures produced small impairments: weekly load (defenders, forwards, and midfielders); 1.5-week smoothed load (midfielders); 4-week differential load (defenders, forwards, and midfielders); and acute:chronic ratio (defenders and forwards). Effects of other measures in other positions were either trivial or unclear. Conclusion: The innovative combination of load was sensitive to performance in this elite Australian football cohort. Periods of high acute load and sustained increases in load impaired match performance. Positional differences should be taken into account for individual training prescription.

Does the recent internal load and strain on players affect match outcome in elite Australian football?

OBJECTIVES: To compare recent internal training load and strain of elite Australian football players for match outcome. DESIGN: Case study. METHODS: Load was quantified from session rating of perceived exertion (sRPE) for individual players from one team in 141 professional Australian football matches over six seasons, then averaged for players that competed for the team each week. Internal weekly-load and weekly-strain (load×monotony) was compared to recent-load and recent-strain (four-week rolling average) as a marker of training-stress balance for each player against the match outcome. Covariates for relative position of teams in the competition and days between matches were modelled. Differences were standardised (effect size; ES) and interpreted using magnitude based inferences. RESULTS: Weekly-load was likely higher for match wins (ES±90% confidence limits; 0.43±0.27), and when days-break was used as a covariate (0.45±0.27) but only possibly higher with relative ladder position covaried (RLP, 0.29±0.33). There was a possibly greater positive training-stress balance for load in wins (0.31; ±0.38) with db (0.39; ±0.39) and RLP covaried (0.27; ±0.48). There were no clear differences for strain for wins and losses or with either covariate. There was a likely greater positive training-stress balance for strain in wins (0.51; ±0.41) with days-break (0.48; ±0.41) but not RLP covaried. CONCLUSIONS: Weekly-load and a positive training-stress balance for strain were the best predictors of match success. The higher weekly-load and training-stress balance for strain highlight the conflict between maintaining the training stimulus and minimising fatigue in Australian football players between matches.

Esophageal stenting in caustic injuries: a modified technique to avoid laparotomy.

OBJECTIVE: To compare the outcomes of a modified laparoscopic intraluminal stenting with the conventional laparatomic technique in patients with esophageal caustic injuries. METHODS: A total of 103 patients with esophageal burns were included in this retrospective analysis. Patients were candidates for esophageal stenting to prevent future stenosis. According to patient preference, stenting was done with either the innovatory stent with the modified technique (52 patients) or the conventional method that required laparotomy (51 patients). The modified technique consists of placing an inflation balloon stent via laparoscopy. Overall mortality and complications after follow-up period (3 months) were compared between the two groups. RESULTS: Two perioperative mortalities were seen, one in each group. Except one patient in the modified technique, all patients returned to normal intake after 3 months of follow-up. However, five patients of the modified group and three in the conventional group developed esophageal strictures (p > 0.05). Gastric outlet obstruction was observed in three patients of the modified group and one in the conventional group (p > 0.05). DeMeester scores showed that there was no gastro-esophageal reflux in both groups (p > 0.05). CONCLUSION: Our results show that the modified technique can reach the efficacy of the conventional method without requiring laparotomy. Thus, far several studies have demonstrated the advantages of laparoscopy over laparotomy. Thus, and in line with the clinical guidelines of the Society of American Gastrointestinal and Endoscopic Surgeons, we recommend using the presented modified technique in patients with caustic esophageal injuries.

Mental health status, aggression, and poor driving distinguish traffic offenders from non-offenders but health status predicts driving behavior in both groups.

BACKGROUND: In Iran, traffic accidents and deaths from traffic accidents are among the highest in the world, and generally, driver behavior rather than technical failures or environmental conditions are responsible for traffic accidents. In a previous study, we showed that among young Iranian male traffic offenders, poor mental health status, along with aggression, predicted poor driving behavior. The aims of the present study were twofold, to determine whether this pattern could be replicated among non-traffic offenders, and to compare the mental health status, aggression, and driving behavior of male traffic offenders and non-offenders. METHODS: A total of 850 male drivers (mean age =34.25 years, standard deviation =10.44) from Kermanshah (Iran) took part in the study. Of these, 443 were offenders (52.1%) and 407 (47.9%) were non-offenders with lowest driving penalty scores applying for attaining an international driving license. Participants completed a questionnaire booklet covering socio-demographic variables, traits of aggression, health status, and driving behavior. RESULTS: Compared to non-offenders, offenders reported higher aggression, poorer mental health status, and worse driving behavior. Among non-offenders, multiple regression indicated that poor health status, but not aggression, independently predicted poor driving behavior. CONCLUSION: Compared to non-offenders, offenders reported higher aggression, poorer health status and driving behavior. Further, the predictive power of poorer mental health status, but not aggression, for driving behavior was replicated for male non-offenders.

Evaluation of anterior chamber angle under dark and light conditions in angle closure glaucoma: An anterior segment OCT study.

AIM: To evaluate changes of nasal and temporal anterior chamber angle (ACA) in subjects with angle closure glaucoma using Spectralis AS-OCT (SAS-OCT) under dark and light conditions. METHODS: Based on dark-room gonioscopy, 24 subjects with open angles and 86 with narrow angles participated in this study. The nasal and temporal angle opening distance at 500 µm anterior to the scleral spur (AOD500), nasal and temporal ACA were measured using SAS-OCT in light and dark conditions. RESULT: In 2 groups, ACA and AOD500 in nasal and temporal quadrants were significantly greater in light compared to dark (all with p=0.000). The AOD500 and ACA were significantly higher in nasal than temporal in measured conditions for 2 groups except the ACA and AOD500 of normal group measured in light. The difference between nasal and temporal in dark (29.07 ± 65.71 µm for AOD500 and 5.7 ± 4.07° for ACA) was greater than light (24.86 ± 79.85 µm for AOD500 and 2.09 ± 7.21° for ACA) condition. But the difference was only significant for ACA (p=0.000). The correlation analysis showed a negative correlation between AOD500 and pupil diameter in temporal and nasal quadrants (both with p=0.000). While temporal AOD500 difference correlated with spherical equivalent, temporal and asal gonioscopy, nasal AOD correlated with IOP, temporal and nasal gonioscopy. CONCLUSIONS: Clinically important changes in ACA structure could be detected with SAS-OCT in nasal and temporal quadrants under different illumination intensity. The results could help in improvement of examination condition for better and more accurate assessment of individuals with angle closure glaucoma.