Biomechanical parameters of the golf swing associated with lower back pain: A systematic review.

Low back pain (LBP) is the most common injury in golfers of all abilities. The primary aim of this review was to improve understanding of human golf swing biomechanics associated with LBP. A systematic review using the PRISMA guidelines was performed. Nine studies satisfying inclusion criteria and dually reporting golf swing biomechanics and LBP were identified. Human golf swing biomechanics potentially associated with LBP include: reduced lumbar flexion velocity; reduced transition phase length; reduced lumbar torsional load; earlier onset of erector spinae contraction; increased lumbar lateral flexion velocity; reduced or greater erector spinae activity; and earlier onset of external oblique contraction. These potential associations were undermined by a very limited and conflicting quality of evidence, study designs which introduced a severe potential for bias and a lack of prospective study design. There is no conclusive evidence to support the commonly held belief that LBP is associated with "poor" golf swing technique. The potential associations identified should be further investigated by prospective studies of robust design, recruiting participants of both sexes and dexterities. Once firm associations have been identified, further research is required to establish how this knowledge can be best integrated into injury prevention and rehabilitation.

LBP has the highest incidence of any injury in elite, sub-elite and recreational golfers, causing a significant burden of injury worldwide.There is very limited and conflicting evidence that some human biomechanical factors in the golf swing may be associated with LBP.Prospective studies investigating the full movement pattern are required in order to improve understanding of the potential relationship between the biomechanics of the golf swing and LBP.

Local neuromuscular characteristics associated with patellofemoral pain: A systematic review and meta-analysis.

BACKGROUND: Local neuromuscular deficits have been reported in people with patellofemoral pain. We synthesised the neuromuscular characteristics associated with patellofemoral pain to help identify interventional targets and potential mechanisms. METHODS: Five databases were searched for local neuromuscular characteristics in case-control studies. Electromyography, flexibility, muscle performance and cross-sectional area data were derived from functional or isolated task investigations and synthesised accordingly. An evidence gap map was constructed. FINDINGS: Sixty-seven studies were included. In functional tasks, electromyographic investigations showed moderate evidence of small effect for vastus medialis onset-delays relative to vastus lateralis (0.44 [0.03, 0.85]) during stepping/stair negotiation tasks, and higher biceps femoris mean excitation amplitudes (0.55 [0.06, 1.04]) in single-leg triple-hop test. In isolated tasks, we found moderate evidence of medium effect for lower Hoffman-reflex amplitude of vastus medialis (-1.12 [-1.56, -0.67]). Muscle performance investigations showed; strong evidence with medium and small effects for lower extensors concentric (-0.61 [-0.81, -0.40]) and eccentric (-0.56 [-0.79, -0.33]) strength, and moderate evidence of medium effect of lower isometric (-0.64 [-0.87, -0.41]) strength, moderate evidence with small effect for rate of force development to 30% (-0.55[-0.89, -0.21]), 60% (-0.57[-0.90, -0.25]) and medium effect to 90% (-0.76[-1.43, -0.10]) of maximum voluntary contraction, and small effect for lower flexors concentric strength (-0.46 [-0.74, -0.19]) and extensors total work (-0.48 [-0.90, -0.07]). Flexibility investigations showed tighter hamstrings (-0.57 [-0.99, -0.14]). INTERPRETATION: Differences within quadriceps and hamstrings motor-control, hamstrings tightness, and quadriceps and hamstrings weakness are associated with patellofemoral pain, and can be used to guide investigations of treatment effects.

Thermographic assessment of the immediate and short term-effects of blood flow restriction exercise on Achilles tendon skin temperature.

OBJECTIVES: To determine the thermal patterning of the Achilles tendon following bodyweight resistance exercise with and without blood-flow restriction (BFR). DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: Twelve asymptomatic recreational runners (Age: 37 ± 10, Height: 169 ± 20, Mass: 73.8 ± 13.4). MAIN OUTCOME MEASURES: Thermograms were taken pre and post exercise with and without a BFR cuff on separate legs. BFR cuff pressure was set at 80% maximal arterial occlusion pressure determined using doppler via the tibial artery. Linear mixed-effects models were used to assess the effect of BFR and time post-exercise on skin-temperature (Tskin). RESULTS: A lower Tskin was seen following BFR exercise at the tendon insertion (P = 0.002), but not at the free tendon (P = 0.234), or the musculotendinous junction (P = 0.933). A significant effect of time upon changes in Tskin was observed in both BFR and non-BFR groups (P = 0.002). No interaction of time and BFR were observed on changes in Tskin (P = 0.726). CONCLUSION: Region specific changes in Tskin were found, with greater and longer reductions observed at the insertion of the Achilles following BFR exercise before returning to baseline. These findings could have implications for the programming of BFR exercise on tendon health. Future research should observe for differences between symptomatic and healthy tendons.

Patellar tendinopathy outcome predictors in jumping athletes: feasibility of measures for a cohort study.

OBJECTIVES: The main aim was to assess feasibility by testing data collection procedures for a cohort study. Measurements validity and reliability were secondary objectives. DESIGN: Feasibility study. SETTING: Combination of remote contact, assessment in clinic and biomechanical evaluation. PARTICIPANTS: 36 jumping athletes (female:17, male:19) equally spread between those with patellar tendinopathy, other knee problems and controls. MAIN OUTCOME MEASURES: Measurements validity, reliability and feasibility. RESULTS: There was no systematic difference between administration methods for patient reported outcome measures and miscellaneous questions (range of d = -0.32 to 0.26) without any order effect (all p > 0.05) except KOOS-PF (p = 0.02). Questionnaires' inter-session reliability was moderate to excellent (ICCs = 0.68-0.93). Pain maps were 94% matched between methods. Training load recall percentage decreased until week-3 with only 20% maintaining a training diary completing the full 6 weeks. The graded loaded challenge was clinically applicable, biomechanically valid with increasing load through progression and reliable (ICCs = 0.63-0.98). CONCLUSION: The tested questionnaires were valid and reliable for online use, therefore being suitable for clinical and research purposes. A shorter survey to reduce burden and collecting training load using shorter recall duration should improve feasibility. Biomechanical measures were valid and reliable, and a graded loaded challenge, suitable for further testing, has been defined.

Warmer waters masculinize wild populations of a fish with temperature-dependent sex determination.

Southern flounder (Paralichthys lethostigma) exhibit environmental sex determination (ESD), where environmental factors can influence phenotypic sex during early juvenile development but only in the presumed XX female genotype. Warm and cold temperatures masculinize fish with mid-range conditions producing at most 50% females. Due to sexually dimorphic growth, southern flounder fisheries are dependent upon larger females. Wild populations could be at risk of masculinization from ESD due to globally increasing water temperatures. We evaluated the effects of habitat and temperature on wild populations of juvenile southern flounder in North Carolina, USA. While northern habitats averaged temperatures near 23 °C and produced the greatest proportion of females, more southerly habitats exhibited warmer temperatures (>27 °C) and consistently produced male-biased sex ratios (up to 94% male). Rearing flounder in the laboratory under temperature regimes mimicking those of natural habitats recapitulated sex ratio differences observed across the wild populations, providing strong evidence that temperature is a key factor influencing sex ratios in nursery habitats. These studies provide evidence of habitat conditions interacting with ESD to affect a key demographic parameter in an economically important fishery. The temperature ranges that yield male-biased sex ratios are within the scope of predicted increases in ocean temperature under climate change.

The MAYAK WORKER DOSIMETRY SYSTEM (MWDS-2013): ESTIMATION OF PLUTONIUM SKELETAL BURDEN FROM LIMITED AUTOPSY BONE SAMPLES FROM MAYAK PA WORKERS.

The method to estimate total skeleton plutonium burden of former Mayak Production Association (MPA) workers from limited bone samples obtained at autopsy is described. From two to nine bone samples were obtained at autopsies conducted from the mid-1950s to 2013. Plutonium was measured using alpha-radiometry up to 2000 and later by alpha-spectrometry. The method was validated using data from whole-body donations from the United States Transuranium and Uranium Registries (USTUR). The developed algorithm overestimated the USTUR values from 20 to 40%, that is quite acceptable for conservative estimation. Late-in-life liver diseases known to redistribute plutonium between liver and skeleton were not associated with significant differences in plutonium deposition among sampled bones, except for the pelvis. Sources of uncertainties are discussed and future studies will address the reduction of these uncertainties. This algorithm can be used to obtain data in support of the development of biokinetic, dosimetric and risk models for humans exposed to plutonium.

The Mayak Worker Dosimetry System (MWDS-2013): Estimate of Pu Content in Lungs and Thoracic Lymph Nodes From a Limited Set of Organ Autopsy Samples.

A method to estimate plutonium content from a limited number of samples of lungs and pulmonary lymph nodes obtained at autopsies of former Mayak Production Association (MPA) workers is described. Historically from one to five samples of lung lobes and one to three respiratory lymph nodes (bronchopulmonary, tracheobronchial and paratracheal) were collected. The samples were used to estimate organ plutonium contents for cases where incomplete sets of samples were obtained, i.e. one to four lung lobes and one to two lymph nodes. This method was developed and validated using individual measurement data from 259 MPA autopsy cases with complete lung samples (five lobes) and three lymph nodes. A good correlation of plutonium content in measurements of two and four lung samples with the content estimate by five lung samples was obtained. The correlations with the individual lymph nodes were less robust than with the lung. The data are used to develop biokinetic, dosimetry and risk models for humans exposed to plutonium.

Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans.

The neuromuscular adaptations in response to muscle stretch training have not been clearly described. In the present study, changes in muscle (at fascicular and whole muscle levels) and tendon mechanics, muscle activity, and spinal motoneuron excitability were examined during standardized plantar flexor stretches after 3 wk of twice daily stretch training (4 × 30 s). No changes were observed in a nonexercising control group (n = 9), however stretch training elicited a 19.9% increase in dorsiflexion range of motion (ROM) and a 28% increase in passive joint moment at end ROM (n = 12). Only a trend toward a decrease in passive plantar flexor moment during stretch (-9.9%; P = 0.15) was observed, and no changes in electromyographic amplitudes during ROM or at end ROM were detected. Decreases in H(max):M(max) (tibial nerve stimulation) were observed at plantar flexed (gastrocnemius medialis and soleus) and neutral (soleus only) joint angles, but not with the ankle dorsiflexed. Muscle and fascicle strain increased (12 vs. 23%) along with a decrease in muscle stiffness (-18%) during stretch to a constant target joint angle. Muscle length at end ROM increased (13%) without a change in fascicle length, fascicle rotation, tendon elongation, or tendon stiffness following training. A lack of change in maximum voluntary contraction moment and rate of force development at any joint angle was taken to indicate a lack of change in series compliance of the muscle-tendon unit. Thus, increases in end ROM were underpinned by increases in maximum tolerable passive joint moment (stretch tolerance) and both muscle and fascicle elongation rather than changes in volitional muscle activation or motoneuron pool excitability.

Reliability, factorial validity, and interrelationships of five commonly used change of direction speed tests.

Change of direction speed (CODS) is often considered a main determinant of successful performance in many team sports and is routinely measured using field-based tests. However, controversy regarding test selection still exists based upon the reliability and specificity of the tests. The purpose of this study was to determine and compare the reliability, factorial validity, and interrelationships of five frequently used CODS tests (Illinois, L-Run, Pro-Agility, T-test, and 505). Forty-four physical education students (male n = 24; female n = 20; age; 16.7 ± 0.6), who compete within team sports, to varying levels of competition, participated in this study. Three trials for each of the five tests were recorded. All tests had high (intraclass correlation coefficient) test-retest reliability (r = 0.88-0.95) and low typical percentage error (1.95-2.40%). The principle component factor analysis resulted in the extraction of one significant component which explained 89.52% of the total variance. All selected tests were positively and strongly correlated (r = 0.84-0.89). Based upon the results of this study, it was concluded that all tests are highly reliable and valid measures of CODS, with all tests assessing a general athletic ability to change direction. Future research should investigate the factorial validity of the CODS test within homogenous samples.

Neuromuscular factors influencing the maximum stretch limit of the human plantar flexors.

Maximum joint range of motion is an important parameter influencing functional performance and musculoskeletal injury risk. Nonetheless, a complete description of the muscle architectural and tendon changes that occur during stretch and the factors influencing maximum range of motion is lacking. We measured muscle-tendon elongation and fascicle lengthening and rotation sonographically during maximal plantar flexor stretches in 21 healthy men. Electromyogram (EMG) recordings were obtained synchronously with ultrasound and joint moment data, and H-reflex measurements were made with the ankle at neutral (0°) and dorsiflexed (50% maximal passive joint moment) positions; the maximum H amplitude (normalized to maximum M-wave amplitude; M(max)) and H-amplitude elicited at a stimulation intensity that evoked 10% M(max) were obtained. Maximal stretch was accomplished through significant muscle (14.9%; 30 mm) and tendon lengthening (8.4%; 22 mm). There were similar relative changes in fascicle length and angle, but planimetric modeling indicated that the contribution of fascicle rotation to muscle lengthening was small (<4 mm). Subjects with a greater range of motion showed less resistance to stretch and a greater passive joint moment at stretch termination than less flexible subjects (i.e., greater stretch tolerance). Also, greater fascicle rotation accompanied muscle elongation (9.7 vs. 5.9%) and there was a greater tendon length at stretch termination in more flexible subjects. Finally, a moderate correlation between the angle of EMG onset and maximum range of motion was obtained (r = 0.60, P < 0.05), despite there being no difference in H-reflex magnitudes between the groups. Thus clear differences in the neuromuscular responses to stretch were observed between "flexible" and "inflexible" subjects.

"There is a chain of Chinese whispers ...": empirical data support the call to formally teach handover to prequalification doctors.

BACKGROUND: Changing patterns of work in the hospital setting mean different teams look after the same group of patients over the course of any given day. Shift handovers, or hand/sign-off, can give rise to miscommunication of critical information, a patient safety issue. How can we best prepare new doctors for handover? METHODS: This was a qualitative, focus-group study, exploring the views of doctors (Foundation Year, Senior House Officers, Registrars and Consultants) and night nurse practitioners, in Aberdeen, UK. RESULTS: Five focus groups were carried out with 21 participants. Using framework analysis, five main themes relevant to the task of effectively handing over, and how to best teach handover, emerged. These were: definition of handover; experience of handover as a junior doctor; perceptions of junior doctors' handover skills and attitudes; systems factors, and their interaction with individual factors; and the "what" and the "how" of teaching handover. CONCLUSIONS: New doctors feel unprepared for handover and are seen as poor at handing over. Certain skills are required for effective handover, but professional attitudes are also critical. The skills identified reflect those suggested in policy documents based on expert panel views. Poor systems are a barrier to effective learning and practice. Our empirical approach adds to existing knowledge by highlighting that handover is not solely a skills-based task; there are complex interactions between individual and systems factors; and junior doctors should be prepared for handover prequalification. These data can be used to plan optimal handover teaching for medical students.

The effects of smoking and lung health on the organ retention of different plutonium compounds in the Mayak PA workers.

The purpose of this study was to determine the effects of smoking and lung health on the pulmonary and extrapulmonary retention after inhalation of different chemical forms of plutonium with different solubilities in workers from the Mayak Production Association (Ozersk, Russia). Samples of lung, pulmonary lymph nodes, liver and skeleton were obtained from 800 workers who died between 1962-2000. The chemical form of plutonium aerosols, smoking history and presence of lung disease were determined. In workers with normal lung status, all plutonium chemical classes were about equally distributed between the lung parenchyma and pulmonary lymph nodes. The more insoluble chemical forms of plutonium had a greater retention in pulmonary than systemic tissues regardless of smoking history or lung health status. A history of smoking did, however, result in a significantly greater retention of less soluble chemical forms of plutonium in pulmonary tissues of workers with no lung disease. In workers with lung disease, smoking did not significantly influence the terminal organ retention of the different chemical forms of plutonium. These initial data can be used to modify dosimetry and biokinetics models used for estimating radiation risks from plutonium in humans.

Feasibility of using a bone-targeted, macromolecular delivery system coupled with prostaglandin E(1) to promote bone formation in aged, estrogen-deficient rats.

PURPOSE: Macromolecular delivery systems have therapeutic uses because of their ability to deliver and release drugs to specific tissues. The uptake and localization of HPMA copolymers using Asp(8) as the bone-targeting moiety was determined in aged, ovariectomized (ovx) rats. PGE(1) was attached via a cathepsin K-sensitive linkage to HPMA copolymer-Asp(8) conjugate and was tested to determine if it could promote bone formation. MATERIALS AND METHODS: The uptake of FITC-labeled HPMA copolymer-Asp(8) conjugate (P-Asp(8)-FITC) on bone surfaces was compared with the mineralization marker, tetracycline. Then a targeted PGE(1)-HPMA copolymer conjugate (P-Asp(8)-FITC-PGE(1)) was given as a single injection and its effects on bone formation were measured 4 weeks later. RESULTS: P-Asp(8)-FITC preferentially deposited on resorption surfaces, unlike tetracycline. A single injection of P-Asp(8)-FITC-PGE(1) resulted in greater indices of bone formation in aged, ovx rats. CONCLUSIONS: HPMA copolymers can be targeted to bone surfaces using Asp(8), with preferential uptake on resorption surfaces. Additionally, PGE(1) attached to the Asp(8)-targeted HPMA copolymers and given by a single injection resulted in greater bone formation measured 4 weeks later. This initial in vivo study suggests that macromolecular delivery systems targeted to bone may offer some therapeutic opportunities and advantages for the treatment of skeletal diseases.

[Quantitative plutonium microdistribution in bone tissue of vertebra from occupationally exposed worker].

The purpose of this work is the receiving of quantitative data on Pu microdistribution in different structural elements of human bone tissue for local dose assessment and dosimetric models validation. Thoracic vertebra sample was taken for the study from former Mayak worker with rather high Pu burden, including information on occupational and exposure history, medical information and data on Pu content in organs. Lexan film autodiagrams were obtained using method of neutron-induced autoradiography from bone tissue sections. Quantitative analysis of randomly selected vision fields on one of autoradiograms was performed: fission fragment tracks Pu in different bone tissue areas were calculated, surface of bone tissue areas were defined. Quantitative information on Pu microdistribution in human bone tissue was obtained for the first time. On the basis of obtained data quantitative relation of Pu decays in bone volume to decays on bone surface in cortical and trabecular fractions were defined as 2.0 and 0.4, correspondingly. Actual quantitative relation of decays in bone volume to decays on bone surface is significantly different from recommended by ICRP for cortical fraction. Biokinetic model parameters of extrapulmonary ICRP compartment might need to be adjusted after expansion of data set on quantitative Pu microdistribution in other bone types in human that will involve new cases with different exposure pattern of radionuclide.

Comparison of dose estimation from occupational exposure to 239Pu using different modelling approaches.

Several approaches are available for bioassay interpretation when assigning Pu doses to Mayak workers. First, a conventional approach is to apply ICRP models per se. An alternative method involves individualised fitting of bioassay data using Bayesian statistical methods. A third approach is to develop an independent dosimetry system for Mayak workers by adapting ICRP models using a dataset of available bioassay measurements for this population. Thus, a dataset of 42 former Mayak workers, who died of non-radiation effects, with both urine bioassay and post-mortem tissue data was used to test these three approaches. All three approaches proved to be adequate for bioassay and tissue interpretation, and thus for Pu dose reconstruction purposes. However, large discrepancies are observed in the resulting quantitative dose estimates. These discrepancies can, in large part, be explained by differences in the interpretation of Pu behaviour in the lungs in the context of ICRP lung model. Thus, a careful validation of Pu lung dosimetry model is needed in Mayak worker dosimetry systems.

Mayak worker dosimetry study: an overview.

The Mayak Production Association (MPA) was the first plutonium production plant in the former Soviet Union. Workers at the MPA were exposed to relatively large internal radiation intakes and external radiation exposures, particularly in the early years of plant operations. This paper describes the updated dosimetry database, "Doses-2005." Doses-2005 represents a significant improvement in the determination of absorbed organ dose from external radiation and plutonium intake for the original cohort of 18,831 Mayak workers. The methods of dose reconstruction of absorbed organ doses from external radiation uses: 1) archive records of measured dose and worker exposure history, 2) measured energy and directional response characteristics of historical Mayak film dosimeters, and 3) calculated dose conversion factors for Mayak Study-defined exposure scenarios using Monte Carlo techniques. The methods of dose reconstruction for plutonium intake uses two revised models developed from empirical data derived from bioassay and autopsy cases and/or updates from prevailing or emerging International Commission on Radiological Protection models. Other sources of potential significant exposure to workers such as medical diagnostic x-rays, ambient onsite external radiation, neutron radiation, intake of airborne effluent, and intake of nuclides other than plutonium were evaluated to determine their impact on the dose estimates.

Adaptations in cortical and trabecular bone in response to mechanical loading with and without weight bearing.

Exercise that imparts rapid, high-magnitude mechanical loading is considered to be advantageous to bone health. Previous rodent studies have suggested that swimming may also be beneficial to bone. We investigated the differential effects of exercise with and without weight bearing on cortical and trabecular bone. Forty female Sprague-Dawley rats (120 days) were weight-stratified and randomized into four groups: swim control (Cs, n = 10), swim (S, n = 10), treadmill control (Ct, n = 10), and treadmill (T, n = 10). Treadmill speed was adjusted to match the average limb loading frequency used for swimming, and all training progressed to 1 hour/day, 5 days/week, for 12 weeks. Femurs and humeri were assessed for cortical morphometry by peripheral quantitative computed tomography, areal bone mineral density (BMD) by peripheral dual-energy X-ray absorptiometry, mineral content by ashing, strength by three-point bending, and trabecular volume (BV/TV) by micro-computed tomography. Swimming was associated with increases in cortical thickness and BMD in the humerus midshaft and trabecular BV/TV in the distal femur and proximal humerus compared with age-matched controls. Compared to swimming, treadmill training was associated with increases in percent ash of the femur and humerus and Young's modulus of the femur. Swimming appears to engender novel bone strains and osteogenic adaptations in the humerus and femur, which are different from those induced by normal cage activity. In summary, our findings suggest that when limb loading frequency is matched, swimming may afford greater benefits to cortical and trabecular bone than uphill treadmill work in rats.

Ancestry of beagles in lifespan studies of radionuclide toxicity at the University of Utah.

Analysis of the ancestry of the 1,262 lifespan beagles (LSB) entered into lifespan studies at the Radiobiology Division, University of Utah, beginning in 1952 and ending in 1980, indicated that about 97% of ancestor citations in the various pedigrees were of only 10 breeding animals (breeders) among breeders within the beagle colony. In turn, just 18 AKC-registered "champion" beagles from outside of this colony (founders) accounted for about 98% of all ancestor citations among founders for the LSB. We conclude from this study that the animals used in the lifespan radionuclide experiments can be considered to be somewhat genetically interrelated.

Americium in the beagle dog: biokinetic and dosimetric model.

A biokinetic model of the systemic distribution of americium in the beagle dog is presented. The model is based on a previous biokinetic model of plutonium. The data sets used for the development of the model were the measurements of excreted activity (urine and feces) and organ burdens (skeleton, liver, and other soft tissues) for different levels of initial injected activity. In developing the model, the compartmental structure of the skeleton of the plutonium model was adopted, and only the numerical values of parameters were adapted. The model well describes the fractions of americium in the skeleton, liver, and soft tissues and the total fraction excreted in urine and feces. The tuning of the liver clearance parameter provides a realistic description of the change in the partitioning between liver and skeleton for different injection levels. The most significant features of the biokinetics and dosimetry of americium and plutonium in beagles are compared. The total fractions of the clearance to the skeleton and the liver are roughly equal to the value for plutonium, but the partitioning of americium between these organs is reversed with respect to the partitioning of plutonium. 241Am doses to liver and skeleton are similar to 239Pu doses, owing to some counteracting factors. For the highest injection level, the liver mass is dependent on the time post injection. For the skeletal tissues, the dose to the cortical endosteum by far exceeds the dose to the trabecular endosteum and the red marrow. The model provides the basis for statistical survival analyses and risk estimates.