Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study.

BACKGROUND: Only 55% of anterior cruciate ligament-reconstructed (ACLR) athletes return to competitive sports. This brings into question the usefulness of current return to sport (RTS) criteria. High cognitive demand of sport environment clarifies the value of incorporating neurocognitive tests when making decisions regarding the time of RTS. This preliminary study aimed to compare the neurocognitive functions between healthy controls and ACLR male athletes who passed or failed RTS criteria. METHODS: A total of 45 male football players, including 15 ACLR who passed RTS criteria, 15 ACLR who did not pass, and 15 healthy controls participated in this cross-sectional study. The Cambridge Neuropsychological Test Automated Battery was used to measure a battery of neurocognitive tasks, including speed of response, sustained attention, working memory, cognitive flexibility, and response inhibition. RESULTS: The results revealed that compared with both the ACLR-passed and healthy groups, the ACLR-failed group showed greater values of 5-choice movement time (P = .02, P = .01, respectively) but lower values of stop signal reaction time (P = .03, P = .001, respectively) and proportion of successful stops variables (P = .02). In addition, compared with the healthy group, both the ACLR-failed and ACLR-passed groups indicated greater values in between errors (P < .001, P = .008, respectively) and reaction latency variables (P = .002, P = .01, respectively) but lower values of A' (P < .001, P = .007, respectively), probability of hit (P < .001, P = .03, respectively), and percent correct trials variables (P = .006, P = .02, respectively). CONCLUSIONS: Our findings indicated deficits in neurocognitive functions in ACLR male athletes. In addition, poor performance in sustained attention, working memory, and cognitive flexibility measures observed in the ACLR-passed group highlighted the necessity for using a multimodal approach via implementation of neurocognitive measures in conjunction with the functional and muscular assessments when making RTS decisions.

The effects of military body armour on the lower back and knee mechanics during box drop and prone to standing tasks.

Modern day body armour (BA) has been successful at increasing survivability from previously lethal explosives; however, it has been suggested to reduce warfighter's performance and increase risk of injury. Joint biomechanics have a foremost impact on performance and risk of injury. The immediate and prolonged effects of wearing BA on biomechanics of the lower back and knee during box drop (BD) and prone to standing tasks were investigated. The immediate effects of BA on both tasks were an increase of ≥4% (p ≤ 0.02) in temporal task durations and a decrease of ~1.66 N/kg (p = 0.03) in normalised peak ground reaction force for the BD test. The prolonged duration of walking with BA (i.e. 45 min) was not found to cause more changes in our measures than walking without BA. Quantitative data related to the effects of BA are important for risk assessment and mission design such to reduce the risk of injury without compromising performance. Practitioner Summary: The effects of wearing military body armour (BA) on biomechanics of the lower back and knee were investigated. Though wearing BA was found to affect some biomechanical measures related to performance, the prolonged effects of exposure on our measures were the same whether or not the participants wore BA.

Organized sports participation and the association with injury in paediatric patients with haemophilia.

INTRODUCTION: With the wide availability of factor and the routine use of prophylaxis boys with haemophilia are now able to participate in regular physical activity, including organized sports. Current guidelines vary regarding specific recommendations for sports participation and concerns remain regarding safety. AIM: To determine if participation in organized sports is associated with an increased risk for injury in paediatric subjects with haemophilia. METHODS: Retrospective single-centre cohort study from January 1, 2008 to December 31, 2010 in male subjects ages 10-18 years with a factor VIII (FVIII) or FIX level <40%. The number of injuries per subject and participation in organized sports was recorded. RESULTS: 48 male subjects with a mean age of 14.3 ± 2.6 years (range: 10-18.8) were included; 64.6% (31/48) FVIII deficiency, 54.2% (26/48) severe haemophilia, 18.8% (9/48) moderate and 27.1% (13/48) mild. The majority [62.5% (30/48)] of subjects participated in at least one season of organized sport. There were 77 injuries in 36/48 (75%) subjects. The mean number of injuries per subject was 1.6 ± 1.5. There was no statistical difference in the mean number of injuries (P = 0.44) or target joint formation (P = 0.52) between the subjects who participated in organized sports compared to those who did not. CONCLUSION: In this study, participation in organized sports by boys with haemophilia, ages 10-18 years, is common and not associated with an increased number of injuries or the development of a target joint. As injuries occurred equally in both groups, concerted efforts should be directed at reducing injuries in all patients.

The effects of military body armour on the lower back and knee mechanics during toe-touch and two-legged squat tasks.

While effective in the prevention of otherwise lethal injuries, military body armour (BA) has been suggested to reduce warfighter's performance and increase injury-related musculoskeletal conditions. Providing the significant role of joint biomechanics in both performance and risk of injury, the immediate and prolonged effects of wearing BA on biomechanics of the lower back and knee during toe-touch (TT) and two-legged squat (TLS) tasks were investigated. The immediate effects of BA were an increase of >40 ms (p ≤ 0.02) in flexion duration of the dominant joint and an ∼1 s (p ≤ 0.02) increase in overall task duration as well as an ∼18% (p = 0.03) decrease in the lumbopelvic rhythm ratio near the mid-range of trunk flexion. In general the prolonged duration of wearing BA (i.e. 45 min of walking) was not found to cause more changes in our measures than walking without BA. PRACTITIONER SUMMARY: The effects of wearing military BA on biomechanics of the lower back and knee during TT and TLS tasks were investigated. The immediate effects of BA were increased flexion duration, increased overall trial duration and decreased lumbopelvic rhythm near the mid-range of trunk flexion.

Balance training exercises decrease lower-limb strength asymmetry in young tennis players.

The issue of functional asymmetries in the lower-limbs has been the subject of numerous recent investigations concerning many different contact, limited-contact and non-contact sports. The presence of strength asymmetries in the lower-limbs of young athletes practicing various sporting disciplines is considered an intrinsic risk factor for injury; in such cases, compensation strategies should thus be implemented aimed at eliminating, or at least limiting, the degree of asymmetry in order to avoid the negative consequences asymmetries can have upon the health of young sportsmen and women on the long-term. The aim of the present study was to examine the presence of functional asymmetries in the lower-limbs of young tennis players in strength and speed drill performance and to test a specific balance-training programme in its capacity to effectively reduce such asymmetries. Twenty-three young tennis players were randomly assigned to the Experimental Group (EG) (n = 11: 4 females, 7 males; 13.2 ± 0.9 years; 50.8 ± 8.9 Kg; 1.63 ± 0.08 m) or Comparison Group (CG) (n = 12: 4 females, 8 males; 13.0 ± 0.9 years; 51.1 ± 9.2 Kg; 1.61 ± 0.09 m). To quantify percent asymmetries in lower-limb strength before (T0) and following (T1) training, performances were assessed in the one-leg hop test (OLH), side-hop test (SH) and side steps and forward 4.115-m test (4m-SSF). Performances in the 10 and 20m sprint tests and the Foran test were also assessed. The EG completed a total of 12 training sessions directed at balance training: two 30-minute sessions/week over a 6-week period. The CG followed an identical training schedule, but training sessions consisted of tennis-specific drills only. The results reveal significant differences between pre- and post-training tests in the EG only: the degree of lower-limb asymmetry was decreased in the EG following completion of the training programme, as assessed using the OLH test (p < 0.001), SH test (p < 0.001) and 4m-SSF test (p < 0.05). A significant interaction and main effect of training was also observed in the EG: balance training led to a significant reduction in the percent of asymmetry in lower-limb strength, as measured using the SH (p < 0.01), 4m-SSF (p < 0.01) and OLH (p < 0.05) tests. These results confirm that balance training exercises are able to counteract/reduce the degree of asymmetry in lower-limb strength in young tennis players. Key pointsThe determination of functional asymmetries in the lower-limbs has been the subject of numerous recent investigations aimed at the prevention of injuries in many different contact, limited-contact and non-contact sports.Sport-specific movements in tennis impose different loads upon the two lower-limbs and can cause the development of lower-limb strength asymmetries in young tennis players.The planning of athletic conditioning in young tennis players requires that strength in the lower-limbs is evaluated such that appropriate injury prevention strategies may be inserted into training programmes.Balance training exercises, and indeed all tasks performed on unstable surfaces, lead to benefits in sport-specific performance.

Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking.

STUDY OBJECTIVE: Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups. METHODS: We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms "sleepwalking", "somnambulism", "sleep eating", "sleep sex", "sleep talking", and "aggression in sleep" in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95% confidence interval and the probability of statistical significance. RESULTS: 224 videos (102 women, 68 children, 16 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) lower odds of sleepwalking compared to adults and children. Adult females performed complex manual activities during sleepwalking more often than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001). CONCLUSION: Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children. BRIEF SUMMARY AND STUDY IMPACT: Parasomnias present highly variable clinical forms and often cause injuries. Identifying typical phenotypes may help risk management and imply theoretical conclusions. Our study supports the existence of age-specific parasomnia phenotypes. We found that adult women have a high risk of performing dangerous activities during sleep, and elderly males often move violently in bed, likely representing dream enactment behaviors. Elderly people of both sexes have low odds of sleep ambulation- likely representing somnambulism; compared to adults and children, constituting a descending "age slope" of somnambulism that might reflect different underlying pathomechanisms in children versus adults and the elderly.

Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking.

STUDY OBJECTIVE: Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups. METHODS: We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms "sleepwalking", "somnambulism", "sleep eating" "sleep sex", "sleep talking" and "aggression in sleep" in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95 % confidence interval and the probability of statistical significance. RESULTS: 224 videos (102 women; 68 children, 116 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) less odds of ambulation in sleep likely consistent with somnambulism compared to adults and children. Adult females performed complex manual activities during sleepwalking more often, than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001). CONCLUSION: Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children.

Kinematics but not kinetics alterations to single-leg drop jump movements following a subject-tailored fatiguing protocol suggest an increased risk of ACL injury.

Introduction: Neuromuscular fatigue causes a transient reduction of muscle force, and alters the mechanisms of motor control. Whether these alterations increase the risk of anterior cruciate ligament (ACL) injury is still debated. Here we compare the biomechanics of single-leg drop jumps before and after the execution of a fatiguing exercise, evaluating whether this exercise causes biomechanical alterations typically associated with an increased risk of ACL lesion. The intensity of the fatiguing protocol was tailored to the aerobic capacity of each participant, minimizing potential differential effects due to inter-individual variability in fitness. Methods: Twenty-four healthy male volunteers performed single leg drop jumps, before and after a single-set fatiguing session on a cycle ergometer until exhaustion (cadence: 65-70 revolutions per minute). For each participant, the intensity of the fatiguing exercise was set to 110% of the power achieved at their anaerobic threshold, previously identified by means of a cardiopulmonary exercise test. Joint angles and moments, as well as ground reaction forces (GRF) before and after the fatiguing exercise were compared for both the dominant and the non-dominant leg. Results: Following the fatiguing exercise, the hip joint was more extended (landing: Δ=-2.17°, p = 0.005; propulsion: Δ=-1.83°, p = 0.032) and more abducted (landing: Δ=-0.72°, p = 0.01; propulsion: Δ=-1.12°, p = 0.009). Similarly, the knee joint was more extended at landing (non-dominant leg: Δ=-2.67°, p < 0.001; dominant: Δ=-1.4°, p = 0.023), and more abducted at propulsion (both legs: Δ=-0.99°, p < 0.001) and stabilization (both legs: Δ=-1.71°, p < 0.001) hence increasing knee valgus. Fatigue also caused a significant reduction of vertical GRF upon landing (Δ=-0.21 N/kg, p = 0.003), but not during propulsion. Fatigue did not affect joint moments significantly. Conclusion: The increased hip and knee extension, as well as the increased knee abduction we observed after the execution of the fatiguing exercise have been previously identified as risk factors for ACL injury. These results therefore suggest an increased risk of ACL injury after the execution of the participant-tailored fatiguing protocol proposed here. However, the reduced vertical GRF upon landing and the preservation of joint moments are intriguing, as they may suggest the adoption of protective strategies in the fatigued condition to be evaluated in future studied.

Peak torque angle, acceleration time and time to peak torque as additional parameters extracted from isokinetic test in professional soccer players: a cross-sectional study.

This study investigated additional and traditional variables from isokinetic test of thigh muscles in soccer players across different field positions. One hundred and eighty-nine athletes performed maximal concentric isokinetic knee contractions on dominant (DL) and non-dominant limb (NDL) at 60º/s and 240º/s. The additional outcomes peak torque angle (AngPT), acceleration time (AcT) and time to peak torque (TPT) and traditional outcomes Peak torque (PT), total work (TW) and power (Pw) were extracted from the exam. Goalkeepers (GK), side backs (SB), central backs (CB), central defender midfielders (CDM), central attacking midfielders (CAM) and forwards (FW) were considered. Comparisons between limbs and positions demonstrated that SB extensors of the DL presented TPT lower (p = 0.006) and AngPT higher (p = 0.011) than NDL at 60°/s. CDM extensors of the DL showed lower TPT at 60°/s (p = 0.003) and 240°/s (p = 0.024). CAM flexors of the DL showed lower TPT (p = 0.026) and AcT (p = 0.021) at 240°/s than NDL. CB, CDM and CAM extensors of the NDL showed higher PT, TW and Pw than DL (p < 0.05). In conclusion, there are muscle imbalances between limbs in SB, CDM and CAM and across different field positions.

Impact of Holding a Badminton Racket on Spatio-Temporal and Kinetic Parameters During Manual Wheelchair Propulsion.

Introduction: Para badminton entered the Paralympic world for the first time with the 2021 Paralympic Games in Tokyo. The particularity of this sport lies in the handling of the wheelchair and the racket simultaneously. To the best of our knowledge, and considering the youthfulness of this sport, it appears that no study has looked at the impact of the badminton racket on the kinetic and spatiotemporal parameters. Therefore, the aim of our study was to investigate the impact of the badminton racket on the amplitude of kinetic and spatiotemporal parameters of wheelchair propulsion, considered as propulsion effectiveness and risk of injury criteria. We hypothesized that holding a badminton racket while propelling the wheelchair modifies the kinetics and temporal parameters of the athlete's propulsion due to the difficulty to hold the handrim, therefore decreasing propulsion effectiveness and increasing risk of injury. Materials and Methods: For six 90-min sessions, 16 able-bodied individuals were introduced to badminton. No injuries hindered their propulsion. They had to propel with and without a racket held on the dominant side along a 20 m straight line at a constant velocity of 5 km/h. They all used the same sports wheelchair equipped with two instrumented wheels (SmartWheel). Results: Participants increased their maximal total force and force rate of rise but decreased their fraction of effective force with their dominant hand compared to the non-dominant hand when using a racket. In addition, they decreased their fraction of effective force, push time, cycle time, and push angle, and increased their maximal propulsive moment, maximal total force, and force rate of rise when comparing the same dominant hand with and without the racket. Discussion: Using a badminton racket modifies the athlete's force application in a way that is generally related to lower propulsion effectiveness and a higher risk for injury. Indeed, it seems that propulsion with a racket prevents from correctly grabbing the handrim.

Risk factors for shoulder injuries in handball: systematic review.

BACKGROUND: Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17-41%. OBJECTIVE: The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. METHODS: Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. RESULTS: 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50-85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). CONCLUSION: Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. PROTOCOL REGISTRATION: PROSPERO ID: CRD42020138233.

Methodological Proposal for Strength and Power Training in Older Athletes: A Narrative Review.

INTRODUCTION: Within the adult population, it is not uncommon to meet older athletes who challenge the negative stereotypes associated with aging. Although their physical performance is superior to their sedentary counterparts, they are not immune to impaired neuromuscular function, leading to a decreased physical capacity and an increased risk of injuries. Despite the abundant information about the benefits of strength/power training in advanced ages, there are no methodological proposals that guide physical activity professionals to program this type of training. OBJECTIVE: This study aimed to review the factors related to the decrease in sports performance within older athletes and the benefits of a strength/power program in order to provide a methodological proposal to organize training in this population. METHODS: This is a review article. First, databases from PubMed, Science Direct, and SPORTSDiscus and search engines, namely Google Scholar and Scielo, were reviewed, using standard keywords such as strength and power training, evaluation of physical performance, neuromuscular function, and risk of injury in the elderly athlete. All related articles published during the period 1963 to 2020 were considered. A total of 1837 documents were found. By removing 1715 unrelated documents, 122 articles were included in the study after revision control. RESULTS: Strength/power training is key to alleviating the loss of performance in older athletes and the benefits in neuromuscular function, which helps reduce the rate of serious injuries, maintaining sports practice for a longer period of time. In order to design an appropriate program, a prior evaluation of the individual's physical-technical level must be carried out, respecting the biologicalpedagogical principles and safety regulations. CONCLUSION: The methodological proposal delivered in this review can serve as a technical guide for physical activity professionals, which will be able to structure the strength/power training and thus preserve the sports practice in older athletes for a longer time.

Sonographic assessment of pediatric chest wall thickness and width of the intercostal space: correlation with anthropometric data and implications for needle decompression.

BACKGROUND: Emergent needle decompression in children is a rare event for emergency medicine and critical care providers. Hereby, risk of injury of intrathoracic structures is high and knowledge of age-specific values of chest wall thickness and width of the intercostal space (ICS) is crucial to avoid injuries. Investigation of the correlation of chest wall thickness and width of the intercostal space with age and body dimension like weight and height could provide guidance on depth of insertion and choice of the needle. METHODS: We performed a prospective observational clinical trial in a pediatric surgery operating room that included a convenient sample of children aged 0-10 years undergoing elective surgery. Chest wall thickness and width of the intercostal space were measured with ultrasound at 2nd ICS midclavicular line (MCL) and 4th ICS anterior axillary line (AAL). Correlation of these measures with age, height, weight, BMI and Broselow color was calculated. Furthermore, intra-class correlation coefficient was calculated as a measure of reproducibility and the presence of vital structures (e.g., heart, thymus gland, large pulmonary vessels) at the possible insertion sites for needle decompression was investigated. RESULTS: Of 410 potentially eligible patients, 300 were included in the study. Correlation of chest wall thickness was moderate with weight (2nd ICS MCL: r = 0.57; 4th ICS MCL: r = 0.64) and BMI (r = 0.44 and r = 0.6) and was lower with age (r = 0.38 for both intercostal spaces), height (r = 0.42 and r = 0.40) and Broselow color (r = 0.42 and r = 0.38). Correlation of width of the ICS with anthropometric data was generally stronger, with height showing the strongest, albeit not really strong, correlation (r = 0.71 and r = 0.62). Intra-class correlation was excellent with an ICC of 0.93. Vital structures were significantly more often present at 2nd ICS MCL then at 4th ICS AAL (14 vs. 2 patients; p = 0.0042). CONCLUSIONS: Correlation of chest wall thickness and width of the intercostal space with anthropometric data is at most moderate. Insertion depth and width of the intercostal space can therefore not be predicted accurately from anthropometric data. Ultrasound assessment of the thoracic wall appears to be a reliable technique and could therefore assist in reducing the risk of injury and increasing decompression success. Trial registration German clinical trials register, DRKS00014973, Registered February 11th 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014973.

Comparison of Knee and Hip Kinematics during Landing and Cutting between Elite Male Football and Futsal Players.

To design an accurate sport injury prevention program, alterations in the knee and hip kinematic variables involved in injury mechanisms should be known. The main purpose of the current study was to compare knee and hip kinematic variables during landing and cutting among male football and futsal players, and to discuss them within an injury description frame. Twenty football (20.5 ± 2.1 years., 74.5 ± 6.9 kg and 1.79 ± 0.07 m) and twenty futsal players (20.3 ± 2.0 years., 73.5 ± 7.1 kg and 1.78 ± 0.07 m), with at least three years' experience of playing in the Kerman Province League, participated in this study. Hip flexion, knee flexion and knee valgus angle during two main movements with risk of injury, such as landing and cutting, were measured using a motion capture system with passive markers at 120-Hz sampling frequency. Landing and cutting maneuvers were administered in as natural way as possible. Results showed significant differences in landing and cutting maneuvers between groups in hip flexion, knee flexion and knee valgus angle. Results indicated that footballers have less extension of hip and knee joints than futsal players in landing maneuvers, which may be due to the higher requirement of jumping-landing maneuvers when playing football. In cutting maneuvers, footballers showed less hip and knee flexion than futsal players, whereas the knee valgus angle in cutting maneuvers was lower in futsal players. More information on the injury mechanisms of landing and cutting in football and futsal are needed to improve the design of injury prevention programs.

Epidemiology of injuries in elite male and female futsal: a systematic review and meta-analysis.

The main purpose of this study was to conduct a systematic review and meta-analysis quantifying the incidence of injuries in futsal players. A systematic search was conducted using MEDLINE, PubMed, Web of Science and Scopus databases and subsequently, six studies (14 cohorts) were selected. Separate meta-analyses for male and female players were conducted using a Poisson random-effect regression model approach. The overall and match incidence rates in elite male futsal players were 6.8 (95% CI = 0.0-15.2) and 44.9 (95% CI = 17.2-72.6) injuries/1000 hours of exposure. Pooled training injury rate in male players was not calculated due to the lack of studies reporting training injuries in this cohort. For females, an overall, training and match incidence rates of 5.3 (95% CI = 3.5-7), 5.1 (95% CI = 2.7-7.6) and 10.3 (95% CI = 0.6-20.1) injuries/1000 hours of exposure were reported. In males, match incidence rate in International tournaments was 8.5 times higher than in national leagues (77.2 [95% CI = 60.0-94.5] vs 9.1 [95% CI = 0.0-19.3] for international tournaments and national leagues, respectively). Elite male and female futsal players are exposed to a substantial risk of sustaining injuries, especially during matches.

Risk of Injury in Moral Dilemmas With Autonomous Vehicles.

As autonomous machines, such as automated vehicles (AVs) and robots, become pervasive in society, they will inevitably face moral dilemmas where they must make decisions that risk injuring humans. However, prior research has framed these dilemmas in starkly simple terms, i.e., framing decisions as life and death and neglecting the influence of risk of injury to the involved parties on the outcome. Here, we focus on this gap and present experimental work that systematically studies the effect of risk of injury on the decisions people make in these dilemmas. In four experiments, participants were asked to program their AVs to either save five pedestrians, which we refer to as the utilitarian choice, or save the driver, which we refer to as the nonutilitarian choice. The results indicate that most participants made the utilitarian choice but that this choice was moderated in important ways by perceived risk to the driver and risk to the pedestrians. As a second contribution, we demonstrate the value of formulating AV moral dilemmas in a game-theoretic framework that considers the possible influence of others' behavior. In the fourth experiment, we show that participants were more (less) likely to make the utilitarian choice, the more utilitarian (nonutilitarian) other drivers behaved; furthermore, unlike the game-theoretic prediction that decision-makers inevitably converge to nonutilitarianism, we found significant evidence of utilitarianism. We discuss theoretical implications for our understanding of human decision-making in moral dilemmas and practical guidelines for the design of autonomous machines that solve these dilemmas while, at the same time, being likely to be adopted in practice.

Risk of Injury in Physically Active Students: Associated Factors and Quality of Life Aspects.

BACKGROUND: The aim of this study was to assess the potential factors of hypermobility and pain threshold on the risk of injury in physically active students and to verify which domains of quality of life are rated lower by young people with a history of injuries. METHODS: The study included 278 students (138 women and 140 men) who regularly undertake physical activity. Anthropometric measurements, body composition, pain threshold, incidence of hypermobility syndrome, information on the history of injuries to the locomotor system, and the quality of life of the study participants were collected. RESULTS: In the group studied, hypermobility and pain threshold had a statistically significant related on the risk of injury. Participants with a history of injuries had lower scores for an individual's overall perception of their own health and the physical domain. There were also significant differences in the psychological domain of the quality of life between males and females with a history of injuries. CONCLUSION: In the studied group, the risk of injuries was related to diagnosed hypermobility and pain threshold measured on the lower limbs. The study also showed that people with a history of injuries had statistically significantly lower scores in the individual general perception of their own health and in the physical domain. Gender had a significant impact on the quality of life of people with injuries.

Smartphone-Based Answering to School Subject Questions Alters Gait in Young Digital Natives.

Smartphone texting while walking is a very common activity among people of different ages, with the so-called "digital natives" being the category most used to interacting with an electronic device during daily activities, mostly for texting purposes. Previous studies have shown how the concurrency of a smartphone-related task and walking can result in a worsening of stability and an increased risk of injuries for adults; an investigation of whether this effect can be identified also in people of a younger age can improve our understanding of the risks associated with this common activity. In this study, we recruited 29 young adolescents (12 ± 1 years) to test whether walking with a smartphone increases fall and injuries risk, and to quantify this effect. To do so, participants were asked to walk along a walkway, with and without the concurrent writing task on a smartphone; several different parameters linked to stability and risk of fall measures were then calculated from an inertial measurement unit and compared between conditions. Smartphone use determined a reduction of spatio-temporal parameters, including step length (from 0.64 ± 0.08 to 0.55 ± 0.06 m) and gait speed (1.23 ± 0.16 to 0.90 ± 0.16 m/s), and a general worsening of selected indicators of gait stability. This was found to be mostly independent from experience or frequency of use, suggesting that the presence of smartphone activities while walking may determine an increased risk of injury or falls also for a population that grew up being used to this concurrency.

["Hybrid tracheostomy": a low risk procedure for tracheostomy in COVID-19 patients]. / "Hybridtracheostomie" ­ ein risikoarmes Verfahren der Tracheostomie bei COVID-19-Patienten.

BACKGROUND: Tracheostomy in ventilated patients suffering from Coronavirus disease 2019 (COVID-19) carries an increased risk of exposure to virus-containing aerosol for the staff. OBJECTIVE: Evaluation of a risk-reduced procedure for tracheostomy. METHOD: Presentation of "hybrid tracheostomy": a method combining the advantages of conventional surgical and percutaneous dilative tracheostomy. RESULTS: Tracheostomy of six patients using the hybrid method without any complications. CONCLUSION: "Hybrid tracheostomy" offers a minimally invasive and safe procedure with low risk of exposure to virus-containing aerosol.

Alternative Methods of Determining Hamstrings-to-Quadriceps Ratios: a Comprehensive Review.

The hamstrings-to-quadriceps muscle strength ratio calculated by peak torque has been used as an important tool to detect muscle imbalance, monitor knee joint stability, describe muscle strength properties and functionality, and for lower extremity injury prevention and rehabilitation. However, this ratio does not consider other neuromuscular variables that can also influence the antagonist to agonist muscle relationship, such as torque produced at multiple angles of range of motion, explosive strength, muscle size, muscle fatigue, or muscle activation. The aim of this study was to comprehensively review alternative methods of determining the hamstrings-to-quadriceps ratio. These include ratios calculated by angle-specific torque, rate of torque development, muscle size, fatigue index, and muscle activation (measured by electromyography). Collectively, the literature demonstrates that utilizing alternative methods of determining the hamstrings-to-quadriceps ratio can be functionally relevant for a better understanding of the neuromuscular mechanisms underpinning the interaction of strength between hamstrings and quadriceps. However, there is insufficient evidence to recommend any of the alternative methods as sensitive clinical tools for predicting injury risk and monitoring knee joint integrity. Future longitudinal studies, along with injury incidence, are needed to further investigate all alternative methods of determining the hamstrings-to-quadriceps ratio. These have potential to offer insight into how athletes and the general population should be trained for performance enhancement and injury reduction, and may be used along with traditional methods for a thorough assessment of an individual's H:Q muscle balance.