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This article presents a brief history and literature review of chronic traumatic encephalopathy (CTE) in professional athletes that played contact sports. The hypothesis that CTE results from concussion or sub-concussive blows is based largely on several case series investigations with considerable bias. Evidence of CTE in its clinical presentation has not been generally noted in studies of living retired athletes. However, these studies also demonstrated limitation in research methodology. This paper aims to present a balanced perspective amidst a politically charged subject matter.

While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a cause and effect relationship has not yet been demonstrated between CTE and concussions or between CTE and exposure to contact sports, as no prospective longitudinal studies have been performed to address that question. Studies of high-school sports exposure and long-term outcomes have not demonstrated consistent findings.Medical advice regarding return to play and the risk of acute and/or long-term consequences is therefore problematic. It is important that the individual’s right to make their own choices regarding their health is respected. Team, coach, parental, peer or financial pressures should not influence this decision. The choice to return to play after a concussion or mild TBI injury is the athlete’s decision once they have (1) recovered from their injury and have the legal capacity to make an informed decision; (2) been medically assessed and (3) been informed of any possible long-term risks in a language that they can understand.Given the current lack of certainty in relation to long-term outcomes from concussion, is it possible to provide a framework to inform players of current evidence, as part of a consent process, even if the information upon which the decision to return to sport is based remains uncertain and evolving?

OBJECTIVE: The recently published Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury (mTBI) was developed following an extensive review of the scientific literature. Through this review, experts identified limitations in existing pediatric mTBI research related to study setting and generalizability, mechanism of injury and age of cohorts studied, choice of control groups, confounding, measurement issues, reporting of results, and specific study design considerations. This report summarizes those limitations and provides a framework for optimizing the future quality of research conduct and reporting. RESULTS: Specific recommendations are provided related to diagnostic accuracy, population screening, prognostic accuracy, and therapeutic interventions. CONCLUSION: Incorporation of the recommended approaches will increase the yield of eligible research for inclusion in future systematic reviews and guidelines for pediatric mTBI.

The consensus definition of concussion was only agreed in 20011 which means that concussion has just turned 18. It must, therefore, be viewed as an unruly teenager, rebellious and changing, but finally beginning to mature. Along the way, there has been a book, a film, extensive litigation and legislation, millions of words written in the media, thousands of peer-reviewed articles, more consensus meetings, more books and the threat of still more litigation. Hardly a week goes by without another story about concussion hitting the headlines and the centre of the concussion maelstrom is the USA. In terms of global participation, volleyball leads the field with 998 million participants, followed by basketball (400 m), soccer (242 m), badminton (200 m) and tennis (60 m). Not the strongest line-up for sports involving concussion and in the USA, the list is only slightly …

Importance Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. Objective To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. Evidence Review The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015. Findings The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment. Conclusions and Relevance This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.

Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, and Department of Defense, the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of clinical research studies and clinical treatment outcomes, increase data quality, facilitate data sharing across studies, reduce study start-up time, more effectively aggregate information into metadata results, and educate new clinical investigators. The SRC CDE Working Group consisted of 32 worldwide experts in concussion from varied fields of related expertise divided into three Subgroups: Acute (3 months post-concussion). To develop CDEs, the Subgroups reviewed various domains, then selected from, refined, and added to existing CDEs, case report forms and field-tested data elements from national registries and funded research studies. Recommendations were posted to the NINDS CDE Website for Public Review from February 2017 to April 2017. Following an internal Working Group review of recommendations, along with consideration of comments received from the Public Review period, the first iteration (Version 1.0) of the NINDS SRC CDEs was completed in June 2017. The recommendations include Core and Supplemental–Highly Recommended CDEs for cognitive data elements and symptom checklists, as well as other outcomes and end-points (e.g., vestibular, oculomotor, balance, anxiety, depression), and sample case report forms (e.g., injury reporting, demographics, concussion history) for domains typically included in clinical research studies. The NINDS SRC CDEs and supporting documents are publicly available on the NINDS CDE website www.commondataelements.ninds.nih.gov. Widespread use of CDEs by researchers and clinicians will facilitate consistent SRC clinical research and trial design, data sharing, and metadata retrospective analysis.

OBJECTIVE: To conduct a systematic review of the literature regarding assessment and treatment modalities in patients with persistent symptoms following sport-related concussion (SRC). DATA SOURCES: We searched Medline, Embase, SPORTSDiscus, PsycINFO, CINAHL, Cochrane library and ProQuest Dissertation & Theses Global electronic databases. STUDY ELIGIBILITY CRITERIA: Studies were included if they were original research, reported on SRC as the primary source of injury, included patients with persistent postconcussive symptoms (>10 days) and investigated the role of assessment or treatment modalities. RESULTS: Of 3225 articles identified in the preliminary search, 25 articles met the inclusion criteria. 11 articles were concerned with assessment and 14 articles with treatment of persistent symptoms following SRC. There were three randomised control trials and one quasi-experimental study. The remainder consisting of cross-sectional studies, historical cohorts and case series. SUMMARY: 'Persistent symptoms' following SRC can be defined as clinical recovery that falls outside expected time frames (ie, >10-14 days in adults and >4 weeks in children). It does not reflect a single pathophysiological entity, but describes a constellation of non-specific post-traumatic symptoms that may be linked to coexisting and/or confounding pathologies. A detailed multimodal clinical assessment is required to identify specific primary and secondary processes, and treatment should target specific pathologies identified. There is preliminary evidence supporting the use of symptom-limited aerobic exercise, targeted physical therapy and a collaborative approach that includes cognitive behavioural therapy. Management of patients with persistent symptoms is challenging and should occur in a multidisciplinary collaborative setting, with healthcare providers with experience in SRC.

Objective Systematic review of possible long-term effects of sports-related concussion in retired athletes. Data sources Ten electronic databases. Study selection Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as >10 years after the injury. Data extraction Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors. Results Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes. Conclusion Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.

This work presents a systematic evaluation of the influence of lipids and casein on the performance of a chromatographic capture step for the recovery of a target protein from transgenic milk. Lactoperoxidase (LPO) was spiked at concentrations typical of those to be expected for transgenic proteins in commercial bovine milk and the dynamic adsorption of LPO to fixed beds of SP Sepharose FF studied in frontal analysis experiments. By removing successively selected components from whole milk, their individual influence on the dynamic adsorption behaviour of LPO could be studied. A mathematical model, fitted to the breakthrough curves of LPO, provided a quantitative measure of parameters describing mass transfer and adsorption in the column. A significant reduction in column capacity for LPO in the presence of milk or whey was recorded, which could be attributed to competing adsorption of alkaline earth metal ions to the cation exchange resin. While the high concentrations of lipids present in whole milk did strongly reduce the column permeability, no significant influence of either casein or low concentrations of lipids on the hydraulic properties of columns or on the adsorption of LPO could be detected. The results indicate that chromatography, which forms an essential part of all current large-scale processes for the recovery of proteins from transgenic milk, could potentially be moved further upstream. Alternatively, existing operations for the removal of lipid and casein could be re-designed so as to maximise product yields. This suggests that significant product losses during current pre-chromatography milk purification could be reduced or potentially even avoided.

Background:It has been previously shown that professional jockeys suffer high rates of fatal and non-fatal injuries in the pursuit of their occupation. Little is known, however, about differences in injury rates between countries.Aim:To determine the rate of fatal and non-fatal injuries in flat and jump jockeys in France and to compare the injury rates with those in Great Britain and IrelandMethod:Prospectively collected injury data on professional jockeys were used as the basis of the analysis.Results:Limb fractures occur four times more often in both flat and jump racing in France than in Great Britain. Similarly dislocations are diagnosed 20 times more often in flat and three times more often in jump racing. This difference is surprising given that French jockeys have fewer falls per ride than their British counterparts in flat racing, although they do have more falls than the British in jump racing. Similarly concussion rates seem to be higher in French jockeys, although there may be a difference in the diagnostic methods used in the different countries. By contrast, soft tissue injuries account for a far smaller percentage of injuries than in Great Britain.Conclusion:There are striking differences in injury rates between countries which may be explained in part by a difference in track conditions—for example, harder tracks in France—or different styles of racing—for example, larger fields of horses per race in France.

Professional horse racing is an exciting and demanding sport with high injury rates. Surprisingly few epidemiological studies have been published and no prospective studies have been reported. This paper reviews the literature and provides a detailed breakdown of injuries in Great Britain and the Republic of Ireland for 1992-2000. The introduction of protective equipment is discussed and evidence for its effectiveness put forward.

Cross-linked enzyme crystals (CLECs) are a novel form of immobilized biocatalyst designed for application in industrial biotransformation processes. In this work we have investigated the mechanical stability of agitated CLEC suspensions in relation to the design and scale-up of bioconversions carried out in stirred-tank reactors. By careful control of the crystallization conditions yeast alcohol dehydrogenase I (YADHI) microcrystals of different size were first prepared having either an hexagonal (approximately 12 microm) or rod-shaped (approximately 4.6 microm) morphology. These were then cross-linked with glutaraldehyde to form CLECs. The rate of breakage of the CLEC suspensions was subsequently measured in a rotating disk shear device (total volume, 11 mL) by monitoring the change in crystal size distribution with time. This device is designed to mimic the shear and energy dissipation rates found in a range of process scale equipment and may be used to study the mechanical stability of any immobilized biocatalyst preparation. Experiments were performed as a function of the speed and duration of disk rotation, CLEC concentration (0.26-2.5 mg.mL(-1)) and energy dissipation rate (2.2 x 10(3) to 6.8 x 10(5) W.kg(-1)). No breakage of the rod-shaped CLECs was observed over the entire range of experimental conditions investigated. Breakage of the larger hexagonal-shaped CLECs did occur, however, at energy dissipation rates, epsilon(max), above 1.0 x 10(5) W.kg(-1), where the calculated length scale of turbulence was around 2.0 microm. Based on visual observation of the sheared CLEC suspensions and models of crystal breakage, it was concluded that breakage of the hexagonal-shaped CLECs occurred due to shear induced attrition. Measurement of the catalytic activity of both the hexagonal and rod-shaped CLECs showed no significant change in activity before and after shearing.

Crystallization has recently emerged as a suitable process for the manufacture of biocatalysts in the form of cross-linked enzyme crystals (CLECs) or for the recovery of proteins from fermentation broths. In both instances it is essential to define conditions which control crystal size and habit, and that yield a reliable recovery of the active protein. Experiments to define the crystallization conditions usually depend on a factorial design (either incomplete or sparse matrix) or reverse screening techniques. In this work, we describe a simple procedure that allows the effect of three factors, for example protein concentration, precipitant concentration and pH, to be varied simultaneously and smoothly over a wide range. The results are mapped onto a simple triangular diagram where a 'window of crystallization' is immediately apparent, and that conveniently describes variations either in the crystal features, such as their yield, size, and habit, or in the recovery of biological activity. The approach is illustrated with two enzymes, yeast alcohol dehydrogenase (ADH I) and Candida rugosa lipase. For ADH the formation of two crystal habits (rod and hexagonal) could be controlled as a function of pH (6.5-10) and temperature (4-25 degrees C). At pH 7, in 10 to 16% w/v polyethylene glycol (PEG) 4000, only rod-shaped crystals formed whereas at pH 8, in 10 to 14% w/v PEG, only hexagonal crystals existed. For both enzymes, catalyst recovery was greatest at high crystallization agent concentrations and low protein concentration. For ADH, the greatest activity recovery was 87% whereas for the lipase crystals, by using 45% v/v 2-methyl-2,4-pentanediol (MPD) as the crystallization agent, a crystal recovery of 250 crystals per µl was obtained. For the lipase system, the use of crystal seeding was also shown to increase the crystal recovery by up to a factor of four. From the crystallization windows, the original conditions based on literature precedent (35% v/v MPD, 1 mM CaCl(2), 1.8 mg protein/ml) were altered (47.5% v/v MPD, 2 mM CaCl(2), 3 mg protein/ml). This led to an improved recovery of the lipase under conditions that scale reliably from 0.5 ml to 500 ml with no change in size, shape or recovery of the crystals themselves. Finally, these crystals were crosslinked with 5% v/v glutaraldehyde and mass and activity balances were calculated for the entire process of CLEC production. Up to 35% of the lipase activity present in the crude solid was finally recovered in the lipase CLECs after propan-2-ol fractionation, crystallization, and crosslinking.

Cross-linked enzyme crystals (CLECs®) are a novel form of immobilised biocatalyst designed for application in large-scale biotransformation processes. In this work we review the production and characterisation of CLECs® prepared from three enzymes (yeast alcohol dehydrogenase I (YADHI), Candida rugosa lipase and α-chymotrypsin) over a range of crystallisation and cross-linking conditions. Optimisation and control of the crystallisation process, with respect to crystal form and enzyme activity yield, was facilitated by the use of triangular crystallisation diagrams which allowed three parameters (e.g. protein concentration, precipitant concentration and pH) to be varied simultaneously. These diagrams showed regions, or 'crystallisation windows', in which particular crystal forms or optimal activity recoveries (up to 87%) could be obtained. They also identified conditions for reproducible scale-up of the lipase crystallisation from 0.5 to 500 mL scale.In order to evaluate the suitability of a particular bat...

Background: It has been previously shown that professional jump and flat racing jockeys suffer a high incidence of injury as a consequence of their profession. This paper specifically examines career-ending injuries to professional jockeys in Great Britain. Aims: To investigate career-ending injuries in professional jockeys. Method: Analysis of prospectively collected injury database on professional jockeys. Results: The majority of injuries in this study occurred to the head, shoulder or torso. Fractures were the most common type of injury that led to a decision to end a career, followed by neurological injury to the head and/or spine. Conclusion: Injuries to the head are the most common career-ending injuries, and consideration of injury counter measures could be an important strategy in equestrian sports.

When I was a baby doctor who only shaved once a week, I used to give a talk entitled Child Protection. The audience invariably thought that this was going to be a gentle guide to helmets and mouthguards and were distinctly uncomfortable when my starting sentence was 'As you know, youth sport is a magnet for paedophiles'. The fact that this was in 1994, in the wake of the Hickson swimming scandal, shows just how long it has taken some sports to wake up to the problem. Safeguarding athletes from exploitation and abuse should be the no. 1 priority for everyone involved in sport. However, no. 2 on our priority list should be safeguarding athletes from ignorance, a problem that has frustrated sports physicians since the dawn of time. From the moment that an athlete ruptures an ACL, their knee is doomed. You can speed up the rate of deterioration by encouraging the athlete to return to the activity that caused the injury in …

Biocatalysis has an established role in the manufacture of organic chemicals: glucose isomerase catalyses the manufacture of about 8 × 10 6 tonnes of isoglucose each year, and the annual output of many other reactions exceeds 10 3 tonnes. However, there is a need for a more-varied range of catalysts, and future developments in polymer synthesis may lead to the creation of enzymes that display broader specificity and selectivity. Whether catalysts are isolated from natural sources or are produced chemically, the engineering required to create an efficient and economic process is crucial. New developments should allow the technology to extend well beyond its present base in the pharmaceutical industry.

Methods used in the manufacture of both ethanol and ascorbic acid have been developed over the past 150 years. The early stages of the development of both processes were characterized by the interaction between chemists, biologists and engineers, but social and economic influences also played their part. The history of these two examples illustrates the diversity of skills and influences needed for the application of biological catalysis to large-scale chemical manufacture.

The growth of Escherichia coli in fed-batch and continuous culture is examined and results show that α-amylase production is strongly dependent on specific growth rate (dilution rate) of the culture and production is greatest at an intermediate rate. Using continuous culture, it has also been found that the presence of acetate above a certain concentration reduces both μmax, and the production of recombinant protein.

Introduction There are basically two strategies for carrying out biotransformations: (1) to use pure or partially purified enzymes isolated by the investigator or purchased from a commercial supplier, or (2) to use whole cells. Enzymes are categorized by the Enzyme Commission (EC) according to their functions (Table 2.1), and each individual enzyme is given a unique code made up of four numbers, such as 2.1.2.4. These reference numbers are derived as follows: The first number indicates the class (1 through 6; see Table 2.1). The second number in the series indicates the subclass. For oxidoreductases, the subclass number indicates the type of group in the donor which undergoes oxidation (1 denoting a secondary alcohol group, 2 denoting an aldehyde or ketone unit, etc.); for transferases, it gives an indication of the functional group which is transferred (1 indicates the transfer of a one-carbon unit); for the hydrolases, it earmarks the functional group hydrolyzed (1 is used when an ester group is hydrolyzed); for the lyases, it indicates the group HX (3 indicates the addition of ammonia); for the isomerases, it shows the type of isomerization (2 indicates alkene cis-trans isomerization); for ligases, it indicates the type of bond formed (4 indicates carbon-carbon bond formation). The third number in the series serves to allocate the enzyme to a sub-subclass. For oxidoreductase enzymes, this third number shows the type of acceptor involved [e.g. 1 denotes a co-enzyme, such as nicotinamideadenine dinucleotide phosphate (NADP); 2 denotes a cytochrome; 3 denotes molecular oxygen].

Introduction Biological catalysis has such a pervasive influence on the industries which are closely associated with our daily lives that it is difficult to contain a short review within sensible bounds. The traditional large-scale crafts associated with agriculture, the manufacture of foods and drinks, and the preparation and cleaning of fabrics all use biological catalysis. At the other extreme, biological catalysis has an important role to play in analytical chemistry. Enzymes are used to monitor the levels of metabolites as an important feature in the diagnosis and therapy of disease. These techniques have been extended to the use of enzymes to amplify the responses in antibodybased assays, as well as to mediate the detection of an environmental pollutant at an electrode. The same catalysts also play a role in the degradation of pollutants, which is, perhaps, simply an extension of the role of biochemistry applied to the traditional craft of cleaning. However, it is the use of enzymes in the large-scale manufacture of synthetic organic chemicals which is the main topic of this chapter. The recent interest amongst organic chemists arises from the high degrees of specificity and selectivity that characterize enzyme catalysis. That this is a valuable resource in manufacture cannot be doubted, as judged by the value of the products which it produces. Nevertheless, the methodology should not be oversold. Biocatalysis has a part to play in the modern chemical industry, but it also has limits which it is necessary to understand.

Agriculture competes with microbiology and experimental biochemistry as a resource for the discovery and synthesis of new drugs. In contrast, little of the benefit of legal manufacture returns to agriculture. Plants may lay claim to the input raw material in 25% of all prescriptions, but the safety, added value and efficacy of the drugs themselves are created by the pharmaceutical and fine chemical industries. These industries often replace the agricultural input with material from petrochemical sources, and those which remain are either small in volume or are byproducts of a large volume process. High product costs reflect difficult purifications and extensive chemistry rather than a genuine agricultural value. Modern developments with transgenic animals and plants are unlikely to change this situation. Even where the pharmaceutical industry finds plants or large animals useful for the manufacture of some products, the production itself is likely to stay within the pharmaceutical industry, if only to ensure adequate standards of safety and hygiene. Moreover, the same techniques which allow the biosynthesis of some products to be transferred to plants and animals allow the transfer of others back to cells suitable for growth in fermenters, allowing the fine chemical industry to replace even more of the agricultural output which enters the pharmaceutical industry.

Objective. Vitamin D inadequacy is associated with medication refractory musculoskeletal pain and neuromuscular dysfunction. This vitamin deficiency could subsist as an unrecognized comorbid condition among patients with chronic pain. The primary objective of this study was to determine the prevalence and clinical correlates of vitamin D inadequacy in patients seeking treatment for chronic pain. Design. Retrospective case series. Setting. Multidisciplinary pain rehabilitation center at a tertiary referral medical center. Patients. The study involved 267 chronic pain patients admitted from February to December 2006. Intervention. Serum 25-hydroxyvitamin D (25[OH]D) was drawn at admission. Outcome Measures. Patients with serum 25[OH]D levels ≤20 ng/mL were considered to have inadequate levels and those with levels >20 ng/mL were considered to have adequate levels. Upon admission, opioid intake was documented and patients completed the Short Form-36 Health Status Questionnaire. Results. The prevalence of vitamin D inadequacy was 26% (95% confidence interval, 20.6–31.1%). Among patients using opioids, the mean morphine equivalent dose for the inadequate vitamin D group was 133.5 mg/day compared with 70.0 mg/day for the adequate group (P = 0.001). The mean duration of opioid use for the inadequate and adequate groups were 71.1 months and 43.8 months, respectively (P = 0.023). Opioid users with inadequate levels reported worse physical functioning (P = 0.041) and health perception (P = 0.003) than opioid users with adequate levels. Conclusion. The prevalence and clinical correlates identified in this pilot study provide the basis for the assertion that vitamin D inadequacy may represent an under-recognized source of nociception and impaired neuromuscular functioning among patients with chronic pain.

Objectives: To provide a breakdown of injury incidence from amateur jump racing (also known as point to point racing) in Great Britain and Ireland during 1993–2006 and to compare the injury epidemiology with professional horse racing in Great Britain, Ireland and France. Design: Retrospective review. Setting: Great Britain and Ireland. Participants: Amateur jockeys. Main outcome measures: Injury rates. Results: Injury data suggest that point to point racing is more dangerous from an injury point of view than professional jump racing, which has previously been shown to be more dangerous than flat racing. Amateur jockeys have more falls than their professional counterparts, and this in turn puts them at greater risk of sustaining more serious injuries. Conclusions: Amateur (point to point) jockeys represent a sporting population that previously has been little studied. They represent a group at high risk of injury, and hence formal injury surveillance tracking and counter measures for injury prevention are recommended.

Little evidence exists to guide the selection of methods for teaching clinical diagnosis.To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students.Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost.Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p = .17) and Headache checklist (56% vs. 63%; p = .07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p = .006), but not the Headache SOAP note (69% vs. 67%; p = .85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at 2,190 dollars for the SP format and 2,250 dollars for the WB format. Ongoing costs per case per student were estimated to be 45 dollars for the SP format and 30 dollars for the WB format.WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy.

Principal component analysis (PCA) has been used for the modeling of nonlinear chromatography under overload conditions. A 10-fold range of crude erythromycin samples were loaded onto columns with different stationary-phase chemistries (2 polystyrene, 1 methacrylate) in direct proportion to the bed volumes. The elution profiles indicated slightly concave isotherms for the polystyrene supports and a convex Langmuirian isotherm for the methacrylic support used. The principal component models accounted for over 98% of the original variance in the data for all three columns and were able to give excellent models of complete chromatograms in the absence of first-principle models or physicochemical data. Correlations between sample mass and the principal component scores were made for each that were consistent for the column types despite the different geometries and stationary phases. Linear relationships with high correlation coefficients were observed when the scores of the same principal component were compared between columns. Such correlations offer considerable potential for modeling of nonlinear chromatography.

An 18.3 m (60 ft) simple span bridge is South Carolina's first use of a glass fiber reinforced polymer (GFRP) bridge deck system. This paper describes the initial preparation and instrumentation of this structure including the use of surveying techniques to determine overall bridge deflections. Also outlined are the procedures used for in situ load testing the bridge. Critical design criteria such as overall deflections, effective deck widths, bending of the GFRP deck and moment distribution factors are reported for this structure. Data collected indicates that the GFRP deck and steel girders are acting in a composite manner and that the deck system is relatively stiff despite the large girder spacing used. Over the course of the next several years this bridge will be tested on a regular basis to establish the long-term performance of the GFRP deck system.

Candida cloacae cells oxidize long-chain fatty acids to their corresponding dicarboxylic acids (dioic acids) at rates dependent on their chain length and degree of saturation. This is despite the well-known toxicity of the fatty acids. Among the saturated substrates, the oxidation is limited to lauric acid (C12). The addition of pristane (5% v/v), which acts as an inert carrier for the poorly water-soluble substrate, boosts the oxidation of lauric acid to a rate that is comparable to that of dodecane. When dissolved in pristane, myristic (C14) and palmitic (C16) acids are effective carbon sources for C. cloacae, but dioic acid production is very low. Media glucose concentration and pH also influence cell growth and productivity. After the glucose is depleted, oxidation is optimal at a low pH. A two-phase (pristane/water) reaction was tested in a 2-l stirred tank bioreactor in which growth and oxidation were separated. A 50% w/w conversion of lauric acid (10 g/l) to dodecanedioic acid was achieved. The bioreactor also alleviated poor mass transfer characteristics experienced in shake flasks.

At a lunchtime ceremony in Buckingham Palace on 15 October 2008, Professor Roald Bahr was presented with the Prince Philip Medal by His Royal Highness, The Duke of Edinburgh, KG, KT. The medal was awarded to Professor Bahr by the Institute of Sport and Exercise Medicine (ISEM), an organisation founded in 1958 and of which HRH The Duke of Edinburgh is an Honorary Fellow. The Institute was founded by Peter Sebastian and the first Chairman was Sir Arthur Porritt, President of the Royal College of Surgeons of England and later Governor-General of New Zealand. The ISEM, and its Honorary Fellow, played a significant role in the establishment of Sport and Exercise Medicine as a speciality in the UK. At a dinner hosted by HRH The Duke of Edinburgh, held at St James Palace in 1996, HRH urged the President of the Academy of the Medical Royal Colleges, Dame Fiona Caldicott, to revisit the establishment of sports medicine as a speciality after the Academy had …

Not long ago, strawberries and raspberries had a limited summer season, which was eagerly anticipated and never seemed to last long enough. Salads were exclusively a feature of summer lunches (lettuces did not stay fresh in storage) and winter saw a seemingly endless supply of root vegetables (which did store well and most people hated with a passion). Now we expect to have a choice of produce that takes no account of the season and relies on our fruits and vegetables collecting more air miles than Charley Veley (reputed to be the most travelled man in the world having visited 807 of the 871 countries in the world (Observer, 28 February 2010)). The same applies to modern professional and elite sport; what was once the off season (a time to take a holiday and relax) is now an opportunity for athletes and teams to tour abroad and to compete at the highest level. In Great Britain, all the major professional sports (soccer, tennis, horseracing, cricket and rugby) involve an 11+ month …

Results presented here show that loss of progesterone 11α-hydroxylase activity in Rhizopus nigricans in aqueous-organic two-liquid phase and cosolvent systems correlates well with the concentration of solvent in the cell membranes . Rhizopus nigricans is shown to retain full 11α-hydroxylase activity at saturating aqueous phase concentrations of hexane and the higher primary alcohols. This reflects their inability to attain a critical concentration in the cell membranes. The relationship between our own findings and the previously described correlation of the logarithm of the partition coefficient with activity retention is explained and design parameters are proposed that may be used to select solvents for future biocatalytic systems .

This paper adds to the small body of literature available on horse-related injuries by clearly highlighting the need for …

Principal component analysis (PCA) was used to analyse the behaviour of a chromatographic separation as its scale increased. Three 4.6 mm diameter columns identical in every respect except for column length (25, 15 and 5 cm), were used to generate the data from a test system based on the reversed-phase HPLC separation of crude erythromycin on a polystyrene matrix (PLRP 1000) having a particle diameter of 8 mu;m and a pore diameter of 100 nm. The species were separated with an isocratic solvent composed of 45/55 acetonitrile/water at about pH 7. An experimental design technique was used to investigate the effects of four process variables (load volume, load concentration, temperature and pH of buffer) on the chromatogram shapes. Following appropriate pre-processing of the chromatographic data, subsets of critical chromatograms were selected which sufficiently characterised the entire data set. From this subset, the corresponding runs were performed on the different sized columns and principal component models were generated for each. At 5 and 15 cm a single principal component was sufficient to characterise all the variance in the chromatograms which the range of process variables introduced, but at 25 cm two principal components were required, particularly to characterise the chromatograms with small loads. Excellent correlations were observed between the first principal components at the three scales. The possibility of predicting the separations on the 25 cm column from an analysis of the separations observed at 5 cm was investigated. The study revealed that good predictions could be made at high loads (>92%) , but the model was not effective at low loads because of the need to incorporate a second principal component which was not defined by the range of variables applied to the 5 cm column.