Description:
Background Clinically it is understood that rapid increases in training loads expose an athlete to an increased risk of injury; however, there are no systematic reviews to qualify this statement. Objective The aim of this systematic review was to determine training and competition loads, and the relationship between injury, illness and soreness. Methods The MEDLINE, SPORTDiscus, CINAHL and EMBASE databases were searched using a predefined search strategy. Studies were included if they analysed the relationship between training or competition loads and injury or illness, and were published prior to October 2015. Participants were athletes of any age or level of competition. The quality of the studies included in the review was evaluated using the Newcastle-Ottawa Scale (NOS). The level of evidence was defined as strong, 'consistent findings among multiple high-quality randomised controlled trials (RCTs)'; moderate, 'consistent findings among multiple low-quality RCTs and/or non-randomised controlled trials (CCTs) and/or one high-quality RCT'; limited, 'one low-quality RCT and/or CCTs, conflicting evidence'; conflicting, 'inconsistent findings among multiple trials (RCTs and/or CCTs)'; or no evidence, 'no RCTs or CCTs'. Results A total of 799 studies were identified; 23 studies met the inclusion criteria, and a further 12 studies that were not identified in the search but met the inclusion criteria were subsequently added to the review. The largest number of studies evaluated the relationship between injuries and training load in rugby league players (n = 9) followed by cricket (n = 5), football (n = 3), Australian Football (n = 3), rugby union (n = 2), volleyball (n = 2), baseball (n = 2), water polo (n = 1), rowing (n = 1), basketball (n = 1), swimming (n = 1), middle-distance runners (n = 1) and various sports combined (n = 1). Moderate evidence for a significant relationship was observed between training loads and injury incidence in the majority of studies (n = 27, 93 %). In addition, moderate evidence exists for a significant relationship between training loads and illness incidence (n = 6, 75 %). Training loads were reported to have a protective effect against injury (n = 9, 31 %) and illness (n = 1, 13 %). The median (range) NOS score for injury and illness was 8 (5-9) and 6 (5-9), respectively. Limitations A limitation of this systematic review was the a priori search strategy. Twelve further studies were included that were not identified in the search strategy, thus potentially introducing bias. The quality assessment was completed by only one author. Conclusions The results of this systematic review highlight that there is emerging moderate evidence for the relationship between the training load applied to an athlete and the occurrence of injury and illness. Implications The training load applied to an athlete appears to be related to their risk of injury and/or illness. Sports science and medicine professionals working with athletes should monitor this load and avoid acute spikes in loads. It is recommended that internal load as the product of the rate of perceived exertion (10-point modified Borg) and duration be used when determining injury risk in team-based sports. External loads measured as throw counts should also be monitored and collected across a season to determine injury risk in throwing populations. Global positioning system-derived distances should be utilised in team sports, and injury monitoring should occur for at least 4 weeks after spikes in loads.
Description:
Disturbance has been considered essential for maintaining biodiversity in temperate grassy ecosystems in Australia. This has been particularly well demonstrated for inter-tussock plant species in C-4 Themeda-dominated grasslands in mesic environments. Disturbance is also thought crucial to maintain the structure of preferred habitat for some animals. Relationships between disturbance and diversity may be contingent on ecosystem productivity, but little is known about the generality of the disturbance-promoting-diversity paradigm across the range of temperate grasslands. To date, the disturbance-promoting-diversity paradigm has taken a univariate approach to the drivers of biodiversity; rainfall is seen as a key driver of productivity, which then drives diversity, mediated by disturbance. We argue that this framework is too simplistic as biodiversity drivers are multivariate. We suggest that the accumulation of phytomass (live and dead plant material) is an important determinant of diversity in grassy ecosystems and that phytomass accumulation is governed by multiple drivers (of which disturbance is just one). For fauna, it is structure - not biomass - that determines habitat suitability, and this can be moderated by both abiotic and biotic drivers. The assumption that there is a consistent effect of disturbance on diversity through the range of temperate grassland settings in southern Australia ignores the likelihood that biodiversity also responds to other factors such as spatial heterogeneity in the environment, resource availability and climatic variation. We developed a conceptual model of the multivariate drivers of grassland diversity that explores mechanisms underpinning patterns of species richness. Despite four decades of research, it is clear that our understanding of the multivariate drivers of diversity across the range of temperate grasslands in Australia is still incomplete. Further research into the conditions under which disturbance is required to maintain biodiversity in grasslands is integral to conservation planning in these endangered systems.
Description:
Arsenic contamination of drinking water, which can occur naturally or because of human activities such as mining, is the single most important public health issue in Bangladesh. Fifty out of the 64 districts in the country have arsenic concentration of groundwater exceeding 50 µg L
Description:
Background: A recent meta-analysis left open a significant question regarding altered time perception in depression: Why do depressed people overproduce short durations and under-produce longer durations if their present experience is that time flows slowly? Experience and judgement of time do not seem to accord with one another. Analysis: By excluding two of the six studies on methodological grounds from a previous meta-analysis of medium-length interval productions, and re-analysing the remaining four studies, the present paper finds that subjective time accelerates from initial dilation within present experience (approximately 1 s duration) to subsequent acceleration within working memory (approximately 30 s duration) when depressed. Proposals: It is proposed that depressive time dilation and acceleration refer to the default mode and central executive networks, respectively. The acceleration effect is suggested to occur due to mood congruency between long intervals, boredom, and depression. This mood congruency leads to the automatic recall of intrusive, negative, and non-specific autobiographical long-term memories used to judge intervals from previous experience. Acceleration in working memory then occurs according to the contextual change model of duration estimation. Limitations: The meta-analysis is limited to four studies only, but provides a potential link between time experience and judgement within the same explanatory model. Conclusions: Similarities between psychological time dilation/acceleration and physical time dilation/acceleration are discussed.
Description:
Training loads contribute to sports injury risk but their mitigation has rarely been considered in a sports injury prevention framework. A key concept behind monitoring training loads for injury prevention is to screen for those at increased risk of injury so that workloads can be adjusted to minimise these risks. This review describes how advances in management of workload can be applied as a preventive measure. Primary prevention involves screening for preparticipation load risk factors, such as low training loads, prior to a training period or competition. Secondary prevention involves screening for workloads that are known to precede an injury developing so that modification can be undertaken to mitigate this risk. Tertiary prevention involves rehabilitation practices that include a graded return to training programme to reduce the risk of sustaining a subsequent injury. The association of training loads with injury incidence is now established. Prevention measures such as rule changes that affect the workload of an athlete are universal whereas those that address risk factors of an asymptomatic subgroup are more selective. Prevention measures, when implemented for asymptomatic individuals exhibiting possible injury risk factors, are indicated for an athlete at risk of developing a sports injury. Seven key indicated risks and associated prevention measures are proposed.
Tumour microenvironment and metabolic plasticity in cancer and cancer stem cells : Perspectives on metabolic and immune regulatory signatures in chemoresistant ovarian cancer stem cells
Description:
Cancer stem cells (CSCs) are a sub-population of tumour cells, which are responsible to drive tumour growth, metastasis and therapy resistance. It has recently been proposed that enhanced glucose metabolism and immune evasion by tumour cells are linked, and are modulated by the changing tumour microenvironment (TME) that creates a competition for nutrient consumption between tumour and different sub-types of cells attracted to the TME. To facilitate efficient nutrient distribution, oncogene-induced inflammatory milieu in the tumours facilitate adaptive metabolic changes in the surrounding non-malignant cells to secrete metabolites that are used as alternative nutrient sources by the tumours to sustain its increasing energy needs for growth and anabolic functions. This scenario also affects CSCs residing at the primary or metastatic niches. This review summarises recent advances in our understanding of the metabolic phenotypes of cancer cells and CSCs and how these processes are affected by the TME. We also discuss how the evolving TME modulates tumour cells and CSCs in cancer progression. Using previously described proteomic and genomic platforms, ovarian cancer cell lines and a mouse xenograft model we highlight the existence of metabolic and immune regulatory signatures in chemoresistant ovarian CSCs, and discuss how these processes may affect recurrence in ovarian tumours. We propose that progress in cancer control and eradication may depend not only on the elimination of highly chemoresistant CSCs, but also in designing novel strategies which would intervene with the tumour-promoting TME factors.
Description:
Cancer stem cells (CSCs) are a sub-population of tumour cells, which are responsible to drive tumour growth, metastasis and therapy resistance. It has recently been proposed that enhanced glucose metabolism and immune evasion by tumour cells are linked, and are modulated by the changing tumour microenvironment (TME) that creates a competition for nutrient consumption between tumour and different sub-types of cells attracted to the TME. To facilitate efficient nutrient distribution, oncogene-induced inflammatory milieu in the tumours facilitate adaptive metabolic changes in the surrounding non-malignant cells to secrete metabolites that are used as alternative nutrient sources by the tumours to sustain its increasing energy needs for growth and anabolic functions. This scenario also affects CSCs residing at the primary or metastatic niches. This review summarises recent advances in our understanding of the metabolic phenotypes of cancer cells and CSCs and how these processes are affected by the TME. We also discuss how the evolving TME modulates tumour cells and CSCs in cancer progression. Using previously described proteomic and genomic platforms, ovarian cancer cell lines and a mouse xenograft model we highlight the existence of metabolic and immune regulatory signatures in chemoresistant ovarian CSCs, and discuss how these processes may affect recurrence in ovarian tumours. We propose that progress in cancer control and eradication may depend not only on the elimination of highly chemoresistant CSCs, but also in designing novel strategies which would intervene with the tumour-promoting TME factors.
Description:
Objectives: To summarize available peer-reviewed publications about public knowledge and awareness of diabetes mellitus (DM) among the population of Saudi Arabia. Methods: We followed the standard reporting guidelines outlined in the PRISMA statement for the preparation of this systematic review. In February 2018 we conducted literature searches of PubMed, Scopus, BIOSIS Citation Index, and Web of Science using the following keywords: “Knowledge” OR “Awareness” AND “Diabetes Mellitus” AND “Saudi Arabia.” Records were screened, and relevant studies were selected and synthesized narratively. Results: Nineteen articles are included in our systematic review. These studies included the following populations: DM patients (n=13), healthcare workers (n=3), medical students (n=1), secondary school students (n=1), and general population (n=1). Most studies found a lack of public awareness of the risk factors and complications of DM. Among medical students and healthcare workers, knowledge about the epidemiology of the disease and angle of insulin injection was deficient. Conclusion: This review highlights the need for increased knowledge and awareness of DM among the Saudi population. The means of improving knowledge and awareness of DM needs to be integrated into existing healthcare systems and processes to better inform patients, families, and communities about this chronic disease.
Description:
Objectives: To summarize available peer-reviewed publications about public knowledge and awareness of diabetes mellitus (DM) among the population of Saudi Arabia. Methods: We followed the standard reporting guidelines outlined in the PRISMA statement for the preparation of this systematic review. In February 2018 we conducted literature searches of PubMed, Scopus, BIOSIS Citation Index, and Web of Science using the following keywords: “Knowledge” OR “Awareness” AND “Diabetes Mellitus” AND “Saudi Arabia.” Records were screened, and relevant studies were selected and synthesized narratively. Results: Nineteen articles are included in our systematic review. These studies included the following populations: DM patients (n=13), healthcare workers (n=3), medical students (n=1), secondary school students (n=1), and general population (n=1). Most studies found a lack of public awareness of the risk factors and complications of DM. Among medical students and healthcare workers, knowledge about the epidemiology of the disease and angle of insulin injection was deficient. Conclusion: This review highlights the need for increased knowledge and awareness of DM among the Saudi population. The means of improving knowledge and awareness of DM needs to be integrated into existing healthcare systems and processes to better inform patients, families, and communities about this chronic disease.
Description:
INTRODUCTION: Whilst football has been found to have many positive effects from a health perspective, injuries are common, particularly at the elite or professional level of play. Injury surveillance is therefore required to inform the development and implementation of strategies to increase safety in professional football codes. EVIDENCE ACQUISITION: A systematic search of peer reviewed and available grey literature was conducted to identify publications presenting methodological details of ongoing injury surveillance systems in professional football codes. Data extracted included population under surveillance, player/team coverage, injury definition and other relevant information. EVIDENCE SYNTHESIS: Following literature search and review, seven injury surveillance systems were identified that record ongoing data within professional football codes. A range of methodologies was used across the surveillance systems with variations in the definitions of injury, who records the data, the data-recording tool and dissemination of the data. CONCLUSIONS: There are many benefits for football associations, clubs and players themselves in conducting comprehensive injury surveillance. A range of surveillance methods is employed across the different football codes including injury definitions. Some professional football codes have developed consensus statements, which provide guidance on key issues relating to injury surveillance. Dissemination of findings differed with some systems publishing via peer review journals, with others through annual disclosure to the media. Financial considerations and funding are a crucial factor for creating and maintaining an injury surveillance system. Findings from professional football injury surveillance have been used to implement rule changes and develop preventive programmes, all aimed at increasing player safety.
Description:
INTRODUCTION: Whilst football has been found to have many positive effects from a health perspective, injuries are common, particularly at the elite or professional level of play. Injury surveillance is therefore required to inform the development and implementation of strategies to increase safety in professional football codes. EVIDENCE ACQUISITION: A systematic search of peer reviewed and available grey literature was conducted to identify publications presenting methodological details of ongoing injury surveillance systems in professional football codes. Data extracted included population under surveillance, player/team coverage, injury definition and other relevant information. EVIDENCE SYNTHESIS: Following literature search and review, seven injury surveillance systems were identified that record ongoing data within professional football codes. A range of methodologies was used across the surveillance systems with variations in the definitions of injury, who records the data, the data-recording tool and dissemination of the data. CONCLUSIONS: There are many benefits for football associations, clubs and players themselves in conducting comprehensive injury surveillance. A range of surveillance methods is employed across the different football codes including injury definitions. Some professional football codes have developed consensus statements, which provide guidance on key issues relating to injury surveillance. Dissemination of findings differed with some systems publishing via peer review journals, with others through annual disclosure to the media. Financial considerations and funding are a crucial factor for creating and maintaining an injury surveillance system. Findings from professional football injury surveillance have been used to implement rule changes and develop preventive programmes, all aimed at increasing player safety.
Description:
The Pacific region, also referred to as Oceania, is a geographically widespread region populated by people of diverse cultures and ethnicities. Indigenous people in the region (Melanesians, Polynesians, Micronesians, Papuans, and Indigenous Australians) are over-represented on national, regional, and global scales for the burden of infectious and non-communicable diseases. Although social and environmental factors such as poverty, education, and access to health-care are assumed to be major drivers of this disease burden, there is also developing evidence that genetic and microbiotic factors should also be considered. To date, studies investigating genetic and/or microbiotic links with vulnerabilities to infectious and non-communicable diseases have mostly focused on populations in Europe, Asia, and USA, with uncertain associations for other populations such as indigenous communities in Oceania. Recent developments in personalized medicine have shown that identifying ethnicity-linked genetic vulnerabilities can be important for medical management. Although our understanding of the impacts of the gut microbiome on health is still in the early stages, it is likely that equivalent vulnerabilities will also be identified through the interaction between gut microbiome composition and function with pathogens and the host immune system. As rapid economic, dietary, and cultural changes occur throughout Oceania it becomes increasingly important that further research is conducted within indigenous populations to address the double burden of high rates of infectious diseases and rapidly rising non-communicable diseases so that comprehensive development goals can be planned. In this article, we review the current knowledge on the impact of nutrition, genetics, and the gut microbiome on infectious diseases in indigenous people of the Pacific region.
Description:
The Pacific region, also referred to as Oceania, is a geographically widespread region populated by people of diverse cultures and ethnicities. Indigenous people in the region (Melanesians, Polynesians, Micronesians, Papuans, and Indigenous Australians) are over-represented on national, regional, and global scales for the burden of infectious and non-communicable diseases. Although social and environmental factors such as poverty, education, and access to health-care are assumed to be major drivers of this disease burden, there is also developing evidence that genetic and microbiotic factors should also be considered. To date, studies investigating genetic and/or microbiotic links with vulnerabilities to infectious and non-communicable diseases have mostly focused on populations in Europe, Asia, and USA, with uncertain associations for other populations such as indigenous communities in Oceania. Recent developments in personalized medicine have shown that identifying ethnicity-linked genetic vulnerabilities can be important for medical management. Although our understanding of the impacts of the gut microbiome on health is still in the early stages, it is likely that equivalent vulnerabilities will also be identified through the interaction between gut microbiome composition and function with pathogens and the host immune system. As rapid economic, dietary, and cultural changes occur throughout Oceania it becomes increasingly important that further research is conducted within indigenous populations to address the double burden of high rates of infectious diseases and rapidly rising non-communicable diseases so that comprehensive development goals can be planned. In this article, we review the current knowledge on the impact of nutrition, genetics, and the gut microbiome on infectious diseases in indigenous people of the Pacific region.
Description:
Langerhans cell histiocytosis is characterized by lesions containing inflammatory immune cells, including myeloid cells and T cells. Patient mortality remains unacceptably high and new treatment options are required. Several LCH studies have identified aberrant frequencies of T cell subsets with potential immune regulatory properties. High numbers of Foxp3+ regulatory T cells and gamma-delta T cells have been reported in patients with LCH, although, the cause of their presence or their significance is not yet clear. This review describes the current understanding of how LCH develops and progresses, focusing on the growing evidence that regulatory T cell subsets may be important and discussing the exciting potential for harnessing these cells to treat LCH using immune based therapies.