Save the Mekong Delta from drowning.

Policy must address drivers, not just symptoms, of subsidence.

Characterising urban zinc generation to identify surface pollutant hotspots in a low intensity rainfall climate.

Characterising stormwater runoff quality provides useful insights into the dynamics of pollutant generation and wash off rates. These can be used to prioritise stormwater management strategies. This study examined the effects of a low intensity rainfall climate on zinc contributions from different impermeable urban surface types. First flush (FF) and steady state samples were collected from seven different surfaces for characterisation, and the data were also used to calibrate an event-based pollutant load model to predict individual 'hotspot' surfaces across the catchment. Unpainted galvanised roofs generated very high concentrations of zinc, primarily in the more biologically available dissolved form. An older, unpainted galvanised roof had FF concentrations averaging 32,338 µg/L, while the new unpainted roof averaged 4,782 µg/L. Roads and carparks also had elevated zinc, but FF concentrations averaged only 822-1,584 µg/L. Modelling and mapping expected zinc loads from individual impermeable surfaces across the catchment identified specific commercial roof surfaces to be targeted for zinc management. The results validate a policy strategy to replace old galvanised roof materials and avoid unpainted galvanised roofing in future urban development for better urban water quality outcomes. In the interim, readily-implemented treatment options are required to help mitigate chronic zinc impacts on receiving waterways.

Osmotic potential calculations of inorganic and organic aqueous solutions over wide solute concentration levels and temperatures.

PURPOSE: To demonstrate that the authors' new "aqueous solution vs pure water" equation to calculate osmotic potential may be used to calculate the osmotic potentials of inorganic and organic aqueous solutions over wide ranges of solute concentrations and temperatures. Currently, the osmotic potentials of solutions used for medical purposes are calculated from equations based on the thermodynamics of the gas laws which are only accurate at low temperature and solute concentration levels. Some solutions used in medicine may need their osmotic potentials calculated more accurately to take into account solute concentrations and temperatures. METHODS: The authors experimented with their new equation for calculating the osmotic potentials of inorganic and organic aqueous solutions up to and beyond body temperatures by adjusting three of its factors; (a) the volume property of pure water, (b) the number of "free" water molecules per unit volume of solution, "Nf," and (c) the "t" factor expressing the cooperative structural relaxation time of pure water at given temperatures. Adequate information on the volume property of pure water at different temperatures is available in the literature. However, as little information on the relative densities of inorganic and organic solutions, respectively, at varying temperatures needed to calculate Nf was available, provisional equations were formulated to approximate values. Those values together with tentative t values for different temperatures chosen from values calculated by different workers were substituted into the authors' equation to demonstrate how osmotic potentials could be estimated over temperatures up to and beyond bodily temperatures. RESULTS: The provisional equations formulated to calculate Nf, the number of free water molecules per unit volume of inorganic and organic solute solutions, respectively, over wide concentration ranges compared well with the calculations of Nf using recorded relative density data at 20 °C. They were subsequently used to estimate Nf values at temperatures up to and excess of body temperatures. Those values, together with t values at temperatures up to and in excess of body temperatures recorded in the literature, were substituted in the authors' equation for the provisional calculation of osmotic potentials. The calculations indicated that solution temperatures and solute concentrations have a marked effect on osmotic potentials. CONCLUSIONS: Following work to measure the relative densities of aqueous solutions for the calculation of Nf values and the determination of definitive t values up to and beyond bodily temperatures, the authors' equation would enable the accurate estimations of the osmotic potentials of wide concentrations of aqueous solutions of inorganic and organic solutes over the temperature range. The study illustrates that not only solute concentrations but also temperatures have a marked effect on osmotic potentials, an observation of medical and biological significance.

A novel modelling framework to prioritize estimation of non-point source pollution parameters for quantifying pollutant origin and discharge in urban catchments.

Stormwater runoff in urban catchments contains heavy metals (zinc, copper, lead) and suspended solids (TSS) which can substantially degrade urban waterways. To identify these pollutant sources and quantify their loads the MEDUSA (Modelled Estimates of Discharges for Urban Stormwater Assessments) modelling framework was developed. The model quantifies pollutant build-up and wash-off from individual impervious roof, road and car park surfaces for individual rain events, incorporating differences in pollutant dynamics between surface types and rainfall characteristics. This requires delineating all impervious surfaces and their material types, the drainage network, rainfall characteristics and coefficients for the pollutant dynamics equations. An example application of the model to a small urban catchment demonstrates how the model can be used to identify the magnitude of pollutant loads, their spatial origin and the response of the catchment to changes in specific rainfall characteristics. A sensitivity analysis then identifies the key parameters influencing each pollutant load within the stormwater given the catchment characteristics, which allows development of a targeted calibration process that will enhance the certainty of the model outputs, while minimizing the data collection required for effective calibration. A detailed explanation of the modelling framework and pre-calibration sensitivity analysis is presented.

Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: an Australian retrospective analysis.

BACKGROUND: Elderly patients with diffuse large B-cell lymphoma (DLBCL) have an inferior prognosis, due in part to advanced age and pre-existing comorbidities, with reduced tolerability and deliverability of standard R-CHOP chemotherapy. AIMS: To examine the deliverability, toxicity and efficacy of R-CHOP and the prevalence of the germinal and non-germinal phenotype DLBCL in an elderly Australian cohort. METHODS: This retrospective analysis included patients ≥75 years diagnosed with DLBCL. Comprehensive chemotherapy and toxicity data were collected for patients treated with R-CHOP. Baseline demographics and chemotherapy characteristics were compared with progression-free (PFS) and overall survival (OS). Immunohistochemical staining identified the prevalence of the non-germinal centre (non-GCB) phenotype. RESULTS: Of the 111 patients, 92 (83%) commenced R-CHOP with 26/92 (28%) receiving ≤4 cycles. Median average relative dose (ARD) was 0.80 (0.07-1.17). Median average relative dose intensity (ARDI) was 0.89 (0.33-1.18). Serious adverse events occurred in 77% of patients with ≥Gd3 adverse events in 74%. Overall response rate was 85%. Two-year PFS was 63% and OS 74%. ARD and performance status ≥2 were significant prognostic factors for PFS and OS but not ARDI. Non-GCB-phenotype was identified in 44/72 (61%) of patients with immunohistochemical data. CONCLUSION: Despite high response rates and respectable survival estimates, the absence of standard therapy in 17% of patients, and dose reductions and serious toxicity of R-CHOP in this Australian cohort highlights the need for the development of less toxic yet efficacious treatments for very elderly patients with DLBCL. The high prevalence of the non-GCB phenotype highlights the potential value of targeted biological therapy for this demographic.

Build-up dynamics of heavy metals deposited on impermeable urban surfaces.

A method using thin boards (3 cm thick, 0.56 m(2)) comprising different paving materials typically used in urban environments (2 asphalt types and concrete) was employed to specifically investigate air-borne deposition dynamics of TSS, zinc, copper and lead. Boards were exposed at an urban car park near vehicular traffic to determine the rate of contaminant build-up over a 13-day dry period. Concentration profiles from simulated rainfall wash-off were used to determine contaminant yields at different antecedent dry days. Maximum contaminant yields after 13 days of exposure were 2.7 kg ha(-1) for TSS, 35 g ha(-1) zinc, 2.3 g ha(-1) copper and 0.4 g ha(-1) lead. Accumulation of all contaminants increased over the first week and levelled off thereafter, supporting theoretical assumptions that contaminant accumulation on impervious surfaces asymptotically approaches a maximum. Comparison of different surface types showed approximately four times higher zinc concentrations in runoff from asphalt surfaces and two times higher TSS concentrations in runoff from concrete, which is attributed to different physical and chemical compositions of the pavement types. Contaminant build-up and wash-off behaviours were modelled using exponential and saturation functions commonly applied in the US EPA's Stormwater Management Model (SWMM) showing good correlation between measured and modelled concentrations. Maximum build-up, half-saturation time, build-up rate constants and wash-off coefficients, necessary for stormwater contaminant modelling, were determined for the four contaminants studied. These parameters are required to model contaminant concentrations in urban runoff assisting in stormwater management decisions.

Contaminant removal and hydraulic conductivity of laboratory rain garden systems for stormwater treatment.

In order to evaluate the influence of substrate composition on stormwater treatment and hydraulic effectiveness, mesocosm-scale (180 L, 0.17 m(2)) laboratory rain gardens were established. Saturated (constant head) hydraulic conductivity was determined before and after contaminant (Cu, Zn, Pb and nutrients) removal experiments on three rain garden systems with various proportions of organic topsoil. The system with only topsoil had the lowest saturated hydraulic conductivity (160-164 mm/h) and poorest metal removal efficiency (Cu ≤ 69.0% and Zn ≤ 71.4%). Systems with sand and a sand-topsoil mix demonstrated good metal removal (Cu up to 83.3%, Zn up to 94.5%, Pb up to 97.3%) with adequate hydraulic conductivity (sand: 800-805 mm/h, sand-topsoil: 290-302 mm/h). Total metal amounts in the effluent were <50% of influent amounts for all experiments, with the exception of Cu removal in the topsoil-only system, which was negligible due to high dissolved fraction. Metal removal was greater when effluent pH was elevated (up to 7.38) provided by the calcareous sand in two of the systems, whereas the topsoil-only system lacked an alkaline source. Organic topsoil, a typical component in rain garden systems, influenced pH, resulting in poorer treatment due to higher dissolved metal fractions.

Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study.

BACKGROUND: To determine the incidence of acute retinal necrosis (ARN) in the United Kingdom and to describe the demographics, management, and visual outcome in these patients. METHODS: This was a prospective study carried out by the British Ophthalmological Surveillance Unit (BOSU) between September 2007 and October 2008. Initial and 6-month questionnaires were sent to UK ophthalmologists who reported cases of ARN via the monthly BOSU report card system. RESULTS: In all, 45 confirmed cases (52 eyes) of ARN were reported in the 14-month study period, giving a minimum incidence of 0.63 cases per million population per year. There were 20 females and 25 males. Age ranged from 10 to 94 years. Eight patients had a history of herpetic CNS disease. Aqueous sampling was carried out in 13 patients, vitreous in 27, and cerebrospinal fluid (CSF) in 4. Varicella-zoster virus followed by herpes simplex were the most common causative agents. Treatment in 76% of the cases was with intravenous antivirals; however, 24% received only oral antivirals. In all, 47% of patients had intravitreal antiviral therapy. Visual outcome at 6 months was <6/60 in 48% of the affected eyes. CONCLUSION: The minimum incidence of ARN in the UK is 0.63 cases per million. Patients with a history of herpetic CNS disease should be warned to immediately report any visual symptoms. There is increased use of oral and intravitreal antivirals in initial treatment.

Developing a public information and engagement portal of urban waterways with real-time monitoring and modeling.

Waterways can contribute to the beauty and livelihood of urban areas, but maintaining their hydro-ecosystem health is challenging because they are often recipients of contaminated water from stormwater runoff and other discharges. Public awareness of local waterways' health and community impacts to these waterways is usually poor due to of lack of easily available information. To improve community awareness of water quality in urban waterways in New Zealand, a web portal was developed featuring a real-time waterways monitoring system, a public forum, historical data, interactive maps, contaminant modelling scenarios, mitigation recommendations, and a prototype contamination alert system. The monitoring system featured in the web portal is unique in the use of wireless mesh network technology, direct integration with online modelling, and a clear target of public engagement. The modelling aims to show the origin of contaminants within the local catchment and to help the community prioritize mitigation efforts to improve water quality in local waterways. The contamination alert system aims to keep managers and community members better informed and to provide a more timely response opportunity to avert any unplanned or accidental contamination of the waterways. Preliminary feedback has been positive and is being supported by local and regional authorities. The system was developed in a cost-effective manner providing a community focussed solution for quantifying and mitigating key contaminants in urban catchments and is applicable and transferable to other cities with similar stormwater challenges.

Emergency management of upper airway angio-oedema after routine dental extraction in a patient with C1 esterase deficiency.

Hereditary angio-oedema is rare and potentially life-threatening, being characterised by recurrent episodes of perioral or laryngeal oedema. We describe a 28-year-old woman who developed stridor, orofacial swelling, and drooling several hours after a routine dental extraction. This was initially diagnosed as a spreading dental infection. Only after early oral and maxillofacial review and taking a thorough family history was C1 esterase-inhibitor deficiency diagnosed. She was immediately given C1 esterase-inhibitor concentrate, made a complete recovery and was discharged next day.

Investigation of the mechanisms by which chronic infusion of an acutely subpressor dose of angiotensin II induces hypertension.

The mechanisms by which chronic infusion of an initially subpressor low dose of angiotensin II (ANG II) causes a progressive and sustained hypertension remain unclear. In conscious sheep (n = 6), intravenous infusion of ANG II (2 microg/h) gradually increased mean arterial pressure (MAP) from 82 +/- 3 to 96 +/- 5 mmHg over 7 days (P < 0.001). This was accompanied by peripheral vasoconstriction; total peripheral conductance decreased from 44.6 +/- 6.4 to 38.2 +/- 6.7 ml.min(-1).mmHg(-1) (P < 0.001). Cardiac output and heart rate were unchanged. In the regional circulation, mesenteric, renal, and iliac conductances decreased but blood flows were unchanged. There was no coronary vasoconstriction, and coronary blood flow increased. Ganglion blockade (125 mg/h hexamethonium for 4 h) reduced MAP by 13 +/- 1 mmHg in the control period and by 7 +/- 2 mmHg on day 8 of ANG II treatment. Inhibition of central AT(1) receptors by intracerebroventricular infusion of losartan (1 mg/h for 3 h) had no effect on MAP in the control period or after 7 days of ANG II infusion. Pressor responsiveness to incremental doses of intravenous ANG II (5, 10, 20 microg/h, each for 15 min) was unchanged after 7 days of ANG II infusion. ANG II caused no sodium or water retention. In summary, hypertension due to infusion of a low dose of ANG II was accompanied by generalized peripheral vasoconstriction. Indirect evidence suggested that the hypertension was not neurogenic, but measurement of sympathetic nerve activity is required to confirm this conclusion. There was no evidence for a role for central angiotensinergic mechanisms, increased pressor responsiveness to ANG II, or sodium and fluid retention.

Diversity of the land resources in the Amazonian State of Rondônia, Brazil

Opiniões divergentes são encontradas na literatura com respeito ao uso de terras da Amazônia para agricultura sustentável apos desmatamento. Este artigo busca clarificar a questão com um resumo dos resultados de um estudo dos recursos naturais (clima, atributos de solos e terrenos, e vegetação) do estado de Rondônia. O trabalho seguiu a metodologia do World Soils and Terrain Digital Database (SOTER) e foi financiado pelo banco mundial. Durante a fase de investigação no campo, concentrou-se no estudo de solos onde 2914 perfis de solos foram analisados. O estudo mostra que Rondônia tem um mosaico complexo de unidades de terra com diferenças claras em clima, terrenos, solos e vegetação nativa. Observa-se a combinação de florestas, que originalmente predominaram na região, com savanas naturais mal drenadas e outras savanas bem drenadas mas pobres em nutrientes. As florestas mais altas e vigorosas podem ou podiam ser encontradas crescendo em solos bem drenados derivados de materiais paternos ricos em minerais. Muitos desses solos podem ser, ou estão sendo, utilizados para agricultura produtiva. Solos derivados de materiais paternos pobres em nutrientes suportam bosques baixos e requerem grandes quantidades de cal e fertilizante para agricultura. Por outro lado, bosques baixos com altas populações de palmeiras e pequenas áreas de savanas úmidas cobrem solos mal drenados. É evidente que o desmatamento da floresta no passado foi indiscriminado e isto não pode ser justificado. A variabilidade de solos encontrados em Rondônia indica que os estudos de terrenos e solos realizados na Amazônia ate o momento têm sido muito gerais para que se possa detectar variações significativas nos solos.

Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.

OBJECTIVES: To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis (OA) in older patients. DESIGN: A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment, to check design assumptions and delivery processes. The main study was a randomised controlled trial of the effectiveness of water-based exercise (treatment) compared with usual care (control) in older patients with hip and/or knee OA. The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments. SETTING: Water exercise was delivered in public swimming pools in the UK. Physical function assessments were carried out in established laboratory settings. PARTICIPANTS: 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA took part in the preliminary study. A similar, but larger, group of 312 patients (196 women, 116 men) took part in the main study, randomised into control (159) and water exercise (153) groups. INTERVENTIONS: Control group patients received usual care with quarterly semi-structured telephone interview follow-up only. The intervention in the main study lasted for 1 year, with a further follow-up period of 6 months. MAIN OUTCOME MEASURES: Pain score on the Western Ontario and McMaster Universities OA index (WOMAC). Additional outcome measures were included to evaluate effects on quality of life, cost-effectiveness and physical function measurements. RESULTS: Short-term efficacy of water exercise in the management of lower limb OA was confirmed, with effect sizes ranging from 0.44 [95% confidence interval (CI) 0.03 to 0.85] on WOMAC pain to 0.76 (95% CI 0.33 to 1.17) on WOMAC physical function. Of 153 patients randomised to treatment, 82 (53.5%) were estimated to have complied satisfactorily with their treatment at the 1-year point. This had declined to 28 (18%) by the end of the 6-month follow-up period, during which support for the intervention had been removed and those wishing to continue exercise had to pay their own costs for maintaining their exercise treatment. High levels of co-morbidity were recorded in both groups. Nearly two thirds of all patients had a significant other illness in addition to their OA. Fifty-four control and 53 exercise patients had hospital inpatient episodes during the study period. Water exercise remained effective in the main study but overall effect size was small, on WOMAC pain at 1 year, a reduction of about 10% in group mean pain score. This had declined, and was non-significant, at 18 months. Mean cost difference estimates showed a saving in the water exercise group of pound123--175 per patient per annum and incremental cost-effectiveness ratios ranged from pound3838 to pound5951 per quality-adjusted life-year (QALY). Net reduction in pain was achieved at a net saving of pound135--175 per patient per annum and the ceiling valuation of pound580--740 per unit of WOMAC pain reduction was favourably low. CONCLUSIONS: Group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with lower limb OA, and may be a useful adjunct in the management of hip and/or knee OA. The water-exercise programme produced a favourable cost--benefit outcome, using reduction in WOMAC pain as the measure of benefit. Further research is suggested into other similar public health interventions. Investigation is also needed into how general practice can best be supported to facilitate access to participants for research trials in healthcare, as well as an examination of the infrastructure and workforce capacities for physical activity delivery and the potential extent to which healthcare may be supported in this way. More detailed research is required to develop a better understanding of the types of exercise that will work for the different biomechanical subtypes of knee and hip OA and investigation is needed on access and environmental issues for physical activity programmes for older people, from both a provider and a participant perspective, the societal costs of the different approaches to the management of OA and longer term trends in outcome measures (costs and effects).

Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial.

OBJECTIVE: To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis (OA). DESIGN: A quasi-experimental design consisting of an exercise group and an age-matched control group. SETTING: Public community swimming pool in Sheffield, UK. SUBJECTS: One hundred and six community-dwelling sedentary older people, with confirmed knee-hip osteoarthritis, enrolled in an experimental controlled trial for 12 months. Sixty-six subjects in the exercise group were offered a water-exercise programme. Forty age-matched, nonexercising, 'control' subjects received monthly education material and quarterly telephone calls. INTERVENTIONS: Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors. MAIN MEASURES: Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Secondary outcomes included a battery of performance-based physical function tests. RESULTS: Adherence to exercise averaged 70% (+/- 14%) over the year: 77% of the exercising subjects and 89% control subjects completed both pre- and post-outcome measures. After one year, participants in the exercise group experienced a significant improvement in physical function (4.0 +/- 9.1 versus -0.4 +/- 7.3 units; 95% confidence interval (CI) 0.96-7.96, p < 0.05) and reduction in the perception of pain (1.3 +/- 3.7 versus 0.2 +/- 2.5 units; 95% CI -0.19-2.52, p < 0.05) compared with the control group, as measured by the WOMAC Osteoarthritis Index. In addition, the exercise group performed significantly better in the ascending and descending stairs tests (p < 0.05), had significantly greater improvements in knee range of movement (p < 0.01) and hip range of movements (p < 0.005). There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being (Arthritis Impact Measurement Scales 2 questionnaire). CONCLUSIONS: Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function, pain, general mobility and flexibility after participating in 12 months of community-based water exercise.

Tests for physical function of the elderly with knee and hip osteoarthritis.

This study reports the results of a battery of physical function tests used to assess physical function of older patients with clinical knee and/or hip osteoarthritis (OA), and the correlation to the WOMAC Index (disease-specific questionnaire). A total of 106 sedentary subjects, aged >60 years (mean 69.4, S.D. 5.9) with hip and/or knee OA (mean 12.2 yrs, S.D. 11.0) participated in the study. Mobility, joint flexibility and muscle strength were evaluated by recording time to: walk a distance of 8', ascend/descend 4 stairs, rise from/sit down from a chair (5 times). Hip/knee flexion and isometric quadriceps strength were also measured. Categories of performance were formed by dividing data into quartiles for each test (1=highest, 4=lowest score, 5=unable to complete) and, by summing the category scores, a total summary score (TSS) was obtained. The battery of physical function tests showed an acceptable test-retest reliability (ICC of all tasks > or =0.80) and internal consistency (Cronbach's alpha > or =0.80). Performance scores on walking, stair climb, chair-rise and ROM of affected OA joints were significantly correlated with each other, and with the WOMAC Index (P<0.05, Spearman's correlation). Lower scores on the TSS were associated with lower scores on all the WOMAC Index items (P<0.001). This study shows that a simple battery of physical function tests in combination with the WOMAC Index are reliable and may be useful outcome measures in the evaluation of therapeutic interventions and geriatric rehabilitation.

Knee flexor strength following anterior cruciate ligament reconstruction with the semitendinosus and gracilis tendons.

Knee flexor strength recovery following anterior cruciate ligament reconstruction with the doubled semitendinosus and gracilis tendons was assessed for up to 12 months post-surgery. Twelve patients were followed up, four at 3 months, five at 6 months and three at 12 months post-surgery. Knee flexor moment was recorded using the Biodex System-3 isokinetic dynamometer. Three sets of five repetitions of reciprocal eccentric/ concentric knee flexion contractions were carried out with each set at 1.05, 2.09 or 3.14 rad x s(-1). T-tests were used to test for significant differences between and within groups. The uninjured leg produced greater average peak moments than the injured leg; significant differences (p < 0.05) were seen between the legs at 1.05 rad x s(-1) for the 3-month group concentrically, and all three groups eccentrically. There was no significant difference (p > 0.05) between groups for the percentage deficit between legs. On average, a 23% deficit in average peak moment was still evident at 12 months both eccentrically and concentrically at 1.05 rad x s(-1). Taken as a whole this evidence suggests that there is a deficit in knee flexor strength up to at least 12 months post-surgery following doubled semitendinosus and gracilis tendon graft reconstruction even after a full rehabilitation protocol.

Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes.

BACKGROUND: The aim of this study was to evaluate the relationship between shoulder mobility, rotator muscles' strength and scapular symmetry, and shoulder injuries and/or pain in elite volleyball athletes. METHODS: An isokinetic shoulder muscle strength test, which was performed at speeds of 60/sec and 180/sec, and shoulder mobility and scapula lateral slide tests were conducted bilaterally on 16 subjects, who represented the England elite volleyball players. The subjects also prospectively completed monthly questionnaires during the competition season to report on their shoulder condition. RESULTS: The results showed that the active range of shoulder internal rotation and concentric external rotators' strength in the dominant arm were significantly less, than in the non-dominant arms, but the internal rotators were significantly stronger in both concentric and eccentric tests at both testing speeds. Seven of 16 subjects indicated overt shoulder injury or pain during their training season, nine subjects had shoulder mobility impairment, seven had muscle imbalance, 13 had relative muscle weakness and five had scapular asymmetry. The association between shoulder muscle strength imbalance (eccentric external < concentric internal) of rotators in the dominant arm and shoulder injuries was statistically significant (Fisher's exact test, p<0.05). CONCLUSIONS: We conclude that rotator muscle strength imbalance may play an important role in shoulder injuries in high-level volleyball players.

A descriptive epidemiological study of shoulder injury in top level English male volleyball players.

The aims of this study were to estimate the prevalence and incidence of shoulder sports injuries, to discover the main shoulder injury, and to survey outcome of treatment or injuries in top level male volleyball athletes. Furthermore, the actions which most commonly cause injuries and the differences of physical characteristics between injured and healthy players were also investigated. Fifty-nine English Volleyball Federation division one athletes were recruited in the 1997/98 and 1998/99 seasons. All subjects completed two different questionnaires; a First recruitment and monthly Follow-up questionnaire throughout the period in question. Twenty-seven of the fifty-nine athletes had a history of shoulder sports injury, with a total of 29 injuries reported. The results of the First recruitment showed that overuse type injuries (19/29) were the main shoulder injuries. Cuff muscle tendinitis was predominant in these injuries (14/29). Furthermore, spiking was the major action during which a shoulder injury (23/29) first occurred. In the follow-up phase the incidences of shoulder chronic injury (or pain), re-injury, and new injury in these twenty-seven players were 3.0, 9.3 and 1.0 injuries/1,000 hours of exposure respectively. The mean duration of chronic injury or pain was 2.3 +/- 1.3 (+/- SD) months. The distribution of history of regular training, between injured and healthy subject groups, was significantly different (p = 0.008). This study has identified rotator cuff muscle/tendon injuries or involved lesions as the main shoulder injuries in top level English male volleyball athletes. These injuries result in prolonged shoulder pain symptoms.

Dynamic control and conventional strength ratios of the quadriceps and hamstrings in subjects with anterior cruciate ligament deficiency.

The hamstrings:quadriceps muscle strength ratio has been used as an indicator of normal balance between the knee flexors and extensors. A more functional approach to this strength ratio would be to compare opposite muscle actions of antagonistic muscle groups. The dynamic strength control ratio (DSCR) should give a more appropriate measure relating to knee function. There is a lack of normative data relating to DSCR for anterior cruciate ligament (ACL) deficient subjects. Effects of ACL deficiency on isokinetic peak torque for eccentric and concentric muscle actions of the quadriceps and hamstrings, in conjunction with isometric peak torque, were examined in 10 patients awaiting reconstructive surgery (male = 8, female = 2 ; age = 32.8 +/- 8.3 years; height = 1.77 +/- 0.08 m; mass = 72.1 +/- 12.5 kg). These variables were assessed using an isokinetic dynamometer. The results were considered in terms of the conventional ratio and DSCR. Anterior tibial drawer was measured using a knee ligament arthrometer to confirm clinical diagnosis of ACL rupture. The isokinetic peak torque data analysed were for angular velocities of 1.05 rad s(-1) (60 degrees s(-1)). Significant strength deficits were apparent between normal and injured sides for: concentric isokinetic quadriceps action (p < 0.05); isometric quadriceps action at 70 degrees of knee flexion (p < 0.05); isometric quadriceps action at 40 degrees of knee flexion (p<0.01); eccentric isokinetic hamstrings action (p < 0.05). With bilateral comparison, the conventional strength ratios showed no significant difference, as did the DSCR. The bilateral comparison of isometric strength ratios revealed significant losses in quadriceps strength for the injured side (p < 0.05) but no significant losses in hamstring strength (p > 0.05). Thus, differences can be seen in conventional ratios and DSCR for ACL-deficient subjects. This is an area of clinical interest with the increasing frequency of ACL reconstruction using hamstrings tendons.

Isokinetic performance and shoulder mobility in elite volleyball athletes from the United Kingdom.

OBJECTIVES: To evaluate the differences in strength and mobility of shoulder rotator muscles in the dominant and non-dominant shoulders of elite volleyball players. METHODS: Isokinetic muscle strength tests were performed at speeds of 60 and 120 degrees/s, and shoulder mobility was examined in ten players from the England national men's volleyball squad. The subjects also completed a questionnaire that included a visual prompt and analogue pain scale. RESULTS: The range of motion of internal rotation on the dominant side was less than that on the non-dominant side (p < 0.01). The average peak strength at 60 degrees/s external eccentric contraction was lower than that of internal concentric contraction in the dominant arm, but was higher in the non-dominant arm. Six of the ten subjects reported a shoulder problem, described as a diffuse pain located laterally on the dominant shoulder. CONCLUSIONS: These elite volleyball players had a lower range of motion (internal rotation) and relative muscle imbalance in the dominant compared with the non-dominant shoulder.