Training injuries in elite men's senior and academy (Super League) rugby league; an analysis of 224,000 exposure-hours.

OBJECTIVES: Report two-years of training injury data in senior and academy professional rugby league. DESIGN: Prospective cohort study. METHODS: Match and training time-loss injuries and exposure data were recorded from two-seasons of the European Super League competition. Eleven/12 (2021) and 12/12 (2022) senior and 8/12 (2021) and 12/12 (2022) academy teams participated. Training injuries are described in detail and overall match injuries referred to for comparison only. RESULTS: 224,000 training exposure hours were recorded with 293 injuries at the senior (mean [95 % confidence interval]; 3 [2-3] per 1000 h) and 268 academy level (2 [2-3] per 1000 h), accounting for 31 % and 40 % of all injuries (i.e., matches and training). The severity of training injuries (senior: 35 [30-39], academy: 36 [30-42] days-lost) was similar to match injuries. Lower-limb injuries had the greatest injury incidence at both levels (senior: 1.85 [1.61-2.12], academy: 1.28 [1.08-1.51] per 1000 h). Head injuries at the academy level had greater severity (35 [25-45] vs. 18 [12-14] days-lost; p < 0.01) and burden (17 [16-18] vs. 4 [4-5] days-lost per 1000 h; p = 0.02) than senior level. At the senior level, the incidence of contact injuries was lower than non-contact injuries (risk ratio: 0.29 [0.09-0.88], p = 0.02). CONCLUSIONS: Training injuries accounted for about a third of injuries, with similar injury severity to match-play. Within training there is a higher rate of non-contact vs. contact injuries. Whilst current injury prevention interventions target matches, these data highlight the importance of collecting high quality training injury data to develop and evaluate injury prevention strategies in training.

Longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players.

This is the first study to assess longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players. Thirteen forwards and 11 backs were tested three times over a 10-month period. Assessments included: standing height and body mass, body composition measured by dual x-ray absorptiometry (DXA), a blood panel, resting metabolic rate (RMR) assessed by indirect calorimetry, aerobic capacity (i.e.,[Formula: see text]) evaluated by an incremental treadmill test, and isometric force production measured by a force plate. During the pre-season phase, lean mass increased significantly by ~2% for backs (testing point 1: 47 kg; testing point 2: 48 kg) and forwards (testing point 1: 50 kg; testing point 2: 51 kg) (p = ≤ 0.05). Backs significantly increased their [Formula: see text] by 22% from testing point 1 (40 ml kg-1 min-1) to testing point 3 (49 ml kg-1 min-1) (p = ≤ 0.04). The [Formula: see text] of forwards increased by 10% from testing point 1 (41 ml kg-1 min-1) to testing point 3 (45 ml kg-1 min-1), however this change was not significant (p = ≥ 0.05). Body mass (values represent the range of means across the three testing points) (backs: 68 kg; forwards: 77-78 kg), fat mass percentage (backs: 25-26%; forwards: 30-31%), resting metabolic rate (backs: 7 MJ day-1; forwards: 7 MJ day-1), isometric mid-thigh pull (backs: 2106-2180 N; forwards: 2155-2241 N), isometric bench press (backs: 799-822 N; forwards: 999-1024 N), isometric prone row (backs: 625-628 N; forwards: 667-678 N) and bloods (backs: ferritin 21-29 ug/L, haemoglobin 137-140 g/L, iron 17-21 umol/L, transferrin 3 g/L, transferring saturation 23-28%; forwards: ferritin 31-33 ug/L, haemoglobin 141-145 g/L, iron 20-23 umol/L, transferrin 3 g/L, transferrin saturation 26-31%) did not change (p = ≥ 0.05). This study provides novel longitudinal data which can be used to better prepare women rugby league players for the unique demands of their sport, underpinning female athlete health.

The speed and acceleration of the ball carrier and tackler into contact during front-on tackles in rugby league.

The aim was to use a combination of video analysis and microtechnology (10 Hz global positioning system [GPS]) to quantify and compare the speed and acceleration of ball-carriers and tacklers during the pre-contact phase (contact - 0.5s) of the tackle event during rugby league match-play. Data were collected from 44 professional male rugby league players from two Super League clubs across two competitive matches. Tackle events were coded and subject to three stages of inclusion criteria to identify front-on tackles. 10 Hz GPS data was synchronised with video to extract the speed and acceleration of the ball-carrier and tackler into each front-on tackle (n = 214). Linear mixed effects models (effect size [ES], confidence intervals, p-values) compared differences. Overall, ball-carriers (4.73 ± 1.12 m∙s-1) had greater speed into front-on tackles than tacklers (2.82 ± 1.07 m∙s-1; ES = 1.69). Ball-carriers accelerated (0.67 ± 1.01 m∙s-2) into contact whilst tacklers decelerated (-1.26 ± 1.36 m∙s-2; ES = 1.74). Positional comparisons showed speed was greater during back vs. back (ES = 0.66) and back vs. forward (ES = 0.40) than forward vs. forward tackle events. Findings can be used to inform strategies to improve performance and player welfare.

Survival in a young child with out-of-hospital cardiac arrest: diagnostic dilemma and when to deviate from standard resuscitation guidelines.

A boy in early childhood presented in cardiac arrest. Care was provided out of hospital and in the emergency department as per standard paediatric resuscitation guidelines. Despite initial return of spontaneous circulation following cardiopulmonary resuscitation, two defibrillation shocks and epinephrine via intraosseous access, he had recurrent episodes of pulseless ventricular tachycardia and ventricular fibrillation. In total, 40 defibrillation shocks were administered, and he subsequently stabilised on combined treatment with intravenous esmolol, amiodarone and milrinone. He was transferred to the paediatric intensive care unit and had an automated implantable cardioverter-defibrillator inserted prior to discharge. Genetic testing has confirmed a diagnosis of catecholaminergic polymorphic ventricular tachycardia and it is hypothesised that the childhood excitement at a popular time of year, combined with caffeinated drinks, instigated his initial cardiac arrest which was propagated with iatrogenic epinephrine. He has remained stable since, with no neurological sequelae thus far from a significantly prolonged downtime.

Moving beyond velocity derivatives; using global positioning system data to extract sequential movement patterns at different levels of rugby league match-play.

This study aims to (a) quantify the movement patterns during rugby league match-play and (b) identify if differences exist by levels of competition within the movement patterns and units through the sequential movement pattern (SMP) algorithm. Global Positioning System data were analysed from three competition levels; four Super League regular (regular-SL), three Super League (semi-)Finals (final-SL) and four international rugby league (international) matches. The SMP framework extracted movement pattern data for each athlete within the dataset. Between competition levels, differences were analysed using linear discriminant analysis (LDA). Movement patterns were decomposed into their composite movement units; then Kruskal-Wallis rank-sum and Dunn post-hoc were used to show differences. The SMP algorithm found 121 movement patterns comprised mainly of "walk" and "jog" based movement units. The LDA had an accuracy score of 0.81, showing good separation between competition levels. Linear discriminant 1 and 2 explained 86% and 14% of the variance. The Kruskal-Wallis found differences between competition levels for 9 of 17 movement units. Differences were primarily present between regular-SL and international with other combinations showing less differences. Movement units which showed significant differences between competition levels were mainly composed of low velocities with mixed acceleration and turning angles. The SMP algorithm found 121 movement patterns across all levels of rugby league match-play, of which, 9 were found to show significant differences between competition levels. Of these nine, all showed significant differences present between international and domestic, whereas only four found differences present within the domestic levels. This study shows the SMP algorithm can be used to differentiate between levels of rugby league and that higher levels of competition may have greater velocity demands.Highlights This study shows that movement patterns and movement units can be used to investigate team sports through the application of the SMP frameworkOne hundred and twenty-one movement patterns were found to be present within rugby league match-play, with the walk- and jog-based movement units most prevalent. No movement pattern was unique to a single competition level.Further analysis revealed that the majority of movement units analysed had significant differences between international and domestic rugby league, whereas only four movement units (i.e. f,m,n,q) had significant differences within the two domestic rugby league levels.International rugby league had higher occurrences of the movement patterns consisting of higher velocity movement units (ie. T,S,y). This suggests that international rugby league players may need greater high velocity exposure in training.

The anthropometric and physical qualities of women's rugby league Super League and international players; identifying differences in playing position and level.

Participation in women's rugby league has been growing since the foundation of the English women's rugby league Super League in 2017. However, the evidence base to inform women's rugby league remains sparse. This study provides the largest quantification of anthropometric and physical qualities of women's rugby league players to date, identifying differences between positions (forwards & backs) and playing level (Women's Super League [WSL] vs. International). The height, weight, body composition, lower body strength, jump height, speed and aerobic capacity of 207 players were quantified during the pre-season period. Linear mixed models and effects sizes were used to determine differences between positions and levels. Forwards were significantly (p < 0.05) heavier (forwards: 82.5 ± 14.8kg; backs: 67.7 ± 9.2kg) and have a greater body fat % (forwards: 37.7 ± 6.9%; backs: 30.4 ± 6.3%) than backs. Backs had significantly greater lower body power measured via jump height (forwards: 23.5 ± 4.4cm; backs: 27.6 ± 4.9cm), speed over 10m (forwards: 2.12 ± 0.14s; backs: 1.98 ± 0.11s), 20m (forwards: 3.71 ± 0.27s; backs: 3.46 ± 0.20s), 30m (forwards: 5.29 ± 0.41s; backs: 4.90 ± 0.33s), 40m (forwards: 6.91 ± 0.61s; backs: 6.33 ± 0.46s) and aerobic capacity (forwards: 453.4 ± 258.8m; backs: 665.0 ± 298.2m) than forwards. Additionally, international players were found to have greater anthropometric and physical qualities in comparison to their WSL counterparts. This study adds to the limited evidence base surrounding the anthropometric and physical qualities of elite women's rugby league players. Comparative values for anthropometric and physical qualities are provided which practitioners may use to evaluate the strengths and weaknesses of players, informing training programs to prepare players for the demands of women's rugby league.

Sequential movement pattern-mining (SMP) in field-based team-sport: A framework for quantifying spatiotemporal data and improve training specificity?

Athlete external load is typically quantified as volumes or discretised threshold values using distance, speed and time. A framework accounting for the movement sequences of athletes has previously been proposed using radio frequency data. This study developed a framework to identify sequential movement sequences using GPS-derived spatiotemporal data in team-sports and establish its stability. Thirteen rugby league players during one match were analysed to demonstrate the application of the framework. The framework (Sequential Movement Pattern-mining [SMP]) applies techniques to analyse i) geospatial data (i.e., decimal degree latitude and longitude), ii) determine players turning angles, iii) improve movement descriptor assignment, thus improving movement unit formation and iv) improve the classification and identification of players' frequent SMP. The SMP framework allows for sub-sequences of movement units to be condensed, removing repeated elements, which offers a novel technique for the quantification of similarities or dis-similarities between players and playing positions. The SMP framework provides a robust and stable method that allows, for the first time the analysis of GPS-derived data and identifies the frequent SMP of field-based team-sport athletes. The application of the SMP framework in practice could optimise the outcomes of training of field-based team-sport athletes by improving training specificity.

Using Principal Component Analysis to Compare the Physical Qualities Between Academy and International Youth Rugby League Players.

PURPOSE: To compare the physical qualities between academy and international youth rugby league (RL) players using principal component analysis. METHODS: Six hundred fifty-four males (age = 16.7 [1.4] y; height = 178.4 [13.3] cm; body mass = 82.2 [14.5] kg) from 11 English RL academies participated in this study. Participants completed anthropometric, power (countermovement jump), strength (isometric midthigh pull; IMTP), speed (10 and 40 m speed), and aerobic endurance (prone Yo-Yo IR1) assessments. Principal component analysis was conducted on all physical quality measures. A 1-way analysis of variance with effect sizes was performed on 2 principal components (PCs) to identify differences between academy and international backs, forwards, and pivots at under 16 and 18 age groups. RESULTS: Physical quality measures were reduced to 2 PCs explaining 69.4% of variance. The first PC (35.3%) was influenced by maximum and 10-m momentum, absolute IMTP, and body mass. Ten and forty-meter speed, body mass and fat, prone Yo-Yo, IMTP relative, maximum speed, and countermovement jump contributed to PC2 (34.1%). Significant differences (P < .05, effect size = -1.83) were identified between U18 academy and international backs within PC1. CONCLUSION: Running momentum, absolute IMTP, and body mass contributed to PC1, while numerous qualities influenced PC2. The physical qualities of academy and international youth RL players are similar, excluding U18 backs. Principal component analysis can reduce the dimensionality of a data set and help identify overall differences between playing levels. Findings suggest that RL practitioners should measure multiple physical qualities when assessing physical performance.

Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department.

Background: Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods: A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results: Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9-7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.

Plasma-Lyte 148: A clinical review.

AIM: To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine. METHODS: We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate". All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS: We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text. CONCLUSION: Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.

The relationship between study findings and publication outcome in anesthesia research: a retrospective observational study examining publication bias.

PURPOSE: Many areas of medicine have shown bias towards the publication of studies with positive results. To estimate publication bias in the anesthesia literature, we reviewed all abstracts presented at the American Society of Anesthesiologists (ASA) annual meetings over a four-year period and compared study results (positive vs negative) with publication outcomes. METHODS: This review included all abstracts from the 2001-2004 ASA annual meetings performed as randomized-controlled trials in humans. We scored their outcome results as positive or negative and assessed abstract quality using a 13-point scoring system. We then performed a systematic literature search to identify any subsequent publication of the studies and calculated the relative risk (RR) for journal publication by comparing positive vs negative studies. RESULTS: Of 5,918 abstracts reviewed, 1,052 met inclusion criteria, and 564 (53.6%) of the abstracts proceeded to publication. The RR for abstracts with positive results proceeding to journal publication was 1.42 (95% confidence interval, 1.22 to 1.66; P < 0.001). This result did not change significantly after adjusting for study size and abstract quality score during logistic regression modelling. There was no significant difference in the abstract quality score between positive vs negative studies or between abstracts proceeding vs not proceeding to publication. CONCLUSIONS: Approximately half of the ASA annual meeting abstracts proceed to publication. After adjustment for study quality and size, abstracts with positive results were more likely to proceed to journal publication than those with negative results, suggesting publication bias in the anesthesia literature.