Understanding the relationship between surfing performance and fin design.

This research aimed to determine whether accomplished surfers could accurately perceive how changes to surfboard fin design affected their surfing performance. Four different surfboard fins, including conventional, single-grooved, and double-grooved fins, were developed using computer-aided design combined with additive manufacturing (3D printing). We systematically installed these 3D-printed fins into instrumented surfboards, which six accomplished surfers rode on waves in the ocean in a random order while blinded to the fin condition. We quantified the surfers' wave-riding performance during each surfing bout using a sport-specific tracking device embedded in each instrumented surfboard. After each fin condition, the surfers rated their perceptions of the Drive, Feel, Hold, Speed, Stiffness, and Turnability they experienced while performing turns using a visual analogue scale. Relationships between the surfer's perceptions of the fins and their surfing performance data collected from the tracking devices were then examined. The results revealed that participants preferred the single-grooved fins for Speed and Feel, followed by double-grooved fins, commercially available fins, and conventional fins without grooves. Crucially, the surfers' perceptions of their performance matched the objective data from the embedded sensors. Our findings demonstrate that accomplished surfers can perceive how changes to surfboard fins influence their surfing performance.

Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward.

AIMS: Variable rate intravenous insulin infusion (VRIII) is used perioperatively to maintain normoglycaemia in patients with diabetes who are undergoing surgery. The aims of this project were as follows: (1) to audit the extent to which perioperative prescribing of VRIII for diabetic vascular surgery inpatients at our hospital meets established standards and (2) to use the results of the audit to guide improvement in the quality and safety of prescribing practices and reduce VRIII overuse. METHODS: Vascular surgery inpatients who had perioperative VRIII were included in the audit. Baseline data were collected consecutively from September to November 2021. There were three main interventions: a VRIII Prescribing Checklist, education of junior doctors and ward staff, and electronic prescribing system updates. Postintervention and reaudit data were collected consecutively from March to June 2022. RESULTS: The number of VRIII prescriptions totalled 27 in preintervention, 18 in postintervention and 26 in reaudit periods. Prescribers used the 'refer to paper chart' safety check more frequently postintervention (67%) and on reaudit (77%) compared with preintervention (33%) (p=0.046). Rescue medication was prescribed in 50% of postintervention and 65% of reaudit cases compared with 0% preintervention (p<0.001). Intermediate/long-acting insulin was appropriately amended more often in the postintervention versus preintervention period (75% vs 45%, p=0.041). Overall, VRIII was appropriate for the situation in 85% of cases. CONCLUSIONS: The quality of perioperative VRIII prescribing practices improved following the proposed interventions, with prescribers more frequently using recommended safety measures such as 'refer to paper chart' and rescue medication. There was a marked sustained improvement in prescriber-initiated adjustment of oral diabetes medications and insulins. VRIII is occasionally administered unnecessarily in a subset of patients with type 2 diabetes and may be an area for further study.

Increasing women's participation in biomechanics through National Biomechanics Day events.

Science, technology, engineering and mathematics (STEM) occupations represent one of the broadest gender gaps in any professional field, with women and girls grossly underrepresented in STEM education and careers, particularly engineering and biomechanics. Factors such as bias, stereotyping, and a lack of female role models can significantly influence women's and girls' decisions to enter and remain in the field of biomechanics. A critical first step in increasing the number of female biomechanists is to create early opportunities for girls to explore biomechanics. To address this, international initiatives, such as National Biomechanics Day (NBD), have been developed to expand the awareness, influence, and impact of biomechanics by engaging young people in school biomechanics programs. The Biomechanics Initiative, the official sponsor of NBD, offers grant programs aimed at empowering women to host an NBD event designed to promote biomechanics to girls and women in an immersive, interactive, and engaging manner. In 2021, Biomechanics Research Laboratory (BRL) Ph.D. student Maddison Kirk was a recipient of the grant program. In this paper we describe the BRL NBD event, which involved 20 female athletes from diverse backgrounds, demonstrating to them how biomechanics can be used to assess their physical fitness and performance. Female biomechanists and research assistants running the NBD event acted as female role models to participants, increasing the visibility of women in biomechanics and, in turn, helping to address current bias and stereotyping in STEM. By diversifying biomechanics and ensuring STEM fields are representative of the society in which we live, we can advance the field of biomechanics both nationally and internationally.

Provision of NICE-recommended varicose vein treatment in the NHS.

BACKGROUND: Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins. In the National Health Service (NHS) in England, commissioning of care for people with varicose veins is performed by Clinical Commissioning Groups (CCGs) and clinical guidelines have been developed by the National Institute for Health and Care Excellence (NICE CG168). The Evidence-Based Intervention (EBI) programme was introduced in the NHS with the aim of improving care quality and supporting implementation of NICE CG168. The aim of this study was to assess access to varicose vein treatments in the NHS and the impact of EBI. METHODS: CCG policies for the delivery of varicose vein treatments in the NHS in England were obtained from 2017 (before EBI introduction) and 2019 (after EBI introduction) and categorized by two independent reviewers into levels of compliance with NICE CG168. Hospital Episode Statistics data were compared with the NICE commissioning model predictions. A quality-adjusted life-year was valued at £20 000 (Euro 23 000 15 November 2022). RESULTS: Despite the introduction of the EBI programme, CCG compliance with NICE CG168 fell from 34.0 per cent (64 of 191) to 29.0 per cent (55 of 191). Some 33.0 per cent of CCG policies (63 of 191) became less compliant and only 7.3 per cent (14 of 191) changed to become fully compliant. Overall, 66.5 per cent of CCGs (127 of 191) provided less than the recommended intervention rate before EBI and this increased to 73.3 per cent (140 of191) after EBI. The overall proportion of patients estimated to require treatment annually who received treatment fell from 44.0 to 37.0 per cent. The associated estimated loss in net health benefit was between £164 and 174 million (Euro 188 million and 199 million 15 November 2022) over 3 years. A compliant policy was associated with a higher intervention rate; however, commissioning policy was associated with only 16.8 per cent of the variation in intervention rate (R2 = 0.168, P < 0.001). CONCLUSION: Many local varicose vein commissioning policies in the NHS are not compliant with NICE CG168. More than half of patients who should be offered varicose vein treatment are not receiving it, and there is widespread geographical variation. The EBI programme has not been associated with any improvement in commissioning or access to varicose vein treatment.

Can we predict the landing performance of simulated aerials in surfing?

This study explored which technical and physical attributes could predict superior and/or safe landing performance when surfers performed variations of a simulated aerial task. Fourteen surfers (age 20.6 ± 5.7 years, height 178.1 ± 9.50 cm, mass 70.6 ± 10.8 kg) had their lower limb mobility, squat jump, countermovement jump, and drop-and-stick landing performance assessed. Performance of two aerial variations (Frontside Air (FA) and Frontside Air Reverse (FAR)) was also measured, with variables relating to technical performance (critical feature and subjective ratings) and potential injury risk (relative total peak landing force and loading rates) collected. Multiple linear regressions were used to predict performance of both aerial variations based on a subset of independent variables. Four models could predict performance. Predicted technical capability in the FAR was mostly influenced by lead limb hip extension and lead limb knee flexion range of motion. Potential injury risk when surfers perform an FA and FAR was predicted to be mitigated by increasing lead ankle dorsiflexion range of motion, as well as trail hip extensor mobility to reduce the relative total peak force experienced when landing the FA. These simple outcome measures could be routinely assessed to ensure successful and safe aerial landings in surfing.

Rate of loading, but not lower limb kinematics or muscle activity, is moderated by limb and aerial variation when surfers land aerials.

We aimed to determine whether there were any differences in how surfers used their lead and trail limbs when landing two variations of a simulated aerial manoeuvre, and whether technique affected the forces generated at landing. Fifteen competitive surfers (age 20.3 ± 5.6 years, height 178.2 ± 9.16 cm, mass 71.0 ± 10.5 kg) performed a Frontside Air (FA) and Frontside Air Reverse (FAR), while we collected the impact forces, ankle and knee muscle activity, and kinematic data. A principal component analysis (PCA) was used to reduce 41 dependent variables into 10 components. A two-way MANOVA revealed that although there were no limb x aerial variation interactions, surfers generated significantly higher relative loading rates at landing for the trail limb compared to the lead limb (+28.8 BW/s; F(1,303) = 20.660, p < 0.0001, η2 = 0.064). This was likely due to the surfers "slapping" the trail limb down when landing, rather than controlling placement of the limb. Similarly, higher relative loading rates were generated when landing the FA compared to the FAR (+23.6 BW/s; F(1,303) = 31.655, p < 0.0001, η2 = 0.095), due to less time over which the forces could be dissipated. No relationships between aerial variation or limb were found for any of the kinematic or muscle activity data. Practitioners should consider the higher relative loading rates generated by a surfer's trail limb and when surfers perform a FA when designing dry-land training to improve the aerial performance of surfing athletes.

Training for success: Do simulated aerial landings replicate successful aerial landings performed in the ocean?

PURPOSE: Physical preparation of competitive surfers includes substantial dry-land training. It is currently unknown, however, how closely these exercises replicate surfing maneuvers performed in the ocean. This study compared the technique features displayed by surfers when landing simulated aerial maneuvers on land to critical features previously established as necessary for surfers to successfully land aerials in the ocean during competition. METHODS: Fourteen competitive surfers (age 20.6 ± 5.7 years, height 178.1 ± 9.50 cm, mass 70.6 ± 10.8 kg) were recruited to perform two variations of a simulated aerial task, a Frontside Air (FA) and Frontside Air Reverse (FAR). Joint ranges of motion (ROM), center of pressure, and apparent gaze data were collected during the landing event. Paired t tests or Wilcoxon signed-rank tests were used to identify any significant differences in the outcome variables between the two aerial tasks. RESULTS: Participants displayed 100% and 60% of the critical features associated with successfully landing a FA and FAR, respectively. In both the simulated FA and FAR, participants landed in 1.0-3.7° of dorsiflexion, moving through significantly less ankle joint ROM in the lead limb during the FAR (P < .01). Participants also displayed significantly less knee and hip ROM (P = .002-.048) while landing the FAR compared to the FA. CONCLUSION: The simulated FA and FAR tasks are appropriate training tools for surfers to replicate most of the critical features that a surfer should display to successfully land aerial maneuvers in the ocean. These tasks therefore enable surfers to practice these complex movements in a controlled environment.

Essential Skills for Superior Wave-Riding Performance: A Systematic Review.

Forsyth, JR, Riddiford-Harland, DL, Whitting, JW, Sheppard, JM, and Steele, JR. Essential skills for superior wave-riding performance: A systematic review. J Strength Cond Res 34(10): 3003-3011, 2020-To successfully and safely perform surfing maneuvers, surfers and their coaches need to know how to perform each maneuver correctly. Although some components of the sport are well understood, evidence-based recommendations in the scientific literature on how to perform surfing skills are sparse. The aim of this article was to systematically review the body of literature pertaining to discrete wave-riding skills and characteristics that are associated with the ability of surfers to successfully perform them. Searches of PubMed, SCOPUS, SPORTDiscus with Full-text, and Web of Science were undertaken in January 2019, to identify the most appropriate literature, with secondary searches of reference lists used to create a greater pool of possible articles. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Ten studies deemed appropriate for review captured data from 299 surfers, who were predominantly competitive (78.3%) and male (58.2%). The average Down and Black Quality Index of the articles was 76.3 ± 8.4%, with these articles focusing on the "pop-up" and landing skills. Performance indicators, such as isometric push-up peak forces, force-plate derived and in-water time to pop-up, relative peak forces generated when landing and time-to-stabilization, were all shown to be related to the physical characteristics of surfers and could affect the ability of surfers to successfully ride a wave. Findings from the studies included in this review suggest that the pop-up and landing exhibit trainable qualities that coaches and athletes can use to improve surfing performance.

Life-threatening intraoperative anaphylaxis as a result of chlorhexidine present in Instillagel.

A 70-year-old man with left lower limb critical ischaemia was admitted to our vascular unit for a femoral-popliteal bypass. He had experienced a skin reaction to chlorhexidine 6 months previously during an angioplasty procedure. After intubation, once in the operating theatre, the patient had a urinary catheter inserted using Instillagel. Around 30 min later the patient had a full-blown anaphylactic reaction that required aggressive medical management and the abandoning of surgery. Postoperative allergy testing confirmed that the suspected primary trigger for the anaphylaxis was indeed chlorhexidine, which was present in Instillagel. The patient was also found to have allergies to atracurium and teicoplanin, which had been given on induction. This case report highlights the importance of recognising that Instillagel contains chlorhexidine, and that indeed intraurethral use during routine urinary catheterisation can be a cause of life-threatening anaphylaxis.

Analysis of Scoring of Maneuvers Performed in Elite Men's Professional Surfing Competitions.

PURPOSE: To investigate the influence of turns, tube rides, and aerial maneuvers on the scores awarded in elite men's professional surfing competitions. The successful completion rate and scores associated with different aerial variations were also investigated. METHODS: Video recordings from all 11 events of the 2015 World Surf League men's world championship tour were viewed to classify maneuvers performed by the competitors on each wave as turns, tube rides, and aerials. A 2-way ANOVA was used to determine any main effect or interaction of maneuver type or event location on the wave scores. A 1-way ANOVA was used to determine any main effect of aerial type on successful completion rate. RESULTS: Aerial maneuvers were scored significantly higher than tube rides and turns. A significant main effect existed for maneuver and completion rate. Aerial maneuvers had the lowest completion rate, 45.4%. During the finals series (quarterfinals, semifinals, and finals heats) aerial-maneuver completion rate was higher, 55.4%. The frontside air reverse was the most commonly performed maneuver and received an average score of 6.77 out of 10. CONCLUSION: Professional surfers can optimize their potential single-wave scores during competition by successfully completing aerial maneuvers. However, aerial maneuvers continue to be a high-risk maneuver with a significantly lower completion rate. Our findings suggest that surfers should aim to improve their aerial-maneuver completion rate via surf practice or land-based training drills.

The evolving management of the appendix mass in the era of laparoscopy and interventional radiology.

AIM: An appendix mass is the result of a walled-off perforation of the appendix which localises, resulting in a mass and it is encountered in up to 7% of patients presenting with acute appendicitis. However, its management is controversial due to the lack of high level evidence. This review article sets out a rationale diagnostic and therapeutic strategy for the appendix mass based upon up-to-date available evidence. METHODS: A literature review of the investigation and management of appendix mass/complicated appendicitis was undertaken using PubMed, EMBASE and Google Scholar. RESULTS/CONCLUSION: No prospective studies were identified. The great majority of recent evidence supports a conservative management approach avoiding urgent appendicectomy because of the high risk of major complications and bowel resection. Appendix abscesses over 5 cm in diameter and persistent abscesses should be drained percutaneously along with antibiotics. Appendix phlegmon should be treated with antibiotics alone. Surgery is reserved for patients who fail conservative treatment. Routine interval appendicectomy is not recommended, but should be considered in the context of persistent faecolith, ongoing right iliac fossa pain, recurrent appendicitis and appendix mass persistent beyond 2 weeks. Clinicians should be particularly wary of patients with appendix mass aged over 40 and those with features suggesting malignancy.

Superior mesenteric artery syndrome as a cause for recurrent abdominal pain and vomiting in a 9-year-old girl.

A 9-year-old girl was admitted under our general surgical team with 2 days of diffuse abdominal pain and vomiting. This was one of multiple admissions for similar symptoms over the past 5 years. She was feverish on admission but haemodynamically stable. On examination, she had a diffusely tender and hypersensitive abdomen, with no guarding or peritonism, and no palpable masses. Of note, the patient was very thin, with almost no body fat. Blood tests were otherwise normal, with a normal abdominal X-ray and abdominal ultrasound. She had undergone three previous abdominal ultrasounds over the past 5 years for similar symptoms, all of which were normal. Following this, CT revealed a diagnosis of superior mesenteric artery syndrome. The patient was transferred to our regional children's hospital for analgaesia, nasogastric decompression and nutritional supplementation. She made a swift improvement with plans for ongoing follow-up by the paediatric team.