A comparison of the knowledge and attitudes of concussion within higher and lower leagues of the community rugby union game.

OBJECTIVES: The Rugby Football Union (RFU) HEADCASE initiative aims to educate coaches, referees, and players on concussion. Concussion in community rugby is under-reported. Therefore, players can play a role in concussion safety if they have adequate knowledge and safe attitudes. The study aimed to evaluate and compare the concussion knowledge and attitudes and Return to Play (RTP) of the community rugby union game. DESIGN: A descriptive, cross-sectional study. PARTICIPANTS: Participants (n = 87) were from level 4 or level 8 of the English rugby union league system. MAIN OUTCOME MEASURES: A modified Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version (RoCKAS-ST) questionnaire was distributed to semi-professional and amateur clubs to evaluate players concussion knowledge index (CKI) and concussion attitudes and behaviours index (CAI) regarding RTP. RESULTS: No statistically significant differences existed relating to knowledge, behaviours or attitude. Some worrying gaps in knowledge were identified. CONCLUSIONS: Findings show that community rugby union players are knowledgeable about concussion and have shown safe attitudes, however this doesn't always translate to safe behaviours. There are some gaps in their knowledge that must be addressed relating to coma and coherence of the athlete and in symptom recognition relating to sleep disturbances.

An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend.

OBJECTIVES: The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 min application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend. DESIGN: Pre- and post-intervention. SETTING: University movement analysis laboratory. PARTICIPANTS: Eleven healthy male participants. MAIN OUTCOME MEASURES: Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee. RESULTS: Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P = .035) and coronal (P = .011) planes during the descent phase of a small knee bend following cryotherapy. CONCLUSION: In conclusion a 20 min application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury.

Immunological markers of lung disease due to non-tuberculous mycobacteria.

Lung disease due to non-tuberculous mycobacteria (NTM) is a poorly understood condition that is difficult to treat. Treatment remains problematic as few tools are available to help clinicians monitor disease progression or predict treatment outcome. In this study, plasma levels of several inflammatory molecules and the frequency of circulating T cell subsets were measured in patients with NTM lung disease and known treatment status, and compared with their adult offspring and with unrelated healthy controls. Plasma levels of the chemokine CXCL10 and IL-18 were assessed for associations with treatment efficacy. CXCL10 was higher in patients than adult offspring (p< 0.001) and unrelated controls (p< 0.001). Plasma CXCL10 was also lower in patients who responded well to therapy or who controlled their infection without requiring therapy, when compared to patients who did not respond to therapy (p=0.03). Frequencies of activated (HLA-DR(+)) CD4(+) T cells were higher in patients than adult offspring (p<0.001) and unrelated controls (p<0.05), with the highest frequencies in individuals who had completed at least 6 months of treatment. Frequencies of activated (CD38(+)) CD8(+) T cells in most treatment responders were similar to unrelated controls. Low plasma levels of CXCL10 may reflect successful control of NTM lung disease with or without therapy. Compared with responders, patients who responded poorly to treatment generally had higher plasma levels of CXCL10 and IL-18, and higher frequencies of activated CD8(+) T cells.

Immunopathogenesis of hepatic flare in HIV/hepatitis B virus (HBV)-coinfected individuals after the initiation of HBV-active antiretroviral therapy.

BACKGROUND: The pathogenesis of and risk factors for hepatic flare (HF) after the initiation of hepatitis B virus (HBV)-active antiretroviral therapy (ART) in HIV/HBV-coinfected individuals is not well understood. METHODS: We studied HF in ART-naive HIV/HBV-coinfected individuals in Thailand (n = 36) who were beginning HBV-active ART as part of a prospective clinical trial. HF was defined as an alanine aminotransferase (ALT) level>5 times the upper limit of normal or >200 IU/L higher than that at baseline. Immune mediators (interleukin [IL]-18, IL-2, IL-6, IL-8, IL-10, soluble CD26 [sCD26], sCD30, sCD8, CXCL-10, CCL-2, tumor necrosis factor-alpha, interferon [IFN]-gamma, and IFN-alpha) and activated NK cells were quantified. RESULTS: HBV DNA and ALT levels at baseline were higher in patients with HF (n=8) than in patients without HF (n=28) (P=.01). After the initiation of ART, CXCL-10 levels remained elevated in patients with HF but decreased in patients without HF (P<.01). sCD30 levels increased and were significantly higher at week 8 in patients with HF (P<.05). There was a positive correlation between levels of ALT and levels of CXCL-10, sCD30, CCL-2, and IL-18 at week 8 (the time of peak ALT level) but not at other time points. CONCLUSION: Elevated HBV DNA and ALT levels before the initiation of HBV-active ART are risk factors for HF. The pathogenesis of HF after the initiation of HBV-active ART is probably consistent with immune restoration disease.