The Effect of Altitude and Travel on Rugby Union Performance: Analysis of the 2012 Super Rugby Competition.

The aim of this study was to investigate whether playing rugby at altitude or after travel (domestic and international) disadvantaged teams. In a retrospective longitudinal study, all matches (N = 125) played in the 2012 Super Rugby Competition were analyzed for key performance indicators (KPI) from coded game data provided by OPTA sports data company. Matches were played in a home-away format in New Zealand, South Africa, and Australia. Teams based at sea level but playing at altitude (1,271-1,753 m) were more likely to miss tackles (mean ± 90% confidence interval, 1.4 ± 1.7) and score fewer points in the first half compared with games at sea level. In the second half of games, sea level teams at altitude were very likely to make fewer gain lines (-4.0 ± 2.7) compared with the second half of games at sea level. The decreased ability to break the defensive line, which may be the result of altitude-induced fatigue, could reduce the likelihood of scoring points and winning a game. Travel also had an effect on KPI, where international travel resulted in more missed tackles (1.7 ± 1.3) and less frequent gain lines (-3.0 ± 1.9) in the first half relative to matches at home; overall, away teams (domestic and international) scored 4 less points in the second half compared with home teams. In conclusion, playing away from home in another country, particularly at altitude, can have a detrimental effect on KPI, which may affect the overall performance and the chances of winning matches.

Getting to goal in newly diagnosed type 2 diabetes using combination drug "subtraction therapy".

BACKGROUND: The treatment of newly diagnosed type 2 diabetes mellitus is diverse, with no clear consensus regarding the initial drug regimen or dosing to achieve optimal glycemic control. METHODS: We treated 44 consecutive patients with newly diagnosed type 2 diabetes with maximally tolerated doses of pioglitazone 45 mg/day, metformin 1000-2000 mg/day, and repaglinide 1-4 mg before meals. The doses and drugs were subsequently decreased ("subtraction therapy") to achieve optimal glycemic control and minimize side effects. Three primary outcomes were measured: the short term HbA1c response, the long term HbA1c response, and the incidence of hypoglycemia. RESULTS: All 44 patients responded with a rapid, progressive decline in their HbA1c levels from 11.43±2.3% to 6.17±0.72% (101±25.1 mmol/mol to 44±7.9 mmol/mol) by three months, and remained stable thereafter. An HbA1c ≤7.0% (≤53 mmol/mol) was reached within 1-4 months in 42 of 44 patients, and in every patient by 12 months. Each patient's lowest HbA1c level, 5.65±0.6% (38±6.6 mmol/mol), was reached over 6.3±2.9 months. Patients with initial HbA1c levels >10% (>86 mmol/mol) (n=33) responded similarly as those with HbA1c levels <10% (<86 mmol/mol) (n=11). Combination drug therapy maintained HbA1c levels between 5.0 and 7.0% (31 and 53 mmol/mol) for up to 14.83 years. Only one clinically significant hypoglycemic event occurred during 261.08 person-years of follow-up. CONCLUSIONS: In our experience, combination drug "subtraction therapy" was safe and effective for treating all newly diagnosed type 2 diabetic patients.

Social networking among upper extremity patients.

PURPOSE: Despite their rising popularity, the health care profession has been slow to embrace social networking sites. These are Web-based initiatives, designed to bring people with common interests or activities under a common umbrella. The purpose of this study is to evaluate social networking patterns among upper extremity patients. METHODS: A total of 742 anonymous questionnaires were distributed among upper extremity outpatients, with a 62% response rate (462 were completed). Demographic characteristics (gender, age, level of education, employment, type of health insurance, and income stratification) were defined, and data on computer ownership and frequency of social networking use were collected. Social network users and nonusers were compared according to their demographic and socioeconomic characteristics. RESULTS: Our patient cohort consisted of 450 patients. Of those 450 patients, 418 had a high school education or higher, and 293 reported a college or graduate degree. The majority of patients (282) were employed at the time of the survey, and income was evenly distributed among U.S. Census Bureau quintiles. A total of 349 patients reported computer ownership, and 170 reported using social networking sites. When compared to nonusers, social networking users were younger (p<.001), more educated (p<.001), and more likely to be employed (p = .013). Users also had higher income levels (p=0.028) and had high rates of computer ownership (p<.001). Multivariate regression revealed that younger age (p<.001), computer ownership (p<.001), and higher education (p<.001) were independent predictors of social networking use. Most users (n = 114) regularly visit a single site. Facebook was the most popular site visited (n=142), followed by MySpace (n=28) and Twitter (n=16). CONCLUSIONS: Of the 450 upper extremity patients in our sample, 170 use social networking sites. Younger age, higher level of education, and computer ownership were associated with social networking use. Physicians should consider expanding their use of social networking sites to reach their online patient populations.