First symmetry tests in polarized Z0 decays to bbg

We have made the first direct symmetry tests in the decays of polarized Z0 bosons into fully identified bbg states, collected in the SLD experiment at SLAC. We searched for evidence of parity violation at the bbg vertex by studying the asymmetries in the b-quark polar- and azimuthal-angle distributions, and for evidence of T-odd, CP-even or CP-odd, final-state interactions by measuring angular correlations between the three-jet plane and the Z0 polarization. We found results consistent with standard model expectations and set 95% C. limits on anomalous contributions.

Treatment of plantar fasciitis

Plantar fasciitis is a common cause of heel pain in adults. The disorder classically presents with pain that is particularly severe with the first few steps taken in the morning. In general, plantar fasciitis is a self-limited condition. However, symptoms usually resolve more quickly when the interval between the onset of symptoms and the onset of treatment is shorter. Many treatment options exist, including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery. Usually, plantar fasciitis can be treated successfully by tailoring treatment to an individual's risk factors and preferences.

Medical coverage of high school football in Wisconsin in 1997

OBJECTIVE

The goals of this study were to assess the health care available to Wisconsin high school football players and to assess high schools' compliance with safety requirements of the Wisconsin Interscholastic Athletic Association (WIAA).

DESIGN

The design was a cross-sectional survey-based study.

SETTING

The setting consisted of WIAA high schools.

PARTICIPANTS

Athletic directors of WIAA high school football programs participated in the survey.

MAIN OUTCOME MEASURES

The main outcome measures were the prevalence of medical coverage by physicians, certified athletic trainers, and ambulance personnel at football games and practice and the prevalence of compliance with WIAA requirements.

RESULTS

Seventy-seven percent (302/392) of surveys were returned. Thirty-six percent of schools had a designated team physician. Eighty-seven percent had a trainer, and 86% were certified athletic trainers (Athletic Trainer Certified, ATC). At practice and scrimmage, 79% had an ambulance available or on call, 52% had a trainer present, and 28% had a physician on call. At football games, 71% had an ambulance, 67% a certified athletic trainer, 48% an emergency medical technician, and 45% a physician present. Regarding WIAA requirements, 9% had no accessible phone, 27% had no written emergency plan of action, 92% had gloves, and 92% had blood spill kits. Larger schools had better compliance with WIAA requirements than did smaller schools.

CONCLUSION

Health care coverage was provided mainly by trainers and ambulance personnel, although physicians were routinely present at almost half of all games. Failure to comply with WIAA medical coverage requirements was not infrequent. This study forms the basis for an informational intervention, providing an opportunity to correct deficits.

Swimming injuries and illnesses

Swimming has a distinct profile of injuries and medical conditions. Common problems seen among swimmers include 'swimmer's shoulder,' an overuse injury that causes inflammation of the supraspinatus and/or the biceps tendon; overuse injuries of the elbow, knee, ankle, and back; medical conditions such as asthma, folliculitis, and otitis externa; and problems associated with overtraining. Swimmers are more likely to comply with treatment plans that minimize time spent out of the water. Prevention and treatment of musculoskeletal injuries often focus on proper stroke mechanics.

Snowboarding injuries

Snowboarding is a popular winter sport that involves riding a single board down a ski slope or on a half-pipe snow ramp. Compared with injuries resulting from traditional alpine skiing, snowboarding injuries occur more frequently in the upper extremities and ankles and less frequently in the knees. Different types of snowboard equipment, rider stance and snowboarding activity tend to result in different types of injury. Snowboarder's ankle, a fracture of the lateral talus, must be considered in a snowboarder with a "severe ankle sprain" that has not responded to treatment. Risk of injury may be lowered by using protective equipment, such as a helmet and wrist guards.

After the fall: symptoms in bungee jumpers

A survey of 100 professionally supervised bungee jumpers who used an ankle harness in a single leap from a platform reveals that 42 jumpers had a total of 59 minor medical complaints or symptoms after their jumps. Immediate symptoms included musculoskeletal pain in the ankle, neck, back, and chest, neurologic complaints such as dizziness and headache, and blurred vision. Dizziness was the most common symptom, and neurologic complaints outnumbered musculoskeletal symptoms. All complaints resolved within 1 week of the jump except for lacerations sustained by one person who tried to grab the platform as he was jumping.

In-line skating: use of protective equipment, falling patterns, and injuries

OBJECTIVE

To determine the use of protective equipment, reasons for nonuse of protective equipment, and patterns of injury, falls, and stopping techniques of recreational in-line skaters.

DESIGN

Survey.

PARTICIPANTS

313 in-line recreational skaters observed skating in the parks, on bicycle trails, and on parkways in Milwaukee, Wisconsin and Columbus, Ohio were asked to participate in a short survey in 1995.

MAIN OUTCOME MEASUREMENTS

The frequency of in-line skater use of protective equipment, reasons for nonuse, patterns of injury, and patterns of falls.

RESULTS

Protective equipment was worn most of the time in the following proportions of skaters [95% confidence interval in brackets]: wrist guards (51%) [44.7%-58.1%]; knee pads (36%) [29.3%-42.5%]; elbow pads (15%) [8.4%-22.8%]; and helmets (15%) [8.0%-22.0%]. Reasons cited for not using protective equipment included lack of perceived need (47.3%), discomfort (37.5%), cost (15.9%), and undesirable appearance (15.2%). Stopping techniques included skating off into the grass (14.6%) [11.8%-17.4%] and voluntarily falling (3.5%) [2.1%-4.9%]. Causes of involuntary falls included spontaneous loss of balance (32.9%) [28.9%-36.9%], hitting rocks or other small objects (17.3%) [14.4%-20.2%], uneven pavement (17%) [14.2%-19.8%], and failure to stop (11.3%) [8.4%-14.2%]. Site of initial impact after falling included the hands and wrists (44.6%) [38.3%-50.9%], the knees (19.6%) [16.4%-22.8%], and the buttocks region (17.2%) [14.3%-20.1%]. Injuries had occurred in 26% of the skaters; 14% of injuries were fractures.

CONCLUSIONS

In-line skaters often do not wear protective equipment because they believe it is not necessary. Recent studies have suggested, however, that protective equipment does prevent injuries. Physicians should counsel their patients who are in-line skaters to use protective equipment.

Serial sevens: not the most effective test of mental status in high school athletes

OBJECTIVE

To evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions: the serial sevens test, the serial threes test, and recitation of months of year in reverse order (MOYR).

PARTICIPANTS

High school student athletes in grades 9, 10, 11, and 12 having sports preparticipation physical examinations. The initial study tested 522 consecutive athletes. The follow-up study tested 109 consecutive athletes.

INTERVENTION

The athletes of the initial group were asked to perform a serial sevens test, followed by a serial threes test, and finally to recite the MOYR. The second group was asked to perform the same tests in a random order.

MAIN OUTCOME MEASURES

Participants were given 1-min time limits for each test, with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake.

RESULTS

For the initial group, 51.3% successfully performed serial sevens, 78.7% successfully performed serial threes, and 89.5% successfully recited the MOYR. For the second group, 52.7% successfully performed serial sevens, 78.1% successfully performed serial threes, and 88.9% successfully recited the MOYR. The pass rates were significantly different for both groups. The pass rates were similar for both sexes, all grade levels, and all sports in both test groups. Participants, both overall and in all subgroups, failed serial sevens more often than serial threes and MOYR (p < 0.001 for the initial group; p < 0.0001 for the second group). They failed serial threes more often than MOYR (p < 0.001 for the initial group; p < 0.01 for the second group).

CONCLUSIONS

The percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion; the test lacks specificity. The percentage of athletes passing the MOYR was greatest, perhaps making this a better sideline test than the traditional serial sevens test. However, testing needs to be done in injured athletes before clinical application can be recommended.

Acute pulmonary edema caused by ingestion of hydrochlorothiazide

Hydrochlorothiazide is one of most commonly prescribed antihypertensive diuretics. In this case, an allergic reaction to hydrochlorothiazide resulted in severe pulmonary edema. Hydrochlorothiazide, one of the most commonly prescribed drugs, is a diuretic which is usually well tolerated. Common side effects include dizziness, weakness, fatigue, and cramps. These side effects are usually caused by fluid and electrolyte imbalances. Acute pulmonary edema, first reported by Steinberg in 1968, is a rare but potentially life-threatening allergic reaction to hydrochlorothiazide. This case illustrates many of the typical presenting features of the reaction.

Establishing a high-school-based training room clinic

Being a team physician can be a time-consuming commitment. The team physician is responsible for all aspects of the athlete's care and has the final say in all medical matters related to athletic participation. Primary care physicians are well suited to be team physicians. The training room is an outstanding way to increase physician availability to adolescents and underserved population. Setting up a training room must be planned in advance, including funding, supplies and liability. Most legal problems can be avoided with a contract and proper documentation. The school-based training room provides the physician with an excellent opportunity for community service and can be a very rewarding experience.

Diagnosis and treatment of common knee injuries in athletes

Knee injuries are an all too common occurrence in athletes. Prompt diagnosis, aggressive treatment and rehabilitation is necessary to minimize time away from athletic activity and to maximize function at a competitive level. This article reviews the latest trends in diagnosing and treating common knee injuries in athletes, including ligamentous and meniscal injuries.

Temperature monitoring

Central temperature is usually tightly regulated in human beings. Anesthesia alters the normal thermoregulatory controls of the body. Intraoperatively, mild degrees of hypothermia may provide some cerebral protection. However, the risk of organ dysfunction and shivering require that the anesthesiologist be prepared to treat severe hypothermia. Appropriate measures such as warning the operating room and using forced air blankets can prevent both intraoperative hypothermia and postoperative shivering. The use of temperature measurement is not limited to the operative and immediate recovery periods. Anesthesiologists practicing in intensive care units and in pain clinics use temperature monitoring as a diagnostic tool in a variety of situations.

Neuroleptic malignant syndrome postoperative onset due to levodopa withdrawal

Neuroleptic malignant syndrome is a potentially fatal disorder that may develop in the perioperative period. A case is described in which discontinuation of chronic levodopa therapy precipitated the postoperative development of this syndrome. The differential diagnosis and management principles are reviewed.

Ulnar stress fracture of the nondominant arm in a tennis player using a two-handed backhand

Stress fractures are infrequently seen in non-weight-bearing bones. However, stress fractures may be present in any bone that undergoes repetitive stress. We report an unusual case of stress fracture in the nondominant arm of a tennis player who uses a two-handed backhand stroke.

Clinical evaluation of continuous noninvasive blood pressure monitoring: accuracy and tracking capabilities

A continuous, noninvasive device for blood pressure measurement using pulse transit time has been recently introduced. We compared blood pressure measurement determined using this device with simultaneous invasive blood pressure measurements in 35 patients undergoing general endotracheal anesthesia. Data were analyzed for accuracy and tracking ability of the noninvasive technique, and for frequency of unavailable pressure measurements by each method. A total of 25,133 measurements of systolic pressure, diastolic pressure, and mean arterial pressure (MAP) by each method were collected for comparison from 35 patients. Accuracy was expressed by reporting mean bias (invasive pressure minus noninvasive pressure) and limits of agreement between the two measurements. After correction for the offset found when measuring invasive and oscillometric methods of arterial pressure measurement, the mean biases for systolic, diastolic, and mean pressures by the pulse wave method were -0.37 mm Hg, -0.01 mm Hg, and -0.05 mm Hg, respectively (p < 0.001). The limits of agreement were: -29.0 to 28.2 mm Hg, -14.9 to 14.8 mm Hg, and -19.1 to 19.0 mm Hg, respectively (95% confidence intervals). When blood pressure measured invasively changed over time by more than 10 mm Hg, the noninvasive technique accurately tracked the direction of change 67% of the time. During the entire study, 3.2% of the invasive measurements were unavailable and 12.9% of the noninvasive measurements were unavailable. The continuous noninvasive monitoring technique is not of sufficient accuracy to replace direct invasive measurement of arterial blood pressure, owing to relatively wide limits of agreement between the two methods.(ABSTRACT TRUNCATED AT 250 WORDS)

In-line skating. An observational study of protective equipment used by skaters

OBJECTIVES

To determine the frequency and patterns of use of the various types of protective equipment by in-line skaters and to determine if use of protective equipment was associated with the age, sex, group composition, or expertise of the skater.

DESIGN

A total of 1548 in-line skaters were observed during a 3-month period in Milwaukee, Wis. Identification and protective equipment data were recorded and analyzed by chi 2 tests with Pearson's correlation coefficient.

RESULTS

Overall, 491 skaters (31.7%) wore no protective gear. Wrist guards were worn by 999 skaters (64.5%). Helmets were worn by only 40 skaters (2.6%). Overall, adolescent males, children, and advanced skaters were the least likely to be observed wearing protective equipment.

CONCLUSIONS

Protective equipment is underused by many in-line skaters. Educating in-line skaters about the value of wearing protective equipment, as recommended by equipment manufacturers, may help reduce the severity or incidence of skating injuries.

Characterization of a new ion selective electrode for ionized magnesium in whole blood, plasma, serum, and aqueous samples

Results from a novel ion selective electrode (ISE) for ionized magnesium (Mg2+) correlate well with atomic absorption spectroscopy on aqueous solutions containing from 0.1-3.0 mmol MgCl2/L. Day to day precision (coefficient of variation) of the electrode on protein-based controls is < 4%; aqueous-based controls < 6%. The new ISE is selective for Mg2+ with a selectivity constant for Ca2+ (KMgCa) of 8 x 10(-2). Adding pathophysiologic concentrations of Cd2+, Ca2+, Cu2+, Fe3+, K+, Na+, or Zn2+ to serum and aqueous solutions gave negligible to minimal changes in measured Mg2+. Ligand binding studies in aqueous solution indicate that pathophysiologic concentrations of different anions (e.g. heparin, lactate, bicarbonate, phosphate, acetate and sulfate) bind to Mg2+, effectively reducing its concentration in solution. Likewise, silicon (as either found in Vacuutainer tubes or as chlorosilane) failed to exert any significant effect on measured Mg2+. Addition of Intralipid (up to 500 mg/dL) gave negligible to minimal changes in Mg2+. Mg2+ measurements on whole blood, plasma, and serum for a given human subject's samples are virtually identical, at least within the reference range for Mg2+. Typically, Mg2+ is 71% of TMg, but varies from subject to subject; i.e. Mg2+ cannot be predicted from TMg. Clinical studies revealed that the Mg2+/TMg ratio could be remarkably consistent in sequential samples (e.g., throughout the course of coronary bypass surgery) taken from one patient, but that this ratio could differ dramatically from the ratio in sequential samples taken from another. Mg2+ is held within a narrow range (0.53-0.67 mmol/L) in normal, healthy subjects when compared to TMg (0.70-0.96 mmol/L).

A new method for the rapid determination of ionized Mg2+ in whole blood, serum and plasma

A novel ion selective electrode (ISE) for ionized magnesium (IMg2+) in whole blood (WB), plasma (PL) and serum (S) has now been designed and characterized in normal human subjects, diseased and pregnant subjects. Using this ISE on various levels of aqueous Mg2+ solutions (0.1-3.0mM), mean Mg2+ values are within 94.6 and 99.2% of their targets. The linearity of the ISE (0.1-3.0mM) in aqueous solution and human PL and S ranges between 92.0 and 99.3%. The ISE is highly selective for IMg2+, yielding measurements in less than 2 min, and exhibiting no or negligible effects from physiologic concentrations of Ca2+,Na+,K+ or H+. Ligand binding studies indicate that pathophysiologic concentrations of most smaller molecular weight anions fail to interfere with IMg2+ measurements in aqueous solution, PL or S. Likewise, pathophysiologic concentrations of heavy metals or lipids do not interfere with measurements for IMg2+. Comparison of healthy, normal WB, PL and S IMg2+, using the ISE, with measurements of ultrafilterable Mg by atomic absorption spectroscopy (AAS) are excellent. The mean value for IMg2+ in normal WB, PL and S is 0.58-0.60mM (range = 0.53-0.67mM). Compared to total Mg (TMg) (0.75-0.96mM) and ICa2+ (1.10-1.30mM), IMg2+ is held in a narrow, tight range, representing 71% of TMg. Preliminary studies on plasma and serum IMg2+ during open heart surgery and term pregnancy demonstrate significant abnormalities in IMg2+ and % IMg2+. The new ISE for IMg2+ should prove invaluable and revolutionary in studies of Mg metabolism in both healthy and diseased states.