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BackgroundHealthcare services is an expanding international market with which national healthcare systems engage, and from which they benefit, to greater and lesser degrees. This study examines the case of the China-England engagement in healthcare services as a vehicle for illuminating the way in which such market relationships are constructed.FindingsChina and England have different approaches to the international healthcare services market. Aware of the knowledge and technology gaps between itself and the leading capitalist nations of the West in healthcare, as in other sectors, the Chinese leadership has encouraged a variety of international engagements to facilitate the bridging of these gaps including accessing new supply and demand relationships in international markets. These engagements are situated within an approach to health system development based on establishing broad policy directions, allowing a degree of local innovation, initiating and evaluating pilot studies, and promulgating new programmatic frameworks at central and local levels. The assumption is that the new knowledge and technologies are integrated into this approach and implemented under the guidance of Chinese experts and leaders. England’s healthcare system has the knowledge resources to provide the supply to meet at least some of the China demand but has yet to develop fully the means to enable an efficient market response, though such economic engagement is supported by the UK’s trade related departments of state. As a result, the development of China-England commercial relationships in patient care, professional education and hospital and healthcare service development has been led largely by high status NHS Trusts and private sector organisations with the entrepreneurial capacity to exploit their market position. Drawing on their established international clinicians and commercial teams with experience of domestic private sector provision, these institutions have built trust-based collaborations sufficiently robust to facilitate demand-supply relationships in the international healthcare services market. Often key to the development of relations required to make commercial exchange feasible and practicable are a range of international brokers with the skills and capacity to provide the necessary linkage with individual healthcare consumers and institutional clients in China. Integral to the broker role, and often supplied by the broker itself, are the communication technologies of telemedicine to enable the interaction between consumer and healthcare provider, be this in patient care, professional education or healthcare service development.ConclusionsAlthough England’s healthcare system has the knowledge required to respond to China’s market demand and such economic engagement is supported and actively encouraged by the UK’s trade related departments of state, the response is constrained by multiple domestic demands on its resources and by the limits of the NHS approach to marketisation in healthcare.

Introduction: Both gender and additional load have been shown to affect landing mechanics. Females are at an increased risk of sustaining an anterior cruciate ligament injury and patellofemoral pain syndrome, whereas males are at a greater risk of developing patellar tendinopathy. There is a paucity of literature examining the effects of load position or the comparison between genders during jump landings with additional load. Purpose: To examine the effects of different positions of loading on lower extremity biomechanics during a jump-landing task. An additional purpose was to compare lower extremity biomechanics between genders during loaded and unloaded jump landings. Method: Twenty-four resistance trained males (n = 12, age 21.1 ± 1.4 years, body mass 76.2 ± 10.3 kg, height 1.77 ± 0.08 m) and females (n = 12, age 20.3 ± 1.4 years, body mass 64.4 ± 7.2 kg, height 1.70 ± 0.03 m) were recruited. Three-dimensional lower-limb-joint kinematics and kinetics were measured during 5 bilateral maximal jumps were performed in a randomised order in each of four conditions: unloaded (UL), holding dumbbells (DB), wearing a weighted vest (WV), and with a barbell placed across the shoulders (BB). All loaded conditions were performed with 10% of body weight. A two-way analysis of variance (type of load * gender) was performed on kinetic and kinematic variables. Cohen’s d effect sizes were calculated for differences between load types. Results: Significant differences were shown between genders with the male group exhibiting increased jump height, lower time to peak knee flexion, smaller sagittal plane excursion (ROM), and smaller hip adduction angles at ground contact (IC) and smaller peak hip adduction angles when compared to females. Males were also shown to have significantly greater peak vertical ground reaction force (vGRF), significantly smaller time to peak vGRF, and significantly greater peak knee and hip extension moments. There was no significant interaction between load and gender in all variables measured. All loaded jumps resulted in a significant increase in the time to reach peak knee flexion. Significant decreases were observed in peak hip adduction moment and peak knee valgus moment in the male BB condition and female BB condition respectively when compared to UL jump landings. There was a significant decrease exhibited in vGRF in both genders in the BB condition when compared to the UL condition. Conclusion: Both gender and additional loading alter landing biomechanics in maximal vertical jump landings. Males and females responded similarly to each of the loaded conditions. Findings suggest use of the BB may decrease the risk of injury relative to DB and WV during maximal countermovement jumps in both genders.