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Background Physical activity is associated with ECG phenotypes that may overlap with those observed in conditions predisposing to sudden cardiac death. In 2005 the study group of sports cardiology produced guidelines to differentiate ECG changes likely to reflect physiological adaptation to exercise from those, which should prompt further investigations. The guidelines were updated in 2010 resulting in improved specificity in predominantly Caucasian cohorts (white athletes; WA). We sought to examine the performance of the 2010 guidelines in athletes of African/Afro-Caribbean origin (black athletes; BA). Methods ECG of 923 male BA were evaluated to determine the proportion of individuals requiring further investigations based on the 2005, compared to the updated 2010 guidelines. The same evaluation was performed for a cohort of 1711 male WA and 209 patients with hypertrophic cardiomyopathy (HCM). In addition, the impact of “Refined Criteria” was examined, consisting of an upper limit of 470 msec for QTc and removing the following as abnormalities: (1) isolated voltage criteria for left atrial enlargement (LAE); (2) Isolated voltage criteria for right ventricular hypertrophy (RVH); (3) T-wave inversions (TWI) in V1/2 in WA and V1-V4 in BA. Results Using 2005 guidelines, 549 BA (59.5%) met criteria for a positive ECG requiring referral for further investigations compared to 846 WA (49.4%). In comparison, 398 BA (43.1%) met criteria for a positive ECG using 2010 guidelines [predominantly due to TWI (22.3%), RVH (13.0%) and LAE 8.5%)] compared to 216 WA (12.6%) [predominantly due to TWI (3.0%), RVH (2.8%) and LAE (2.7%)]. All of the HCM patients met the criteria for a positive ECG, regardless of which guidelines were used. Using our “Refined Criteria,” the number of BA with a positive ECG was reduced to 161 (17.4%) and WA to 93 (5.4%). Five patients with HCM had isolated voltage criteria for LAE (2.4%); all were symptomatic apart from 1 (0.5%). Five patients with HCM had voltage criteria for LAE in combination with LVH but no other abnormalities on their ECG; all were symptomatic apart from 1 (0.5%). Conclusions Updated guidelines significantly reduce the number of positive ECG results in WA, but less so in BA, emphasising the need for ethnicity specific criteria to be developed. Refining criteria based on physiological changes known to occur in athlete9s heart results in further reduction in positive ECGs. Our findings in patients with HCM suggest that if found in isolation or in combination with voltage criteria for LVH alone, ECG evidence of LAE may be regarded as a physiological rather than pathological change.

Background It is well-established that fragmented QRS complexes (fQRS) on the 12-lead ECG are a predictor of delayed gadolinium enhancement (DGE) on Cardiac MRI (CMR) and indicate myocardial scar or fibrosis in patients with coronary artery disease and dilated cardiomyopathy. Moreover, fQRS appear to correlate well with arrhythmic events and mortality in these cohorts. However the significance of fQRS in hypertrophic cardiomyopathy (HCM) is yet to be established. We sought to determine whether the presence of fQRS is a predictor of delayed gadolinium enhancement (DGE) on CMR in patients with HCM. Methods The 12-lead ECGs of 82 consecutive patients with HCM who underwent CMR with gadolinium were analysed for the presence of fQRS by two independent readers blinded to the CMR findings. Patients with documented myocardial infarction (n=3) were excluded from further analysis. The ECGs were correlated to CMR findings, and patients separated into DGE positive (DGE+ve; n=44) and negative (DGE−ve; n=35) groups. ECG territories of fQRS were correlated with myocardial segments of DGE on CMR, in order to determine whether areas of fQRS predicted areas of DGE. Results Patients from the DGE+ve and DGE-ve groups were of similar gender (75% vs 77% male respectively, p=1.00) and age (54 ± 19 vs 57 ± 11 years respectively, p=0.41). Fragmented QRS complexes were significantly more prevalent in the DGE+ve group than in the DGE-ve group (68.2% vs 14.3%, p

Introduction Left ventricular non-compaction (LVNC) cardiomyopathy is characterised by increased myocardial trabeculation and recesses. Clinical manifestations of the disorder include progressive left ventricular dilatation, systolic impairment, predilection to fatal arrhythmias and thrombo-embolic events. Studies in heart failure patients demonstrate a high prevalence (up to 30%) of myocardial trabeculations irrespective of the criterion used, and raise the potential diagnosis of LVNC. Given the high prevalence compared with other primary cardiomyopathies, it is unclear whether the myocardial morphology is representative of LVNC or merely an epiphenomenon associated with increased cardiac preload. The large cardiac preload associated with regular participation of intensive exercise results in physiological cardiac remodelling including increased left ventricular wall thickness and cavity size. Isolated case findings have also revealed increased trabeculations in some athletes but the significance of the anomaly is unclear. The distinction between cardiac remodelling from athletic training and LVNC is important when one considers that primary cardiomyopathies are the most commonly implicated cause of exercise related sudden cardiac death in young athletes. The aim of this study was to identify the prevalence and significance of hypertrabeculation in highly trained young athletes. Method Between 2003 and 2011, 1146 athletes, aged 14–35 years, underwent 12-lead ECG and echocardiography. Echocardiograms were analysed in accordance with ASE guidelines and hypetrabeculation was defined as >3 localised protrusions of the ventricular wall >3 mm in thickness associated with intertrabecular recesses. Results were compared with 415 healthy controls of similar age. Results Athletes displayed a higher prevalence of LV HTC compared with controls (18.3% vs 9.0%; p Conclusion The high prevalence of LV HTC in athletes, particularly among African/Afro-Caribbean athletes, suggests that the morphological anomaly represents an ethnically determined physiological epiphenomenon secondary to increased cardiac preload and afterload. Associated marked repolarisation changes and lower LV fractional shortening cannot exclude a myocardial disorder in a small minority. Prolonged longitudinal follow-up in a larger cohort of athletes should identify the precise significance of LV HTC.

Purpose The athlete9s ECG is affected by several demographic factors but there is a paucity of data relating to the impact of the athlete9s sex and ethnicity. The ESC guidelines for ECG interpretation in athletes are derived predominantly from male cohorts. Extrapolating such criteria to athletes of African/afro-Caribbean origin and female athletes may lead to erroneous interpretation. Methods Between 2001 and 2011, 1378 highly trained athletes (55% males, 81% Caucasian) (mean age 21.6±5.43 years); range 14–35 years, underwent cardiac evaluation including 12-ECG and echocardiography. ECGs were analysed for training related (group 1) and training-unrelated (group 2) changes, according to the ESC guidelines. Results Males demonstrated a higher prevalence of Group 1 (89% vs 61%; p= 0.1 mV) (61%), first-degree AV block (10%) were more prevalent in males compared to 14%, 45% and 4.7% females respectively (p=0.0001). Of the group 2 changes, T-wave inversion in leads V1-V4 were more prevalent in female athletes (12%) particularly black females (17%) compared to male athletes (4%; p=0.0001), whereas, T-wave inversion in the inferior leads were more common in males (3.3% vs 0.6%) irrespective of ethnicity. Males demonstrated a higher prevalence of axis deviation (6.7% vs 2.1%; p=0.0001), atrial enlargement (4.2% vs 1.0%; p=0.0002) and right ventricular hypertrophy (RVH) (8.3% vs 2.6%; p=0.0001) compared with females. Caucasian athletes exhibited greater group 1 changes compared with black athletes (73% vs 65%; p=0.0161). Black athletes exhibited a higher prevalence of group 2 ECG changes compared with Caucasian athletes (34% vs 21%; p= Conclusions Male sex and black ethnicity equated to a higher prevalence of Group 1 and 2 ECG changes compared with female sex and Caucasian ethnicity. However, anterior T wave inversion was significantly more common in females, being present in over 10% of athletes irrespective of ethnicity than previously reported. The precise incidence and significance of anterior T-wave inversion in female athletes requires further assessment.

It is well-established that fragmented QRS complexes (fQRS) on the 12-lead electrocardiogram (ECG) are a predictor of delayed gadolinium enhancement (DGE) on Cardiac MRI (CMR) and indicate myocardial scarring in patients with coronary artery disease and dilated cardiomyopathy. Moreover, fQRS appear

Purpose Hypertrophic Cardiomyopathy is a heterogeneous condition with variable phenotypic expression. Current studies are based on predominantly Caucasian cohorts (white patients; WP), therefore the phenotypic manifestations of HCM in individuals of African/Afro-Caribbean origin (black patients; BP) are not fully realised. Data in athletes and hypertensive patients indicate that black ethnicity is associated with a greater prevalence of repolarisation abnormalities on the ECG as well as a greater magnitude of left ventricular hypertrophy (LVH), highlighting the importance of defining the HCM phenotype in this ethnic group. Methods Between 2001 and 2010, 155 consecutive patients with HCM (52 BP, 103 WP) were assessed in 3 specialist cardiomyopathy clinics in South London. All individuals underwent comprehensive cardiac evaluation including 12-lead ECG and echocardiography. Patients subject to therapeutic interventions potentially affecting repolarisation patterns were excluded. Results Black patients revealed significantly different echocardiographic patterns of LVH, with more concentric (44.2% vs 30.1%) and apical (28.8% vs 11.7%) hypertrophy compared to WP who exhibited more asymmetric septal hypertrophy (57.3% vs 25.0%) (p=0.004). Black patients exhibited a similar magnitude of LVH compared to WP (17.3±4.9 vs 18.8±4.1 mm, p=0.069). Relating to ECG repolarisation abnormalities, BP exhibited more T wave inversions in the lateral leads (76.9% vs 60.2%, p=0.038) and deep (≥−0.2 mV) T-wave inversions (69.2% vs 51.5%, p=0.035). Black patients also tended to display more ST segment depression (50.0% vs 35.0%, p=0.071), although this was not statistically significant. In contrast, WP had significantly more pathological Q waves (23.3% vs 9.6%, p=0.039). Conclusions Ethnicity appears to exert a significant effect on ECG and echocardiographic patterns in patients with HCM. A significant proportion of black patients exhibit concentric LVH, highlighting the diagnostic challenges in distinguishing HCM from hypertensive heart disease and physiological adaptation to exercise in black individuals. The greater prevalence of deep T wave inversions and T wave inversions in the lateral leads underscores the importance of further evaluation of black individuals with such ECG repolarisation abnormalities, which may represent the initial expression of HCM.

Background Studies in Caucasian (white) athletes indicate that a significant proportion exhibit an isolated prolonged corrected QT interval (QTc), raising concerns for potentially false diagnoses and disqualification from competitive sport. The prevalence of prolonged QTc interval in athletes of African/Afro-Caribbean (black) descent is unknown. However, this ethnic group generally exhibits a high proportion of ECG repolarisation changes and increased left ventricular wall thickness, that may impact on QTc. Aim We aimed to assess the impact of ethnicity on QTc in young elite athletes. Methods We assessed 3035 elite athletes, aged 14–35 years, who were participating at national and international level in a variety of sporting disciplines. Athletes were evaluated with ECG and 2D echocardiography. Athletes diagnosed with structural heart disease or hypertension were excluded from analysis. Results Demographic and cardiological results are summarised in Abstract 49 table 1. Black male athletes exhibited shorter QTc than white male athletes, but QTc was similar among black and white female athletes. Bivariate analysis revealed that none of T wave inversions, ST segment elevation, or left ventricular wall thickness were associated with QTc. No ethnic difference was observed in prevalence of QT prolongation, as defined by ESC Sports Consensus criteria (male >440 ms; female >460 ms). Conclusion Despite demonstrating a higher prevalence of repolarisation changes and morphological left ventricular hypertrophy, black athletes do not exhibit a longer QTc than white counterparts. Based on ESC Sports Consensus criteria, prevalence of a long QTc in black and white athletes is similar, obviating the need for ethnicity specific criteria for defining a long QTc.

International audience; Purpose Studies in adult, black athletes (BA) demonstrate a high prevalence of ECG repolarisation changes and echocardiographic left ventricular hypertrophy (LVH) that may overlap with hypertrophic cardiomyopathy (HCM). The prevalence of ECG repolarisation changes and echocardiographic LVH in adolescent BA, the group most vulnerable to exercise-related sudden death from HCM, is unknown. Methods This study evaluated 219 male adolescent BA (14-18 years, inclusive) with 12-lead ECG and 2-D echocardiography. Results were compared with 1440 male adolescent WA. Athletes with T wave inversions and morphological LVH were invited for further investigation with exercise stress test, 24 h Holter and CMR. Results ST segment elevation was common in both groups but more frequent in BA (63.5% vs 14.9%, p12 mm vs only 6 (0.4%) WA (p

Field flow computations and, in particular, that of pressure, skin friction, and heat transfer (for high speed flights) are the primary parameters in the design of aerospace vehicles. Most computational schemes based on either the inviscid Euler equations or various forms of the Navier-Stokes equations are remarkably accurate in the predictions of pressure distributions. However, computations of skin friction and heat transfer particularly at high speed have been a source of considerable difficulty. Problems arise not only due to the grid resolution but also due to the particular numerical scheme employed. To address the difficulty associated with accurate computations of the velocity and temperature gradients, a comparative investigation of several Navier-Stokes codes is undertaken. Previous studies with regard to the effect of grid resolution are incorporated into the current investigation. The parametric study includes popular schemes which models the convective terms in the Navier-Stokes equation by second-order central difference approximation, flux-vector splitting schemes, and the addition of linear and nonlinear damping terms.

Introduction Brugada syndrome is an established cause of sudden arrhythmic death syndrome (SADS). The use of higher (2nd-intercostal space) intercostal V1 and V2 leads has been associated with increased surface electrocardiogram (ECG) sensitivity in the detection of the Brugada phenotype, either on the baseline ECG or following provocation using sodium ion channel blocking agents, without compromising specificity. Despite the potential implications, there is a paucity of data relating to the efficacy of this simple methodology in the diagnostic yield of Brugada syndrome in victims of ventricular fibrillation (VF) or 1st-degree relatives of SADS victims. Methods We identified 34 families diagnosed with Brugada syndrome based on the presence of a type-1 ECG in iÝ1 family members in the context of an unexplained VF arrest or a SADS death in a 1st-degree relative. The 12-lead ECGs of 139 individuals, who underwent comprehensive cardiac investigations including an Ajmaline provocation test, when appropriate, were reviewed. Electrocardiograms were performed with leads V1 and V2 placed in both the conventional 4th and the higher 2nd intercostal space. Family members not genetically related to the individuals diagnosed with Brugada syndrome were used as controls. Results Fifty-two of the 139 family members (37%) were diagnosed with Brugada syndrome. Only 6 (12%) individuals exhibited a diagnostic baseline ECG, while the great majority required an Ajmaline provocation test to unmask the Brugada phenotype. Of the 111 individuals who received Ajmaline, 22 (20%) developed the Brugada phenotype in the conventional ECG. The diagnostic Brugada phenotype was observed in 48 (43%) individuals by raising V1 and V2 leads at the 2nd-intercostal space (p Only 18 (53%) of the families were diagnosed on the basis of the standard ECG lead whereas all 34 (100%) families had at least one member with a positive type-1 ECG in the higher intercostal leads (p Conclusion Utilising higher intercostal leads for the detection of Brugada phenotype increases the diagnostic yield when screening families of SADS victims. This is primarily due to increased sensitivity of the Ajmaline provocation test. In our cohort almost 50% of the families and the majority (56%) of 1st-degree family relatives harbouring the Brugada gene would have remained undetected based on the standard 12-lead ECG alone.

Objectives Pre-participation screening of competitive athletes, combining 12-lead ECG with a health questionnaire and physical examination, has been demonstrated to reduce the incidence of sudden cardiac death (SCD) over a long term follow up period. Paradoxically, the vast majority of SCD occur in the non-athletic population and in the absence of antecedent symptoms. In the UK, screening for sinister cardiac disorders is confined only to those individuals with symptoms, or in the context of a family history of premature cardiac disease. In this study we analysed the prevalence of ECG abnormalities in young non-athletic individuals. Methods Between April 2006 and November 2009, 2619 subjects (mean age 18.3 years; range 14–35; 80% male) were investigated with a health questionnaire and 12-lead ECG. The questionnaire related to symptoms suggestive of cardiovascular disease and a family history of premature cardiovascular disease and/or SCD. The 12-lead ECGs were analysed for specific abnormalities as described in the European Society of Cardiology sports cardiology consensus. Specific criteria for an abnormal ECG analysed include P wave abnormalities suggesting left or right atrial enlargement; QRS abnormalities suggesting left ventricular hypertrophy, interventricular conduction delay and frontal plane axis deviation; and ST segment depression and T wave flattening or inversion. Results Of the 2619 individuals investigated a total of 505 (19.3%) individuals demonstrated one or more abnormalities on the 12-lead ECG. The abnormal findings are summarised in the table below: Conclusions These results demonstrate that there is a high prevalence of ECG abnormalities when applying the ESC sports cardiology consensus criteria to young non-athletic individuals. Many of these abnormalities are non-specific in isolation and warrant further investigations to be carried out. This has significant implications on the feasibility and cost-effectiveness of a national cardiovascular screening programme for sinister cardiac disease.

Background Physical training can provoke electrocardiographic changes and echocardiographic left ventricular hypertrophy in a considerable proportion of black athletes but only a minority of white athletes. Consequently, differentiating “black athletes heart” and hypertrophic cardiomyopathy may be challenging. We evaluated the prevalence and significance of electrocardiographic repolarisation anomalies in highly trained black athletes and compared them to white athletes and hypertrophic cardiomyopathy patients in an attempt to differentiate physiology vs pathology. Methods We analysed the electrocardiograms of 1759 male athletes (910 black athletes; 849 white athletes) who underwent preparticipation cardiovascular screening. Further cardiac evaluation was performed, where appropriate. Results were compared with those of 150 hypertrophic cardiomyopathy patients. Results T-wave inversions were present in 76%, 25% and 7% of hypertrophic cardiomyopathy patients, black athletes and white athletes, respectively (p Conclusions Deep T-wave inversions with associated convex ST-segment elevation in leads V1–V4 appear to represent an ethnic variant of “athletes heart”, while deep T-wave inversions in inferior and/or lateral leads merit further cardiovascular investigations and regular follow-up.

Objectives The vast majority of sudden cardiac deaths (SCD) in young individuals occur in the absence of antecedent symptoms. Most deaths are due to hereditary or congenital cardiac abnormalities which can be diagnosed during life and therapeutic interventions are available to minimise the risk of SCD. In most Western countries screening of competitive athletes is supported by numerous sporting governing bodies. However, in the non-athletic population screening is confined only to those individuals with cardiovascular symptoms in the context of a family history of premature cardiac disease. Based on this strategy, most non-athletic individuals at risk of SCD would not be identified. In this study we assessed the impact of screening on the health service. Methods Over a 3-month period 2671 subjects (mean age 18.8 years; range 14–35 years) were screened with a health questionnaire (HQ), and 12-lead electrocardiography (ECG). Screening was performed using a mobile trailer equipped with ECG and echocardiography machines and manned by cardiac physiologists and a cardiologist. The HQ related to symptoms suggestive of cardiovascular disease and a family history of premature SCD. ECGs were analysed by skilled cardiologists in accordance with the ESC sports cardiology consensus. Individuals with abnormalities on the HQ and/or ECG were investigated further with echocardiography performed on site. Individuals warranting further investigation even after this were referred for 24 h Holter monitoring and exercise stress testing. Results Of the total 2671 individuals screened, 2415 (90.4%) had an entirely normal ECG with the remaining 256 (9.6%) requiring on site echocardiography. A further 163 individuals (6.1%) were reassured following echocardiography. Thus a total of 96.5% of all individuals screened were able to leave the mobile cardiac screening unit reassured that no cardiac disorder could be identified in one visit. Only 93 individuals (3.5%) required further investigation after ECG and echocardiography. Preliminary screening identified 16 individuals (0.59%) with cardiac disorders which could prove potentially fatal in five individuals (0.19%) (Brugada ECG pattern: n=2; Wolff-Parkinson-White: n=1; hypertrophic cardiomyopathy: n=1; right ventricular outflow tract ventricular tachycardia (RVOT-VT): n=1). Conclusions Extrapolation of this data suggests large scale screening of non-athletic individuals (even in an expert setting) would be associated with a significant number of individuals (3.5%) requiring further investigation even after ECG and echocardiography. However, a huge proportion of individuals screened (96.5%) can be reassured in one visit. This is of particular relevance when considering that these individuals subsequently do not require primary and/or secondary care review.

To the editor: We read with great interest the case of a sudden cardiac arrest associated with early repolarisation by Magapu and Newall.1 Early repolarisation pattern on the 12-lead electrocardiogram has been linked to an increased risk of malignant arrhythmias, although intense debate exists as to the causal effect, given the high frequency of such repolarisation patterns in the general and athletic population. Our experience with screening of young athletes in the …

Two largely asymptomatic men, a 36-year-old (patient A) and a 56-year-old (patient B), were evaluated following the sudden death of a first-degree relative. Both resting 12-lead electrocardiograms exhibited minor ST-segment elevation in V1 and 0.2 mV saddle-shaped ST-segment elevation in V2. During an exercise test, patient A developed 0.7 mV ST-segment elevation with coved pattern and T-wave inversion in V2 and ST-segment elevation and T-wave inversion in V3, at peak exertion …

Flow visualization experiments in a water tunnel have been conducted to study the interaction of three-dimensional impinging jets for potential STOVL aircraft applications. The test model consisted of a delta wing, a fuselage, two axisymmetric centerline nozzles and two detachable simulated engine inlets. The flow field behavior was studied as a function of model height above a ground plane, jet nozzle spacing, jet exit velocity, angle of attack, and cross flow velocity. The test results showed body and flow field vortex formations, jet interaction effects, jet unsteadiness and a horseshoe shaped ground vortex. At positive angles of attack traditional delta wing leading edge vortices were moved to the lower surface depending on the jet strength and ground proximity. In some cases vortices rotating about an axis normal to the ground plane were observed. These vortices formed near the nozzle exits on the wing lower surface and moved downstream. Under certain conditions these vortices touched down, much like a tornado, before dissipating. The presence of lower surface leading edge vortices, at low heights, suggest the likelihood for strong suckdown effects. Simulated engine inlet operation confirmed the possibility for exhaust reingestion problems at low heights. v

An experimental method has been developed to determine the water droplet impingement characteristics on two- and three-dimensional aircraft surfaces. The experimental water droplet impingement data are used to validate particle trajectory analysis codes that are used in aircraft icing analyses and engine inlet particle separator analyses. The aircraft surface is covered with thin strips of blotter paper in areas of interest. The surface is then exposed to an airstream that contains a dyed-water spray cloud. The water droplet impingement data are extracted from the dyed blotter paper strips by measuring the optical reflectance of each strip with an automated reflectometer. Preliminary experimental and analytical impingement efficiency data are presented for a NLF(1)-0414F airfoil, s swept MS(1)-0317 airfoil, a swept NACA 0012 wingtip and for a Boeing 737-300 engine inlet model.

The cardiovascular benefits of regular physical exercise are well established.1 However, a small proportion of young (≤35 years) athletes with unsuspected heart disease are at increased risk of exercise related sudden cardiac death.2 The majority of such deaths are attributable to cardiac anomalies,2 3 4 most of which can be identified during life. A range of therapeutic strategies can be implemented to prevent fatalities, raising support for screening young athletes in medical and sporting communities.5 6 7 8 9 The efficacy, cost effectiveness, and impact of false positive tests of preparticipation screening strategies are, however, controversial. This article provides a factual overview of preparticipation screening, as more general practitioners are likely to be confronted with the questions relating to cardiovascular screening in athletes in countries where systematic screening programmes are currently not available. #### Summary points #### Sources and selection criteria We searched PubMed and Medline from 1980 onwards using the search terms “pre-participation screening”, “sudden death”, “electrocardiogram”, “athletes”, “black athletes”, and “cost-effectiveness”. Although we scrutinised and selected the highest quality articles, comprising original papers, reviews, recommendations, and consensus reports, the studies are all population based, prospective or retrospective observational reports. …

Extraction of empirical water droplet impingement characteristics from records of wind tunnel dye-tracer experiments has been an extremely time consuming process in the past. Described are a method for extracting impingement data by measuring optical reflectance and a computer controlled laser reflectometer which was designed and built for making these measurements. The instrument increases the efficiency of the data extraction process by at least an order of magnitude. The accuracy of the reflectometer is discussed and some results obtained with the reflectometer are presented. The results are used to verify three-dimensional particle trajectory computer codes, which may then be used for design analysis and certification of aircraft anti-icing/de-icing systems.

An experimental method has been developed to determine the droplet impingement characteristics on two- and three-dimensional bodies. The experimental results provide the essential droplet impingement data required to validate particle trajectory codes, used in aircraft icing analyses and engine inlet particle separator analyses. A body whose water droplet impingement characteristics are required is covered at strategic locations by thin strips of moisture absorbing (blotter) paper, and then exposed to an air stream containing a dyed-water spray cloud. Water droplet impingement data are extracted from the dyed blotter strips, by measuring the optical reflectance of the dye deposit on the strips, using an automated reflectometer. Impingement efficiency data obtained for a NACA 65(2)015 airfoil section, a supercritical airfoil section, and Being 737-300 and axisymmetric inlet models are presented in this paper.

• A combined evaluation of almost all the proposed morphologic and neurologic criteria for estimating gestational age in the neonate was performed on 710 newborns of 28 to 44 weeks' gestation. It is concluded that (1) the neurologic criteria used by Dubowitz et al1in combination with the external (morphologic) criteria of Farr et al2,3give very accurate results of estimation of the gestational age; (2) equally accurate results can be obtained if those criteria with the lowest correlation coefficients—namely, arm and leg recoil, degree of edema, and appearance of the genitalia—are omitted; and (3) the use of only nine external criteria, the assessment of which is easier to perform on sick babies, gives an estimation of gestational age that is accurate for clinical purposes (r = 0.878). (Am J Dis Child130:477-480, 1976)

Aims: The aims of this study were to establish the left ventricular (LV) phenotype in rugby football league (RFL) athletes and to mathematically model the association between LV size, strain (ɛ) and ejection fraction (EF). Methods and results: 139 male athletes underwent echocardiographic LV evaluation including ɛ imaging. Non-athletic males were used for comparison. All absolute and scaled structural indices were significantly larger (P < 0.05) in athletes with a predominance for normal LV geometry. EF and global ɛ were similar between groups but strain rates (SR) were significantly lower (P < 0.05) in athletes. Lower apical rotation (P < 0.001) and twist (P = 0.010) were exhibited in athletes. Conclusion: Normal EF is explained by divergent effects of LV internal diastolic dimension (LVIDd) and mean wall thickness (MWT) on LV function. Reductions in SR and twist may be part of normal physiological LV adaptation in RFL athletes. © 2017 Elsevier B.V.

Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete’s heart and the application of echocardiography have prompted this 2018 update.

Presented here is a case of a young woman, with an undiagnosed osteoid osteoma of the spine, which presented with painful scoliosis in adolescence and was treated by bracing until her accession to adulthood. A more thorough investigation, years after the initial one, revealed the tumor. Surgical excision and stabilization offered the long-awaited cure. Misdiagnosis resulted in intractable pain for years, deformity, the discomfort of brace therapy, and the frustration of a prolonged yet ineffective treatment.

Background/aim Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme.\ud Methods Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated.\ud Results After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%.\ud Conclusions Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.

Background: Right heart enlargement is common in the athletes’ heart phenotype however few data exist regarding interpretation of normal athletic adaptation during Pre-participation Cardiac Screening (PCS) of Rugby Football League (RFL) athletes. Echocardiography is utilised during PCS and thus the primary aim of this study was to establish the normal right ventricular (RV) phenotype in elite RFL athletes using standard 2D echocardiography and myocardial mechanics. The secondary aim was to describe right atrial (RA) structure and function using 2D echocardiography.\ud \ud Methods: 139 male RFL athletes underwent echocardiographic evaluation of the right heart including RV strain (ɛ) and strain rate (SR) imaging using speckle tracking echocardiography (STE). Non-athletic males were used for comparison and allometric scaling was applied for conventional echocardiographic parameters.\ud \ud Results: Scaled RV dimensions were larger in athletes (P0.05) in RV fractional area change (FAC) and RV longitudinal ɛ were observed between groups. Tissue Doppler imaging (TDI) indexed parameters and global strain rate (SR) were lower (P0.05) observed by volume assessment.\ud \ud Conclusions: Reduction in SR and indexed TDI are partly associated with lower HR and increased body mass and are likely to represent normal physiological adaptation in RFL athletes. RA enlargement appears proportional to RV enlargement. These data may aid interpretation of normal athletic adaptation during PCS of RFL athletes.

Regular and prolonged exercise is associated with increased left ventricular wall thickness that can overlap with hypertrophic cardiomyopathy (HCM). Differentiating physiological from pathological hypertrophy has important implications, since HCM is the commonest cause of exercise-related sudden cardiac death in young individuals. Most deaths have been reported in intermittent 'start-stop' sports such as football (soccer) and basketball. The theory is that individuals with HCM are unable to augment stroke volume sufficiently to meet the demands of endurance sports and are accordingly 'selected-out' of participation in such events. We report the case of an ultra-endurance athlete with 25 years of > 50 km competitive running experience, with genetically confirmed HCM; thereby demonstrating that these can be two compatible entities.