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Like many libraries across Canada, Manitoba public libraries have grappled with the challenges that COVID-19 has presented. Libraries have struggled to remain operational and offer a high level of service to patrons within the constraint of public health orders, all the while ensuring the safety and employment of their staff. Within the ever-changing environment of COVID-19, the Manitoba Library Association recognized the need to gather information from the library community in order to better position themselves to lend support and in an attempt to bridge information gaps. This article describes a study conducted by the Manitoba Library Association whereby fifty-five Manitoba public libraries were surveyed to identify how they were responding to COVID-19 and what their needs might be. The survey questions were divided into 6 sections (facilities, services, communications, staffing, connecting, wrap-up) and the results provide information and insight into how the Manitoba library community has dealt with the pandemic. More importantly, the results can serve to guide other libraries in decision-making and preparation for a pandemic., Comme plusieurs bibliothèques au Canada, les bibliothèques publiques du Manitoba ont dû faire face aux défis présentés par la COVID-19. Les bibliothèques ont tenté de demeurer opérationnelles et d’offrir un niveau élevé de service aux usagers en respectant les contraintes des ordonnances de santé publique tout en assurant la sécurité et les emplois de leur personnel. Compte tenu de la constante évolution de la situation de la COVID-19, la Manitoba Library Association a reconnu le besoin de recueillir de l’information pour la communauté des bibliothèques afin qu’elles puissent mieux se positionner pour offrir du soutien et afin de tenter de combler le manque d’information. Cet article décrit une étude menée par la Manitoba Library Association par laquelle 55 bibliothèques publiques du Manitoba ont été sondées afin d’identifier comment elles ont réagi à la COVID-19 et de connaître leurs besoins. Le sondage comportait six sections (installations, services, communications, personnel, relations, sommaire) et les résultats fournissent des informations et un aperçu sur la façon dont la communauté des bibliothèques du Manitoba a réagi à la pandémie. Plus important encore, les résultats peuvent guider les autres bibliothèques dans la prise de décision et la préparation face à une pandémie.

The aim of this study was to investigate the differences between sitting volleyball (SV) skills and para-athletes’ sport classes. Twelve games involving 151 athletes from 11 countries from the Rio ...

Purpose: In volleyball, jump execution is critical for the match outcome. Game-play-related neuromuscular impairments may manifest as decreased jump height (JH) or increased jump total duration, both of which are pivotal for performance. To investigate changes in JH and kinetics with game play, the authors conducted a prospective exploratory analysis using minimal-effect testing (MET) and equivalence testing with the 2 one-sided tests procedure, univariate, and bivariate functional principal component analysis, respectively. Methods: Twelve male varsity athletes completed 3-set matches on 2 consecutive days. Countermovement jumps were performed on a force platform immediately prematch and postmatch on days 1 and 2 and once on days 3 and 4. Results: Across sessions, JH was equivalent (P P > .227). After match 2, MET indicated that relative force at zero velocity (P = .036) decreased, while braking duration (P = .040) and time to peak force (P = .048) increased compared with baseline. With the first and second functional principal components, these alterations, together with decreased relative braking rate of force development (P = .092), were already evident after match 1. On day 4, MET indicated that relative peak force (P = .049), relative force at zero velocity (P = .023), and relative braking rate of force development (P = .021) decreased, whereas braking duration (P = .025) increased from baseline. Conclusions: Impairments in jump kinetics were evident from variables related to the countermovement-jump braking phase, while JH was equivalent. In addition to these experimental findings, the present research provides information for the choice of sample size and smallest effect size of interest when using MET and 1- and 2-dimensional analyses for countermovement-jump height and kinetics.

Concussions are becoming an increasingly important issue in sports, especially in an area like volleyball that, until recently, seemed less prone to such injuries. The purpose of this study was to determine the coefficient of restitution and basic mechanical properties of standardized volleyballs, including stiffness and hysteresis, dependent on different influencing factors. A drop test was performed to calculate the coefficient of restitution based on the time of flight of the ball between the first and second bounce. This was detected using a microphone with a sampling frequency of 44.1 kHz. To determine the mechanical properties, a materials testing machine applied a compression force until a deformation of 50 mm was achieved. These data were sampled with a frequency of 12.5 kHz. The results showed that the three analysed factors in this study, including the ball model, gauge pressure, and incident velocity, had a significant influence on the coefficient of restitution. Therefore, the amount of energy dissipation during an impact situation at low velocities was significantly different within the tested sample of official standardized volleyballs. The stiffness and hysteresis of the volleyballs also varied significantly. These basic mechanical findings raise an interesting question as to whether the investigated factors are appropriate to predict forces acting on the head during a high velocity collision (25–30 m/s), ultimately resulting in a risk of concussion.

The current technological age has created exponential growth in the availability of technology and data in every industry, including sport. It is tempting to get caught up in the excitement of purchasing and implementing technology, but technology has a potential dark side that warrants consideration. Before investing in technology, it is imperative to consider the potential roadblocks, including its limitations and the contextual challenges that compromise implementation in a specific environment. A thoughtful approach is therefore necessary when deciding whether to implement any given technology into practice. In this article, we review the vision and pitfalls behind technology's potential in sport science and medicine applications and then present a critical decision-making framework of 4 simple questions to help practitioners decide whether to purchase and implement a given technology.

A high incidence of overuse knee injuries among youth basketball players may be attributed to number of jumps. Wearable technology may be an effective tool for measuring jump load compared to traditional counting methods. The purpose of this study was to validate a commercially available jump counter (VERT® Classic) in youth basketball practices and games, and to identify the characteristics (i.e., height, direction, takeoff) of jumps recorded by the VERT® Classic. 46 (19F, 27M) youth basketball players wore a VERT® Classic and were recorded on video during games and practices. The number of jumps recorded by the VERT® Classic and evaluated by video raters were compared for each jump characteristic using intraclass correlation coefficient (ICC(3

A time-loss injury definition continues to be the most widely used injury definition despite evidence that it fails to accurately capture overuse injuries. An overuse injury questionnaire, using an “all complaints” definition has been created to address the limitation of a time-loss definition. The main aim of this work was to determine the effect that injury definition and registration methodology has on the collection of knee injuries among elite level volleyball players. To reach this goal, seventy-two volleyball players were prospectively followed over 32-weeks. Time-loss injuries were captured using an individual injury report form (IIRF). Study participants completed an overuse injury questionnaire (mOIQ) via a weekly short message service (SMS). The IIRF captured 15 time-loss knee injuries in 72 study participants (20%). Based on the mOIQ, 84.7% of participants reported having a knee problem and 66.7% sustained a substantial knee problem. All IIRF knee injuries captured were also registered by the mOIQ. Agreement on the specific diagnosis occurred for 66.7% of injuries resulting in a moderate Kappa score of 0.51. In conclusion, an overuse injury questionnaire provided a greater understanding of the magnitude and burden of knee injuries in this population.

Objectives To validate the use of an inertial measurement unit (IMU) for the collection of total jump count and assess the validity of an IMU for the measurement of jump height against 3-D motion analysis. Design Cross sectional validation study. Setting 3D motion-capture laboratory and field based settings. Participants Thirteen elite adolescent volleyball players. Independent variables Participants performed structured drills, played a 4 set volleyball match and performed twelve counter movement jumps. Main outcome measures Jump counts from structured drills and match play were validated against visual count from recorded video. Jump height during the counter movement jumps was validated against concurrent 3-D motion-capture data. Results The IMU device captured more total jumps (1032) than visual inspection (977) during match play. During structured practice, device jump count sensitivity was strong (96.8%) while specificity was perfect (100%). The IMU underestimated jump height compared to 3D motion-capture with mean differences for maximal and submaximal jumps of 2.5 cm (95%CI: 1.3 to 3.8) and 4.1 cm (3.1–5.1), respectively. Conclusion The IMU offers a valid measuring tool for jump count. Although the IMU underestimates maximal and submaximal jump height, our findings demonstrate its practical utility for field-based measurement of jump load.

Background: Chronic kidney disease (CKD) is common in patients with type 2 diabetes mellitus (T2DM) and limits therapeutic options. Dipeptidyl peptidase-4 (DPP-4) inhibitors represent a novel class of oral glucose-lowering agents and are known to be safe and effective in the general population. Methods: We searched Cochrane, EMBASE, and PubMed from the time of their inception until March 2015. We included randomized controlled trials analyzing the efficacy (change in hemoglobin A1C [HbA1C]) and safety of DPP-4 agents in individuals with reduced kidney function (estimated glomerular filtration rate 2). We extracted study characteristics, participants' baseline characteristics, and safety outcomes from eligible studies. We performed a random effects meta-analysis to summarize the change in HbA1C and the relative risk of cardiovascular events in patients with T2DM and CKD. We also collected data on hypoglycemia, other serious adverse events, and mortality. Results: We reviewed 12 studies with 4,403 patients with CKD and 239 on dialysis, finding a mean weighted decline in HbA1C of -0.48 (95% CI -0.61 to -0.35) with DPP-4 inhibitor therapy compared to placebo. DPP-4 inhibitors did not result in any additional adverse events, hypoglycemic episodes, or increased mortality. Restricting to studies with low risk of bias did not alter these findings. Conclusions: DPP-4 inhibitors can lower HbA1C without increasing the risk of cardiovascular or other major adverse events in patients with CKD. Few studies reported critical adverse events such as heart failure and hypersensitivity. If compared with other oral antiglycemic drugs, the effect of DPP-4 inhibitors is limited; however, their low risk of hypoglycemia may favor their use in patients with CKD. Summary: This systematic review of DPP-4 inhibitors in CKD suggests that they reduce HbA1C by about 0.5%. Furthermore, there was not any increase in the risk for significant adverse events. More research is needed to determine the safety and efficacy of DPP-4 inhibitors in CKD.

Sport is becoming increasingly competitive and athletes are being exposed to greater physical demands, leaving them prone to injuries. Monitoring athletes with the use of wearable technology could provide a way to potentially manage training and competition loads and reduce injuries. One such technology is the VERT inertial measurement unit, a commercially available discrete wearable device containing a 3-axis accelerometer, 3-axis gyroscope and 3-axis magnetometer. Some of the main measurement outputs include jump count, jump height and landing impacts. While several studies have examined the accuracy of the VERT’s measures of jump height and jump count, landing impact force has not yet been investigated. The objective of this research study was to explore the validity of the VERT landing impact values. We hypothesized that the absolute peak VERT acceleration values during a jump-land cycle would fall within 10% of the peak acceleration values derived simultaneously from a research-grade accelerometer (Shimmer). Fourteen elite university-level volleyball players each performed 10 jumps while wearing both devices simultaneously. The results showed that VERT peak accelerations were variable (limits of agreement of -84.13% and 52.37%) and had a propensity to be lower (mean bias of -15.88%) when compared to the Shimmer. In conclusion, the validity of the VERT device’s landing impact values are generally poor, when compared to the Shimmer.

BackgroundEarly accurate detection of acute kidney injury (AKI) occurring after cardiac surgery may improve morbidity and mortality. Although several novel biomarkers have been developed for the early detection of AKI, their clinical utility in the critical intraoperative and immediate postoperative period remains unclear.Study DesignSystematic review and meta-analysis.Setting & PopulationAdult patients having cardiac surgery.Selection Criteria for StudiesEMBASE, CINAHL, Cochrane Library, Scopus, and PubMed from January 1990 until January 2015 were systematically searched for cohort studies reporting the utility of novel biomarkers for the early diagnosis of AKI after adult cardiac surgery. Reviewers extracted data for study design, population, timing of biomarker measurement and AKI occurrence, biomarker performance (area under the receiver operating characteristic curve [AUROC]), and risk of bias.Index TestsNovel urine, plasma, and serum AKI biomarkers, measured intraoperatively and in the early postoperative period (

Objectives To examine potential intrinsic risk factors that may contribute to the onset of jumper's knee in elite level-male volleyball players. Design Prospective Cohort Study. Setting Varsity and National team volleyball gymnasiums. Participants Sixty elite adult male volleyball players from Canada. Assessment of risk factors Players completed a series of risk factor assessments at the commencement of their seasons, including vertical jump (cm), ankle dorsiflexion range (degrees), dynamic balance (normalized distance reached; cm), dynamic knee alignment (degrees), and landing mechanics (degrees). Main outcome measure Self-reported knee problems, captured via short message service. Results Knee problem prevalence was 75% [95% confidence intervals (CIs): 62.2-84.6] and the incidence rate for substantial injuries over the study period was 30 injuries/100 players/season (95% CI: 19.5-43.1). No risk factor was found to significantly predict the future occurrence of developing jumper's knee. The odds ratios were close to unity (range: 0.94-1.07) with narrow confidence intervals and P > 0.05. Conclusions A more sensitive capture of overuse knee problems did not result in the identification of distinct risk factors for the development of jumper's knee. These findings highlight a lack of available methodology to accurately assess risk factors for overuse injuries.

This article highlights the library service initiatives of a small academic satellite hospital library. The success of these initiatives is dependent on the partnerships that have been forged between the librarian and the health care professionals in various hospital departments. The service initiatives include a collaborative training program on point-of-care resources, health literacy training, participation in orientation, NICHE (Nurses Improving Care for Healthsystem Elders) program support, e-mail alerts for senior administration, movie programming, and research support. These initiatives are described in detail.

Background: Anemia is a common complication associated with kidney failure and is marked by poor health and increased risk of morbidity and mortality. There are ongoing concerns with the use of Erythropoietin Stimulating Agents (ESAs) to treat anemia in patients with kidney failure on dialysis. Questions as to their benefits, harms and overall effect on quality of life are still relevant today. Our objective was to systematically review studies evaluating the cost-effectiveness of ESAs in patients with kidney failure on dialysis. Methods: We performed a systematic review of studies determining the cost-effectiveness of ESAs in adult patients on dialysis. Databases, including PubMed, EMBASE, and Cochrane Database of Systematic Reviews, were searched from their establishment until June 2013. Studies that reported an incremental cost-effectiveness ratio of hemoglobin correction strategies based on ESA treatments in comparison to red blood cell transfusions, lower hemoglobin targets, or no ESA treatment were included. Results: Seven studies met inclusion criteria. Reported cost/quality-adjusted life-year (QALY) ratios ranged from USD 931-677,749/QALY across five studies comparing ESAs to red blood cell transfusions. There was heterogeneity in results when considering higher hemoglobin targets, with studies finding higher targets to be both dominant and dominated. Mortality, hospitalization, and utility estimates were major drivers. Conclusions: There is substantial variability in the estimates of the cost-effectiveness of using ESAs in the dialysis population. New models incorporating recent meta-analyses for estimates of utility, mortality, and hospitalization changes would allow for a more comprehensive answer to this question.

ObjectivesThe objective of this systematic review was to study the impact of preoperative physical activity levels on adult cardiac surgical patients’ postoperative: (1) major adverse cardiac and cerebrovascular events (MACCEs), (2) adverse events within 30 days, (3) hospital length of stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5) activities of daily living (ADLs), (6) quality of life, (7) cardiac rehabilitation attendance and (8) physical activity behaviour.MethodsA systematic search of MEDLINE, Embase, AgeLine and Cochrane library for cohort studies was conducted.ResultsEleven studies (n=5733 patients) met the inclusion criteria. Only self-reported physical activity tools were used. Few studies used multivariate analyses to compare active versus inactive patients prior to surgery. When comparing patients who were active versus inactive preoperatively, there were mixed findings for MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that adjusted for confounding variables, five studies found a protective, independent association between physical activity and MACCE (n=1), 30-day postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies found no protective association for 30-day postoperative events (n=1) and postoperative ADLs (n=1). No studies investigated if activity status before surgery impacted quality of life or cardiac rehabilitation attendance postoperatively. Three studies found that active patients prior to surgery were more likely to be inactive postoperatively.ConclusionDue to the mixed findings, the literature does not presently support that self-reported preoperative physical activity behaviour is associated with postoperative cardiac surgical outcomes. Future studies should objectively measure physical activity, clearly define outcomes and adjust for clinically relevant variables.RegistrationTrial registration numberNCT02219815. PROSPERO number CRD42015023606.

Spikes in training and competition workloads, especially in undertrained athletes, increase injury risk.1 However, just as attributing athletic injuries to single risk factors is an oversimplification of the injury process,2 3 interpreting this workload-injury relationship should not be done in isolation. Instead, we must further unpack how (ie, through which mechanisms) workload spikes might result in injury, and what characteristics make athletes more robust or more susceptible to injury at any given workload. In other words, which factors mediate the workload-injury relationship, and which moderate the relationship. Like dominoes being knocked over, mediators can be viewed as the intermediary steps that explain the association between an observed variable and an outcome.4 In this context, mediating variables help to explain ‘why changes in workloads might cause injuries?’ For example, it is known that rugby league players exposed to spikes in running workloads, indicated by a high acute:chronic workload ratio, are at an increased risk for non-contact injuries.5 One potential explanation is that neuromuscular fatigue mediates this relationship, such that increased …

There is limited literature on hospital archives projects. Hospitals understandably have a strong focus on patient care, but there is still a critical need to keep institutional archives. Among their many uses, institutional archives preserve corporate memory, provide evidence of interactions with community, and assist in contemporary decision making. This column describes a university-hospital partnership to undertake a one-year project to preserve, detail, and digitize ten boxes, or approximately 3.8 meters, of materials dating from 1980 to 2006. This project serves as a model for other hospital or health care facilities wanting to preserve and more actively engage with their archival collections.

BACKGROUND: Blastomycosis is an uncommon granulomatous pulmonary and extrapulmonary infectious disease caused by the thermally dimorphic fungusBlastomyces dermatitidis. Diagnosis may be delayed or difficult because of varied presentation. The characteristics of blastomycosis on computed tomographic (CT) scan of the chest are not well characterized.METHODS: The images from 34 chest CT scans from patients with confirmed pulmonary blastomycosis were retrospectively reviewed.RESULTS: The most common CT findings were air bronchograms in 22 patients (65%), consolidation in 21 patients (62%), nodules (smaller than 3 cm) in 21 patients (62%) and lymph node enlargement (mediastinal and hilar nodes combined) in 12 patients (35%). Only four patients (12%) had a miliary pattern.CONCLUSIONS: A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation.

BACKGROUND: Blastomycosis is potentially fatal, but environmental risk factors for acquiring blastomycosis are not well established.METHOD: Matched cross-sectional questionnaire of 112 patients with history of blastomycosis and 118 control subjects in Manitoba and northwestern Ontario.RESULTS: The most common tissues involved with blastomycosis were pulmonary, skin and soft tissues, and bone. A significantly greater proportion of patients with blastomycosis than control subjects were involved in outdoor occupations. A significantly greater percentage of patients with blastomycosis were immunosuppressed either from collagen vascular disease or immunosuppressive therapy, or had hypothyroidism. A significant association between canine and human blastomycosis was not observed.CONCLUSIONS: Independent risk factors for development of blastomycosis included immunosuppression for any reason (including drugs or disease), collagen vascular disease, being an outdoor worker, and having a coworker with blastomycosis. Canine blastomycosis was not a risk factor for human disease in dog owners.

Delirium is an acute syndrome that involves fluctuating changes in attention and cognition. Although delirium is the most common neurologic complication after cardiac operation, data about its impact on long-term outcomes are lacking. The purpose of this systematic review was to examine the effect of postoperative delirium (PoD) on long-term outcomes, including morbidity, probability of death, cognitive decline, institutionalization, and health-related quality of life (HRQoL) in patients undergoing cardiac operation. After performing this systematic review we determined that PoD after cardiac operation is associated with an increased risk of probability of death and readmission to the hospital and a decrease in cognitive function, overall function, and HRQoL.

Necrotizing fasciitis is a serious and potentially life-threatening condition. Although bite wounds are common, they are not frequently reported as a cause of necrotizing fasciitis. In the present article, two cases of bite-associated necrotizing fasciitis caused by group A streptococcus are reported. Previously published cases are also reviewed.

Objective To assess the incidence of concussions among adolescent volleyball players in Canada. Design Cross sectional survey. Setting Online survey. Participants In total, 663 registered Volleyball Canada members completed a national survey, with a response rate of 13.0%; web-based survey response rates rarely exceed 5%. The 452 (68.2%) female and 211 (31.8%) male responders had a mean age of 16.2 (95% CI: 16.1to 16.4) years with a range from 14 to 19 years. Assessment of risk factors The type of environment: controlled non-competitive environment (practice or warm-up) versus competitive game play environment. Outcome measures Whether the athletes sustained a concussion as defined by the 2012 Zurich Consensus. Main results A total of 86 concussions were reported, of which 52 were in the previous 12 months, yielding a one-year cumulative incidence per 100 athletes of 7.1 (95% CI: 4.3 to 11.4) and 7.5 (95% CI: 5.4 to 10.3) for males and females, respectively. In total, 57.1% (95% CI: 46.2 to 67.5) of all concussions involved ball-to-head contact. Player-to-player contact and head-to-floor contact were less prevalent at 20.2% (95% CI: 12.8 to 30.4) and 15.5% (95% CI: 9.1 to 25.1) respectively. Practice environment accounted for 46.5% of all concussions while 38.4% occurred in game play. The remaining 15.1% occurred in warm-up. In total, 61.6% (95% CI: 50.2 to 71.7) of concussions occurred outside of free-flow competitive game play, in a more structured environment. Conclusions There is a significant margin for injury prevention as a substantial proportion (61.6%) of concussions happening in a noncompetitive, controlled environment that may be amenable to change that would reduce the potential for such injury. Competing interests The authors have no competing interest to state.

Background There is a growing body of evidence illustrating the contribution of training load to musculoskeletal injury risk. There is a gap in the literature, however, regarding the impact of training on concussion risk. Objective To evaluate the association between sport-specific participation volume and concussion risk in male youth ice hockey players. Design Cohort study. Setting Community ice rinks and sport medicine clinics (2011–15 hockey seasons). Patients (or Participants) Male Pee Wee (11–12 years old), Bantam (13–14 years old) and Midget (15–17 years old) ice hockey players were eligible. Players were excluded if they reported unhealed injuries at study entry, had missing/systematically incomplete hockey participation exposure data, or if they sustained a concussion but participation volume could not be estimated from the day of injury. Interventions (or Assessment of Risk Factors) Cumulative hockey participation volume (CPHV) was estimated based on participation exposure data reported by team designate. The association between concussion risk and total 7-day and 28-day CHPV was evaluated using multivariable logistic regression [OR (95%CI)]. Models were adjusted for concussion history and cluster by player (α Main Outcome Measurements Medically diagnosed concussion. Results Participants who met the inclusion criteria (n=1235/1990) sustained 34 medically diagnosed concussions. Increased concussion risk was associated with hourly increases in 7-day CHPV [OR=1.16 (95%CI: 1.08–1.25), p Conclusions Increased hockey participation volume was associated with increased concussion risk in male youth ice hockey players. This is the first study to explore the association between training volume and concussion risk. Future research utilizing objective volume measurements and training response tools will be critical to the development of primary concussion prevention strategies that optimize the role of training load.

Background A multitude of risk factors have been reported to increase an athlete9s risk of developing jumper9s knee. An overuse injury definition has been cited as more sensitive in capturing knee injuries when compared to a time-loss injury definition. To date, risk factors for jumper9s knee have not been assessed for the development of knee problems captured by an overuse injury definition. Objective To assess a multitude of potential intrinsic risk factors for jumper9s knee in volleyball players. Design Prospective Cohort. Setting Collegiate and national team training facilities. Patients (or Participants) Sixty elite adult male volleyball players were recruited from collegiate and national team programs in Canada. Interventions (or Assessment of Risk Factors) Participants completed risk factor assessments at the commencement of the season including: vertical jump ability (cm), weight bearing ankle dorsiflexion range (degrees), dynamic balance (cm), dynamic knee alignment (degrees) and landing mechanics (degrees). Main Outcome Measurements Self-reporting knee problems utilizing an overuse injury questionnaire collected via short message service (SMS) was completed prospectively over one season. Substantial knee problems were identified and logistic regression was used to estimate odds ratios for each risk factor independently. Results The season prevalence of knee problems was 75.0% (95% CI: 62.2 to 84.6) and the incidence proportion of those rated as substantial was 30.0% (95% CI: 19.5 to 43.1). The SMS system of tracking overuse injuries demonstrated 98.2% completeness. No single risk factor was found to predict substantial knee problems. All odds ratios were close to unity with narrow confidence intervals (0.91–1.07) and p>0.05. Conclusions A more sensitive capture of overuse knee injuries did not result in the identification of distinct risk factors for the development of jumper9s knee. These findings bring question to the utility of field based pre-season risk factor assessment for the identification of at risk athletes.

Reactivation of latent Mycobacterium tuberculosis infection is an important health concern for patients on hemodialysis because of their immunosuppressed state and in kidney transplant patients receiving immunosuppressive therapy to prevent organ rejection. There are several tests available to determine the presence of latent tuberculosis infection: the tuberculin skin test (TST), QuantiFERON-TB Gold (QFT-G), and T-SPOT.TB. The objective of this study is to evaluate the diagnostic accuracy of these tests in determining latent tuberculosis infection in the hemodialysis population.The study design was a systematic review. We selected studies with adequate information to ascertain test sensitivity or specificity of the TST, QFT-G, and TSPOT.TB with regards to determining latent tuberculosis infection in the hemodialysis population.One hundred two articles were selected for full review, and 17 were included in the meta-analysis. The TST had a pooled sensitivity of 31% (26%-36%, 95% confidence interval) and specificity of 63% (60%-65%) across eight studies. The QFT-G test had a pooled sensitivity of 53% (46%-59%) and specificity of 69% (65%-72%) across nine studies. The T-SPOT.TB test had a pooled sensitivity of 50% (42%-59%) and specificity of 67% (61%-73%) across three studies.The QFT-G and the T-SPOT.TB tests were more sensitive than the TST for diagnosis of latent tuberculosis infection in patients on hemodialysis while offering a comparable level of specificity. This systematic review calls into question the practice of using the TST to screen in this population, especially in patients considered for kidney transplantation.

A 68-year-old Aboriginal man who lived in northwestern Ontario presented to a local hospital with back pain and fever. Over the past several days, crops of vesicopustular lesions, primarily affecting his extremities, had developed. The lesions gradually became hemorrhagic and tender. He was unaware

Background Frailty is a condition characterized by a decline in physical function and functional capacity. Common symptoms of frailty, such as weakness and exhaustion, are prevalent in patients with chronic kidney disease (CKD). The increased vulnerability of frail patients with coexisting CKD may place them at a heightened risk of encountering additional health complications. The purpose of this systematic review was to explore the link between frailty, CKD and clinical outcomes. Methods We searched for cross sectional and prospective studies in the general population and in the CKD population indexed in EMBASE, Pubmed, Web of Science, CINAHL, Cochrane and Ageline examining the association between frailty and CKD and those relating frailty in patients with CKD to clinical outcomes. Results We screened 5,066 abstracts and retrieved 108 studies for full text review. We identified 7 studies associating frailty or physical function to CKD. From the 7 studies, we identified only two studies that related frailty in patients with CKD to a clinical outcome. CKD was consistently associated with increasing frailty or reduced physical function [odds ratios (OR) 1.30 to 3.12]. In patients with CKD, frailty was associated with a greater than two-fold higher risk of dialysis and/or death [OR from 2.0 to 5.88]. Conclusions CKD is associated with a higher risk of frailty or diminished physical function. Furthermore, the presence of frailty in patients with CKD may lead to a higher risk of mortality. Further research must be conducted to understand the mechanisms of frailty in CKD and to confirm its association with clinical outcomes.

Background The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear. Purpose To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis. Data sources Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening. Study selection Randomized, controlled trials that evaluated the treatment of anemia with ESAs, including erythropoietin and darbepoetin, targeted higher versus lower hemoglobin levels, and used validated HRQOL metrics. Data extraction Study characteristics, quality, and data were assessed independently by 2 reviewers. Outcome measures were scores on the Short Form-36 Health Survey (SF-36), Kidney Dialysis Questionnaire (KDQ), and other tools. Data synthesis Of 17 eligible studies, 13 reported SF-36 outcomes and 4 reported KDQ outcomes. Study populations consisted of patients not undergoing dialysis (n = 12), those undergoing dialysis (n = 4), or a mixed sample (n = 1). Only 4 studies had low risk of bias. Pooled analyses showed that higher hemoglobin targets resulted in no statistically or clinically significant differences in SF-36 or KDQ domains. Differences in HRQOL were further attenuated in studies at low risk of bias and in subgroups of dialysis recipients. Limitation Statistically significant heterogeneity among studies, few good-quality studies, and possible publication bias. Conclusion ESA treatment of anemia to obtain higher hemoglobin targets does not result in important differences in HRQOL in patients with CKD. Primary funding source KRESCENT and Manitoba Health Research Council Establishment.

Blastomycosis is a granulomatous infection caused by the thermally dimorphic fungus, Blastomyces dermatitidis, for which seasonal variation has been proposed. We conducted a retrospective review of medical records of 324 patients with blastomycosis in Manitoba and northwestern Ontario. The average age of patients at the time of diagnosis was 39+/-20 (range, 0-85) years. Symptoms referable to blastomycosis were first noted in the autumn and winter (September to February) by 63% of the patients. The seasonal distribution of cases was different for localized pulmonary infection than the disseminated disease (P0.0001). For localized lung disease, the peak incidence of symptom onset occurred in the autumn, and lowest incidence in the spring; one half (50%) of the patients with diffuse lung disease had onset of symptoms in the spring months and a few (11%) cases occurred during the summer. We noted a distinct seasonal variation in the clinical presentation of blastomycosis. The observed pattern suggests that summer environmental exposure and acquisition of the infection results in an early (1-6 months) localized pneumonia in the majority of cases, followed by later (4-9 months) reactivation or slow progression of asymptomatic infection resulting in isolated extrapulmonary or disseminated hematogenous disease in the minority.

A retrospective study of 45 patients hospitalized with blastomycosis of bones or joints revealed 41 cases of osteomyelitis and 12 cases of septic arthritis. The majority were men (35 [78%] patients) and non-Aboriginal (32 [71%] patients). Median time from the onset of symptoms to hospitalization was shorter in women than men (male, 48 d; female, 14 d; P < 0.02), and shorter for Aboriginals than non-Aboriginals (non-Aboriginal, 50 d; Aboriginal, 19 d; P < 0.04). Cutaneous disease was present in 33 (73%) patients, and lung involvement was present in 29 (64%) patients. The most common osseous sites of involvement were the lower limb and axial skeleton. Common orthopaedic symptoms of bone lesions included bone pain in 42 (78%) patients, swelling in 32 (59%) patients, and soft tissue abscesses in 21 (39%) patients. Joint infection (12 patients) manifested as a monoarticular arthropathy presenting with effusion in 9 (75%) patients, pain in 8 (67%) patients, and decreased range of motion in 5 (42%) patients. Osseous blastomycosis can mimic bacterial infection and should be included in the differential diagnosis of bone and joint infection in patients who have visited or who live in geographic regions where B dermatitidis is endemic.

Background Knee joint injury has been associated with changes in hip and knee joint function and is a known risk factor for the development of post-traumatic osteoarthritis (PTOA). The Vertical Drop Jump (VDJ) and Single Leg Squat Test (SLS) have been used to examine lower extremity neuromuscular control. Objective To determine if young adults with and without a 3–10 year history of knee joint injury differ in frontal knee angles or knee ankle ratio during VDJ and SLS. Design Historical Cohort. Setting Laboratory Setting. Participants 25 individuals with history of intra-articular knee joint injury, sustained participating in sport 3–10 years previously, and 25 matched (age, sex, sport) uninjured controls (16 males;17–26 yrs: 34 females;14–26 yrs). Risk factor assessment History or no history of intra-articular knee injury (clinical diagnosis resulting in time loss from sport). Main outcome measurements Frontal knee angle (FKA) (degrees) and knee and ankle separation distances (KAR) were measured from an image representing the lowest moment of the SLS and VDJ extracted from video and measured using ImageJ (National Institute of Health, v.1.47) software. Test-retest reliability (sub-sample n=20) was examined (ICC) and descriptive statistics (means, 95%CI) used to compare study groups. Results No differences in right to left FKA differential was found for the injured participants compared to matched controls during the SLS (ICC 0.97) [injured 5.78 ° (3.01, 8.54); uninjured 4.75 ° (1.85, 7.66) or VDJ (ICC 0.98) [injured 7.69 ° (2.58, 12.80); uninjured 9.64 ° (5.57, 13.70)]. Similarly, no between groups differences for KAR (ICC 0.99) were demonstrated [injured 1.00 (0.90, 1.09); uninjured 1.04 (0.97, 1.12)]. Conclusions Individuals with a 3–10 year history of knee injury demonstrate similar FKA and KAR during the VDJ and SLS compared to healthy controls. These finding are encouraging as the functional joint changes associated with knee joint injury do not appear to be present in this timeframe post-injury.