Citations

ABSTRACT The diagnosis of Lyme borreliosis (LB) is commonly made by serologic testing with Western blot (WB) analysis serving as an important supplemental assay. Although specific, the interpretation of WBs for diagnosis of LB (i.e., Lyme WBs) is subjective, with considerable variability in results. In addition, the processing, reading, and interpretation of Lyme WBs are laborious and time-consuming procedures. With the need for rapid processing and more objective interpretation of Lyme WBs, we evaluated the performances of two automated interpretive systems, TrinBlot/BLOTrix (Trinity Biotech, Carlsbad, CA) and BeeBlot/ViraScan (Viramed Biotech AG, Munich, Germany), using 518 serum specimens submitted to our laboratory for Lyme WB analysis. The results of routine testing with visual interpretation were compared to those obtained by BLOTrix analysis of MarBlot immunoglobulin M (IgM) and IgG and by ViraScan analysis of ViraBlot and ViraStripe IgM and IgG assays. BLOTrix analysis demonstrated an agreement of 84.7% for IgM and 87.3% for IgG compared to visual reading and interpretation. ViraScan analysis of the ViraBlot assays demonstrated agreements of 85.7% for IgM and 94.2% for IgG, while ViraScan analysis of the ViraStripe IgM and IgG assays showed agreements of 87.1 and 93.1%, respectively. Testing by the automated systems yielded an average time savings of 64 min/run compared to processing, reading, and interpretation by our current procedure. Our findings demonstrated that automated processing and interpretive systems yield results comparable to those of visual interpretation, while reducing the subjectivity and time required for Lyme WB analysis.

Abstract The objective of lung volume reduction surgery (LVRS) is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Appropriate patient selection and preoperative preparation are prerequisites for successful LVRS. An effective LVRS program requires participation by and communication between experts from pulmonary medicine, thoracic surgery, thoracic anesthesiology, critical care medicine, rehabilitation medicine, respiratory therapy, chest radiology, and nursing. The critical analysis of perioperative outcomes has influenced details of the conduct of the procedure and has established a bilateral, stapled approach as the standard of care for LVRS. The National Emphysema Treatment Trial (NETT) remains the world's largest multi-center, randomized trial comparing LVRS to maximal medical therapy. NETT purposely enrolled a broad spectrum of anatomic patterns of emphysema. This, along with the prospective, audited collection of extensive demographic, physiologic, radiographic, surgical and quality-of-life data, has positioned NETT as the most robust repository of evidence to guide the refinement of patient selection criteria for LVRS, to assist surgeons in providing optimal intraoperative and postoperative care, and to establish benchmarks for survival, complication rates, return to independent living, and durability of response. This article reviews the evolution of current LVRS practice with a particular emphasis on technical aspects of the operation, including the predictors and consequences of its most common complications.

Prompted by an intrigue with the challenges of goaltending, questionnaires were given to 67 youth hockey goalies. Seventy-six percent responded that the psychological aspects of the position caused the greatest difficulties. A subsequent study examined the relationship between psychological, situational, and physiological variables and on-ice performance. Goalies completed psychometric instruments before going on the ice and their electrocardiograms were monitored during on-ice stations. Subjects were videotaped at the Puck Shooting Machine (PSM) station. Mean heart rate (HR) was 163 beats per minute (bpm) at the PSM and 175 bpm at other stressful stations (e.g., breakaway and slap shot). Goalies with 100% saves (N=7) were older, more experienced, less anxious, and had faster HR's than those who performed poorly. Because elevated arousal levels were detected at the goalie camp, a subsequent study of different Bantam, High School, and Junior A goalies (N=13) were studied during 31 games. Rapid HR's were sustained during games, even when goalies were standing still.

The incidence of aggression in ice hockey and the consequences of violent on-ice behavior is of major concern to those interested in the safety of the sport. The purpose of this paper is to examine the history of aggression in hockey, how it is measured and why it happens. A hypothetical integrated model of antecedents of aggression in hockey is presented which may guide future research investigations. Officiating in ice hockey, penalty statistics at specific levels of participation, and the categorization of penalties are discussed. An assessment was done to determine whether there has been a change in player's perceptions of the attitudes of significant others toward aggression. The results were compared to previous research [1], which examined reinforcers of aggressive behavior in hockey players. A case study of an injured hockey player is presented which depicts the physical and psychosocial consequences of a penalized aggressive on-ice incident. Steps that can be taken to reduce aggression and identify barriers that are likely to impede attempts to reduce aggression in the game will be discussed. Suggestions for future research are presented.

The goal of sports injury research is to improve understanding of injuries in a specific sport in order to facilitate prevention. Comprehension of epidemiology principles is necessary to design research protocols which are both accurate and pragmatic. Common pitfalls in sports epidemiology include selection bias, detection bias, transfer bias, recall bias, susceptibility bias, and confounding. Calculation of an injury rate requires precise measurement of the number of events (numerator) and the population-at-risk (denominator). Viable strategies for determining the incidence and characteristics of injuries and for observing outcome after an intervention in the sport of ice hockey include prospective cohort observational and interventional analyses.

Studying goalies, who play a key position in hockey requires examining psychophysiologic variables and their relationship to performance during games when the outcome is important [15]. This investigation tested all three aspects of emotion (subjective, physiologic changes, and performance). Nine male goalies completed questionnaires and provided salivary cortisol before, during, and after each game. Heart rate (ECG signal) was integrated with the goalie's performance video. Goalies rated on Likert Scales; headaches, stomach aches, insomnia, nervousness, and awareness of heart pounding. Data from 16 games were obtained. Of nine, two goalies provided data on three games each; one goalie was classified as a responder and the other a non-responder, based on salivary cortisol levels (SCL). The responder's SCL increased 572% between baseline and post-period assessments, whereas SCL in the non-responder increased 50% above baseline. The responder's SCL increased 8 times baseline when he faced 16 shots in a period. The responder goalie's game heart rates (HRs) were 160,152, and 167 beats per minute (bpm) and the non-responder's HRs were 147, 132, and 142 bpm for three games. Game performance was similar for both goalies.

In the sport of ice hockey, the incidence of injury has been investigated at multiple levels of participation based on collective player exposure, which assumes equal playing time among participants. However, playing time varies enormously between individual players on a given team due to variability in the number and length of shifts. Individual player monitoring, although labor intensive, more accurately identifies risk factors for sustaining injuries. Specific player exposure data are necessary for detailed analysis of factors such as style of play, illegal activities, equipment, player size, and officiating. In addition, prospective, uniform and accurate collection of exposure data may permit meaningful comparison of injury rates between levels of participation in ice hockey and also among different sports. Refinement of data collection tools that determine individual player injury exposure will increase the power of the denominator and facilitate prevention of ice hockey injuries.

The purpose of this investigation was to examine the components of intimidation in ice hockey and to determine their effects on players, coaches, and referees. In a pilot test, hockey coaches (N = 17) from three levels of participation were invited to an informal, exploratory symposium to assess their opinions on the role of intimidation in ice hockey. The following themes emerged: a) coaches' behavior and expectations, b) observable behavior, c) player's perceived role, and d) sociological factors. A preliminary intimidation model was developed. A survey including 80 open- ended questionnaires designed to stimulate discussion on the definition of intimidation, methods used to intimidate, and factors perceived as intimidating, was distributed to players (N = 66), coaches (N = 8), and referees (N = 6). The data were analyzed using qualitative methods [1,2] and intimidation was defined. Results support a theoretical model, which serves as a point of departure for future research and visually depicts the components of intimidation and their interactions.