scholarly journals Good versus bad medical stoppages in boxing: Stopping a fight in time

2017 ◽  
Vol 28 (3) ◽  
Author(s):  
N Sethi
Keyword(s):  
Causes Of Death ◽  
Good Practice ◽  
Health And Safety ◽  
The United States ◽  
Medical Community ◽  
Contact Sport ◽  
Common Causes ◽  
Evidence Based Guidelines ◽  
Professional Boxing ◽  
Impact Syndrome

Background: Professional boxing is a popular contact sport with a high risk for both acute and chronic traumatic brain injury (TBI). Although rare, many boxers have died in the ring or soon after the completion of a bout. The most common causes of death in these cases are usually acute subdural hematomas, acute epidural hematomas, a subarachnoid haemorrhage, an intracranial haemorrhage or Second Impact Syndrome (SIS). Ringside physicians are entrusted with the health and safety of boxers in the ring and in the immediate aftermath of a bout.Discussion: As per the Uniform Boxing Rules (approved August 25, 2001, Amended August 2, 2002, Amended July 3, 2008, Amended July 24, 2012, Amended July 29, 2014), the referee is the sole arbiter of a bout and is the only individual authorised to stop a contest. [1]In some states in the United States and in other countries around the world, the referee and the ringside physician are the sole arbiters of a fight and the only individuals authorised to enter the fighting area at any time during the competition and also authorised to stop a fight. This raises the important question of when should a fight be stopped on medical grounds.Conclusion: Standardising medical stoppage decisions in boxing will help to protect a boxer’s health and safety in the ring. Good practice guidelines for medical stoppage due to suspected TBI are suggested. It is recommended that the medical community debate the proposed guidelines vigorously, in order that evidence-based guidelines can be developed in conjunction with professional boxing governing bodies.

scholarly journals Post-concussion return to boxing protocol

2016 ◽  
Vol 28 (2) ◽  
pp. 61-62
Author(s):  
N Sethi
Keyword(s):  
National Football League ◽  
Return To Play ◽  
Medical Community ◽  
Decision Making Process ◽  
Cognitive Rest ◽  
Biomechanical Forces ◽  
Evidence Based Guidelines ◽  
Professional Boxing ◽  
The Brain ◽  
Impact Syndrome

Background: Concussion is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Immediately following a concussion, an athlete is usually advised physical and cognitive rest until post-concussion symptoms abate. The athlete then enters a stepwise return-to-play protocol. Premature return to play risks a second concussion, second impact syndrome, exacerbation and persistence of post-concussive symptoms. Various sports governing organisations such as the National Football League have developed post-concussion return to play protocols.Discussion: Professional boxing is a popular contact sport in which concussions are common. Professional boxing currently lacks a standardised post-concussion return to boxing protocol. Professional boxers are arbitrarily suspended for periods ranging from 30 to 90 days after suffering a technical knockout (TKO) due to multiple head and body shots or after a knockout (KO). For some boxers a neurology clearance is requested prior to their return to boxing.Conclusion: Developing and implementing a post-concussion return to the boxing protocol will standardise a return to boxing decision-making process and help to protect a boxer’s health. This paper proposes a post-concussion return to boxing protocol with the recommendation that the proposed protocol be debated vigorously by the scientific community and evidence-based guidelines be developed by the medical community in conjunction with the professional boxing governing bodies.

scholarly journals Advances in the understanding of trauma-induced coagulopathy

Blood ◽  
2016 ◽  
Vol 128 (8) ◽  
pp. 1043-1049 ◽  
Author(s):  
Ronald Chang ◽  
Jessica C. Cardenas ◽  
Charles E. Wade ◽  
John B. Holcomb
Keyword(s):  
Animal Studies ◽  
Causes Of Death ◽  
Endothelial Activation ◽  
The United States ◽  
Trauma Patients ◽  
Platelet Dysfunction ◽  
Intracranial Injury ◽  
Trauma Induced Coagulopathy ◽  
Common Causes

Abstract Ten percent of deaths worldwide are due to trauma, and it is the third most common cause of death in the United States. Despite a profound upregulation in procoagulant mechanisms, one-quarter of trauma patients present with laboratory-based evidence of trauma-induced coagulopathy (TIC), which is associated with poorer outcomes including increased mortality. The most common causes of death after trauma are hemorrhage and traumatic brain injury (TBI). The management of TIC has significant implications in both because many hemorrhagic deaths could be preventable, and TIC is associated with progression of intracranial injury after TBI. This review covers the most recent evidence and advances in our understanding of TIC, including the role of platelet dysfunction, endothelial activation, and fibrinolysis. Trauma induces a plethora of biochemical and physiologic changes, and despite numerous studies reporting differences in coagulation parameters between trauma patients and uninjured controls, it is unclear whether some of these differences may be “normal” after trauma. Comparisons between trauma patients with differing outcomes and use of animal studies have shed some light on this issue, but much of the data continue to be correlative with causative links lacking. In particular, there are little data linking the laboratory-based abnormalities with true clinically evident coagulopathic bleeding. For these reasons, TIC continues to be a significant diagnostic and therapeutic challenge.

scholarly journals Persistent and extreme outliers in causes of death by state, 1999-2013

2015 ◽  
Author(s):  
Francis P Boscoe
Keyword(s):  
United States ◽  
Heart Disease ◽  
Causes Of Death ◽  
The United States ◽  
Mortality Rates ◽  
National Rate ◽  
Common Causes ◽  
Specific Mortality

In the United States, state-specific mortality rates that are high relative to national rates can result from legitimate reasons or from variability in coding practices. This paper identifies instances of state-specific mortality rates that were at least twice the national rate in each of three consecutive five-year periods (termed persistent outliers), along with rates that were at least five times the national rate in at least one five-year period (termed extreme outliers). The resulting set of 71 outliers, 12 of which appeared on both lists, illuminates mortality variations within the country, including some that are amenable to improvement either because they represent preventable causes of death or highlight weaknesses in coding techniques. Because the approach used here is based on relative rather than absolute mortality, it is not dominated by the most common causes of death such as heart disease and cancer.

scholarly journals Neuroimaging in contact sports: Determining brain fitness before and after a bout

2017 ◽  
Vol 29 (1) ◽  
pp. 1-4
Author(s):  
N Sethi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Chronic Traumatic Encephalopathy ◽  
Personalised Medicine ◽  
The United States ◽  
Medical Community ◽  
Acute Subdural Hematoma ◽  
Individual Risk ◽  
Contact Sports ◽  
Professional Boxing

Background: Professional boxing and mixed martial arts (MMA) are popular contact sports with high risk for both acute and chronic traumatic brain injury (TBI). Although rare, combatants have died in the ring/cage or soon after the completion of the bout. The cause of death in these cases is usually acute subdural hematoma, acute epidural hematoma, subarachnoid haemorrhage, intracranial haemorrhage, or second-impact syndrome (SIS). Neuroimaging or brain imaging is currently included in the process of registering for a license to fight in a combat sport in most states in the United States and around the world. However, the required imaging specifics and frequency vary.Discussion: Neuroimaging serves two distinct roles in the individualised care of a combatant, representing a step towards personalised medicine and individual risk stratification. Neuroimaging prior to licensure helps to identify and/or exclude coincidental or clinically suspected brain lesions which may pose a risk for rupture, bleeding or other catastrophic and important brain injury. Neuroimaging in the immediate aftermath of a bout primarily serves to rule out acute traumatic brain injury. Neuroimaging may also be carried out to assess for evidence of structural brain injury which may make a combatant more likely to express late-life neuropsychiatric sequelae of brain injury, such as chronic traumatic encephalopathy. As such, neuroimaging plays a prognostic role and aids in the determination of whether the combatant should be allowed to continue to participate in future bouts or not.Conclusion: Currently there are no established neuroimaging guidelines for contact sports. Standardising neuroimaging guidelines both for licensure as well as neuroimaging modality, and protocols to assess for both acute and chronic traumatic brain injury. This will assist in protecting the combatant’s health and safety, both in the ring/cage, and after their professional careers have ended. Some suggested guidelines are provided based on currently available medical literature. It is recommended that these guidelines be debated vigorously by the scientific community and that evidence-based guidelines be developed by the medical community in conjunction with professional boxing and MMA governing bodies.

scholarly journals Persistent and extreme outliers in causes of death by state, 1999-2013

2015 ◽  
Author(s):  
Francis P Boscoe
Keyword(s):  
United States ◽  
Heart Disease ◽  
Causes Of Death ◽  
The United States ◽  
Mortality Rates ◽  
National Rate ◽  
Common Causes ◽  
Specific Mortality

In the United States, state-specific mortality rates that are high relative to national rates can result from legitimate reasons or from variability in coding practices. This paper identifies instances of state-specific mortality rates that were at least twice the national rate in each of three consecutive five-year periods (termed persistent outliers), along with rates that were at least five times the national rate in at least one five-year period (termed extreme outliers). The resulting set of 71 outliers, 12 of which appeared on both lists, illuminates mortality variations within the country, including some that are amenable to improvement either because they represent preventable causes of death or highlight weaknesses in coding techniques. Because the approach used here is based on relative rather than absolute mortality, it is not dominated by the most common causes of death such as heart disease and cancer.

scholarly journals Persistent and extreme outliers in causes of death by state, 1999-2013

2015 ◽  
Author(s):  
Francis P Boscoe
Keyword(s):  
United States ◽  
Heart Disease ◽  
Causes Of Death ◽  
The United States ◽  
Mortality Rates ◽  
National Rate ◽  
Common Causes ◽  
Specific Mortality

In the United States, state-specific mortality rates that are high relative to national rates can result from legitimate reasons or from variability in coding practices. This paper identifies instances of state-specific mortality rates that were at least twice the national rate in each of three consecutive five-year periods (termed persistent outliers), along with rates that were at least five times the national rate in at least one five-year period (termed extreme outliers). The resulting set of 71 outliers, 12 of which appeared on both lists, illuminates mortality variations within the country, including some that are amenable to improvement either because they represent preventable causes of death or highlight weaknesses in coding techniques. Because the approach used here is based on relative rather than absolute mortality, it is not dominated by the most common causes of death such as heart disease and cancer.

scholarly journals Persistent and extreme outliers in causes of death by state, 1999–2013

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1336 ◽  
Author(s):  
Francis P. Boscoe
Keyword(s):  
United States ◽  
Heart Disease ◽  
Causes Of Death ◽  
The United States ◽  
Mortality Rates ◽  
National Rate ◽  
Common Causes ◽  
Specific Mortality

In the United States, state-specific mortality rates that are high relative to national rates can result from legitimate reasons or from variability in coding practices. This paper identifies instances of state-specific mortality rates that were at least twice the national rate in each of three consecutive five-year periods (termed persistent outliers), along with rates that were at least five times the national rate in at least one five-year period (termed extreme outliers). The resulting set of 71 outliers, 12 of which appear on both lists, illuminates mortality variations within the country, including some that are amenable to improvement either because they represent preventable causes of death or highlight weaknesses in coding techniques. Because the approach used here is based on relative rather than absolute mortality, it is not dominated by the most common causes of death such as heart disease and cancer.

Suicidal Death Autopsy Analysis at Dhaka Medical College

1970 ◽  
Vol 40 (1) ◽  
pp. 18-21 ◽  
Author(s):  
MN Hossain ◽  
Z Rahman ◽  
S Akhter
Keyword(s):  
Forensic Medicine ◽  
Causes Of Death ◽  
Cross Sectional Study ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Autopsy Report ◽  
Common Causes ◽  
Suicidal Death

A cross sectional study was carried out at the department of Forensic Medicine in Dhaka Medical College during the period of January 2008 to December 2009. Data were collected from 3rd copy of the post mortem reports which were preserved in the department of Forensic Medicine with the verbal consent of the doctors who performed autopsy report. During this period total 5114 autopsies were conducted. Out of this 970 cases (19%) were suicidal in nature. It was noticed that all suicidal deaths occurred from 10 years to all age group respectively, but top amongst age group of suicidal deaths occurred in between 21 to 30 years of people. Suicidal deaths are more common in female than male. Suicidal deaths due to hanging is highest, next common causes of death due to organophosphorus compund poisoning. Suicidal deaths by hanging is more in female than male but in poisoning cases male are more lvictimised than female. Objectives of our study are to see the occurrence and methods of suicidal death. DOI: http://dx.doi.org/10.3329/bmj.v40i1.9957 BMJ 2011; 40(1): 18-21

From Scarcity to Abundance: Achieving Quality-Assured Mass Higher Education

2011 ◽  
Vol 15 (2) ◽  
Author(s):  
Peter P. Smith
Keyword(s):  
Higher Education ◽  
Knowledge Economy ◽  
Good Practice ◽  
The United States ◽  
The Other ◽  
Secondary System ◽  
Mass Higher Education ◽  
Post Secondary ◽  
One Year ◽  
The One

The United States is in a bind. On the one hand, we need millions of additional citizens with at least one year of successful post-secondary experience to adapt to the knowledge economy. Both the Gates and Lumina Foundations, and our President, have championed this goal in different ways. On the other hand, we have a post-secondary system that is trapped between rising costs and stagnant effectiveness, seemingly unable to respond effectively to this challenge. This paper analyzes several aspects of this problem, describes changes in the society that create the basis for solutions, and offers several examples from Kaplan University of emerging practice that suggests what good practice might look like in a world where quality-assured mass higher education is the norm.

Knowledge and Practice of Mothers Regarding the Prevention and Management of Malnutrition Among Preschool Children – A Cross Sectional Survey

2017 ◽  
Vol 9 (5) ◽  
Author(s):  
Mahfouz R. Nath ◽  
C. Kanniammal
Keyword(s):  
Preschool Children ◽  
Good Practice ◽  
Strong Association ◽  
Educational Status ◽  
Nursing Interventions ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Economic Class ◽  
Common Causes ◽  
Knowledge And Practice

Malnutrition remains one of the most common causes of morbidity and mortality among children throughout the world. Malnutrition has been responsible, directly or indirectly for 60% of the 10.9 million deaths annually among children under five. The research study was aimed to assess the knowledge and practice of mothers of preschool children regarding the prevention and management of malnutrition. The design used was descriptive cross sectional survey. The study was conducted in a coastal setting of Trivandrum district with a sample size of 115. Data collection was done by self administered structured questionnaire by conducting mothers meeting at selected Anganwadis. According to the results of the study 19.1% of mothers had good knowledge and 34.8 % of mothers had poor knowledge. Regarding practice only 24.3 % of mothers reported good practice while 36.6 % of mothers reported poor practice. There was a strong association between the knowledge and Practice of mothers and selected socio demographic variables such as educational status of mothers and socio economic class (p less than 0.01)). The study findings can be used for planning targeted nursing interventions in coastal areas for mothers of preschool children.

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