Injury time

first_img Previous Article Next Article Injury timeOn 1 Apr 2001 in Personnel Today Comments are closed. Overuse injuries are the major cause of days lost during military trainingbut they are not always easy to spot. Advice on diagnosis, treatment andprevention is given, by Susan GregoryIntroduction Bassingbourn Barracks is an initial training regiment for the Army. Thereare approximately 1,500 recruits undertaking their Phase 1 basic training atany one time. Overuse injuries, particularly in the lower limbs, are the majorcause of days lost during military training and one of the most common of theseinjuries is stress fracture1. Background Initial training is for 11 weeks and many recruits find the discipline andarduous exercise regimes hard to settle into and decide to leave. Recruits who are injured during the course of their training at Bassingbournare transferred into the rehabilitation platoon. Running, according to Bruknerand colleagues2, is the major cause of tibial stress fractures. Although stressfractures can occur at any time they are most commonly seen in week five. Definition Stress fractures are the result of repetitive abnormal or excessive loadingof bone. The fractures can be partial or complete resulting from repeatedstress that is lower than that required to fracture the bone in a single load3.Bone is a living tissue and has the ability to remodel and adapt to thephysical stresses imposed upon it. Increases in bone mass appear to beinfluenced by the type of exercise training performed. This stress reaction can be graded from normal remodelling (grade 0) tostress fracture (grade 4), with mild, moderate and severe stress reaction inbetween. Risk factors Risk factors for any injury may be classified as extrinsic or intrinsic.Injuries occur as a result of the sum of various extrinsic or intrinsic factorsat any given point in time. In military studies female recruits have a higher risk of stress fracturesthan male recruits with similar training volumes. Schaffer and colleagues’recent study4 revealed that 21.6 per cent of high-risk individuals experiencedmore than three times as many stress fractures as low-risk individuals. Thissuggests that the risk of stress fractures is increased by poor physicalfitness and low levels of physical activity prior to entry into training. Specific aspects of the training regime can influence stress fracturedevelopment and military studies have shown that modifying the training candecrease their incidence. These interventions include rest periods, eliminationof running and marching on concrete, and a reduction of high- impact activity.These may reduce stress fractures by allowing time for bone microdamage to berepaired and by decreasing the load applied to bone. Athletic footwear, insoles and orthotics aim to attenuate the shock ofground contact and to control motion of the foot and ankle. Surprisingly, a newform of infantry boot produced the lowest strains compared to various sportsshoes, despite the relatively higher weight and sole durometry of the boot6. Signs and symptoms – Local redness and/or swelling. – Local bony tenderness. – Antalgic gait. – History of a gradual onset of pain first noted during/after strenuousexercise. – Pain gradually progressing during non-sports activities, or at rest,leading to reduced activity. – Typically, a recent change in the training regime either with increasedactivity or mileage. – A focal, isolated site of pain. – Pain that is mild at rest but is exacerbated on the first loading of thelimb. – Sliding a vibrating tuning fork along the skin will severely exacerbatethe pain in a localised area at the site of a stress fracture. Nursing model Within the medical centre at Bassingbourn there are no set models in use toassess and plan care. Each nurse develops his or her own method of assessmentand examination within a general framework of guidelines and protocols. Case study The client is referred to as Barry, not his real name, in order to ensuremedical confidentiality. Barry is 17 years of age. He completed eight weeks of basictraining and presented to the medical centre with left shin pain. Inspection of both lower limbs including the knee, ankle and lumbar spine,will indicate any focus of deformity, swelling or redness. Red streaks above anarea of swelling with associated warmth point to infection. Inspection of thefoot for any areas of broken skin may identify a source of contamination. Stress fractures can be so localised that a point of maximal tenderness can becovered with a single finger. Multiple stress fractures are possible in thesame limb. Left shin pain Barry admitted during questioning that he had been suffering from shin painfor six weeks. He did not want to miss any of his training and decided to tryand cope with the problem. The pain however has worsened, with Barryexperiencing pain on initial weight bearing at the start of the day. On examination of both of Barry’s legs he was found to be tender over theleft tibia. There was no obvious sign of injury or trauma. In view of thelength of time Barry had been experiencing pain, and because of its worseningnature, it was important not to delay treatment further. Barry was excusedboots, issued with crutches to ensure no further weight bearing on the leftleg, and referred to the Senior Medical Officer. Barry was given a full examination by the SMO who gave a provisionaldiagnosis of left tibia stress fracture. He was referred to physiotherapy andto the sports medicine department at Addenbrookes Hospital for a bone scan andadvice regarding his future management. Barry was transferred to Aisne Platoon (rehabilitation). Due to Barrysuffering pain and having difficulty in mobilising the SMO admitted him to theward at the medical centre for rest and observation. Health care pathway A health care pathway demonstrates the multi-professional approach taken inBarry’s care and treatment indicating at what stage in the process outsideagencies were involved. These agencies were: – Physiotherapy – Bone Scan – Army welfare – Family doctor – Rehabilitation Interdisciplinary teamwork involves all team members at formal team meetingsand is explicitly patient centred, focused on what the patient needs ratherthan what the individual therapist can do. For these meetings to be successfuleach member of the team has to have an understanding of the techniques used byothers, accepting some overlapping of roles. Physiotherapy Early treatment has been demonstrated by research3 to be a key factor inreturning to full fitness. Physiotherapy is available to military personnel onsite daily. A pneumatic leg brace was applied to Barry’s lower left leg.Swenson and colleagues7 highlight the use of an “Aircast” brace inreducing the amount of time taken to return to full training. Barry wasinstructed to carry on using crutches. Ice therapy and short wave pulsedtreatment was given on six occasions. Progress of a stress fracture is monitored clinically. Patients can resumeactivities when healing is evident, that is, when they are pain free duringactivities of daily living and there is no local tenderness. Return to activityis gradual. Bone scan Barry’s bone scan confirmed a “grossly abnormal” increased traceruptake in the posteromedial aspect of the left tibia at the junction of theproximal with the distal. The appearance was consistent with a high gradestress fracture. Two weeks sick leave was agreed and Barry’s family doctor wasinformed of the diagnosis, treatment and medication to date. Rehabilitation On return from sick leave Barry was seen by the SMO. Now relatively painfree he was discharged from the ward and transferred back into Aisne Platoon tocommence his rehabilitation. Phase 1 Barry was allowed to perform normal activities of daily living. Aerobicfitness was maintained by cycling. As Barry was pain free at rest, activerehabilitation was undertaken in the form of a gradual return to weight bearingexercise, from walking through to jogging in trainers. Once Barry was able tojog pain free in trainers, without carrying any weight, he was able to passinto Phase 2. Phase 2 Physical fitness in Phase 2 rehabilitation is of utmost importance. Herejogging increased to running at normal pace, with physical training exercisesand marching. If at any time Barry had experienced pain he would have beenreturned to Phase 1 training, as stress fractures can recur. Barry’s progress throughout rehabilitation was closely monitored by thephysical fitness team, physiotherapists and the medical team. Barry reportedweekly to the occupational health nurse with progress reports. With full agreement of the rehabilitation team Barry was considered fit,allowing him to return to full training. Barry passed his test with no pain. OH nurses are in a unique position to understand clients’ illness/disabilitybecause of their familiarity of the workplace setting and training schedules. Conclusions Stress fractures represent a significant cause of sickness absence during militaryrecruits’ basic training. The financial implications of lost training days,medical discharges and potential litigation is considerable. All staff need to be aware of the implications of delayed treatment whenassessing recruits presenting with limb pain or injury. Careful questioning andhistory taking in an initial assessment is of great importance as some recruitsmay be unwilling to admit to having pain. This is usually borne out of a fearof being taken out of training. Health promotion and education can raise awareness of the importance ofseeking advice early. Awareness of any possible contributing factors along withrecognition of the signs and symptoms of chronic injuries such as stressfractures may reduce the incidence. Recommendations It is suggested that the following research-based recommendations regardingthe prevention and treatment of stress fractures should be implemented. – Potential recruits should be made more aware of the physical demands ofbasic training at pre-selection interviews and at recruitment centres. – Prior to enlistment, candidates should be given a training schedule tofollow to improve their physical fitness and activity level. – Recruits should perform alternative aerobic exercise with low impactloading for one week after week 2 or 3 of their basic training5. – Alternative exercise such as swimming or cycling should be added into theweekly training schedule instead of running5. – The training programme needs to be reviewed if there is an increased incidenceof stress fractures in any one part of the schedule. – Nursing staff need to be aware of the signs and symptoms of stressfractures and the importance of early diagnosis and treatment by continualeducation. – Health education needs to be increased to the recruits when they arestarting basic training to alert them to seek advice early with regard to painor difficulties with the training programme. References 1. Hoffman J, Chapnik L, Shamis A. (1999a) The effect of leg strength on theincidence of lower extremity overuse injuries during military training.Military Medicine; 164(2): 153-6. 2. Brukner P, Bradshaw C, Bennell K. (1998a) Managing common stressfractures, let risk level guide treatment. The Physician and Sports Medicine;26(8): 40. 3. Brukner P, Bradshaw C, Bennell K. (1998b) Managing common stressfractures, let risk level guide treatment. The Physician and Sports Medicine;26(8): 39-47. 4. Schaffer RA, Brodine SK, Almeida SA et al. (1999) Use of simple measuresof physical activity to predict stress fractures in young men undergoing arigorous physical training program. American Journal Epidemiology; 149: 236-42.5. Bennell K, Matheson G, Meeuwisse W, Brukner P. (1999) Risk factors forstress fractures. Sports Medicine; 28(2): 91-122. 6. Milogram C, Burr D, Fyhrie D, et al. (1996) The effect of shoe gear onhuman tibial strains recorded during dynamic loading: a pilot study. Foot andAnkle 17: 667-71. 7. Swenson EJ, DeHaven KE, Sebastianelli WJ, et al. (1997) The effect of apneumatic leg brace on return to play in athletes with tibial stress fractures.American Journal of Sport Medicine; 25: 322. The author is one of nine nurses working in the medical centre atBassingbourn Barracks which is an initial training regiment for the Army. Related posts:No related photos.last_img read more

… in brief

first_imgRelated posts:No related photos. This week’s news in briefFast food winner Carol Turnham, HR administrator at Zurich Financial Services has won aChristmas lunch on the Orient Express in the CronerTraining competition. launches a new competition nextTuesday in association with Bupa International. If you would like to win aweekend for two in Barcelona, visit today (Tuesday 1October). Directive in force The EC Fixed-Term Workers Directive becomes law today. The law is designedto stop fixed-term workers from being discriminated against and stops companiesusing a succession of fixed-term contracts to employ the same person.Fixed-term workers will also get improved access to training and information onpermanent jobs. news addiction Staff are far more likely to be addicted to web news and shopping thanpornography, a poll has found. Websense, the monitoring software provider,found 24 per cent of respondents thought shopping sites were the mostaddictive, 23 per cent news, 18 per cent pornography and 8 per cent gambling.  www.websense.comBonus benefits Bonuses are still the most common benefit offered to City staff – despitethe continuing economic downturn and poor stock market – a study by financerecruitment firm David Chorley has found. In all, 97 per cent of City companiesincorporate a bonus scheme within the pay system. The average bonus was between5 and 15 per cent. rife at work Nearly half of older staff have experienced age discrimination in theworkplace, according to a survey of 2,100 older workers by website FiftyOn. Theresearch shows 44 per cent of respondents have experienced ageism at work andof those, 66.3 per cent decided to leave that job because of the position theywere placed in. Comments are closed. Previous Article Next Article … in briefOn 1 Oct 2002 in Personnel Todaylast_img read more

Barclays chases growth by doubling bonuses

first_img Comments are closed. Barclays chases growth by doubling bonusesOn 19 Nov 2002 in Personnel Today Barclays Bank has doubled the amount of money it is investing in staffbonuses to help it meet its ambitious plans for growth. The bank aims to double its value every four years and has changed its bonusstructure in a bid to achieve this objective. All staff are eligible to receive a bonus connected to the company’sperformance against its key objectives. The bank also operates a profit share scheme that pays out up to 9 per centof staff salaries. Jeremy Orbell, executive director of reward at Barclays, told delegates atthe conference last week that the company’s new bonus structure has at leastdoubled the amount of money the company spends on bonuses. He revealed Barclays staff are now eligible for bonuses of up to 40 per centof salary in most cases – and as high as 100 per cent for senior staff –whereas in the past, it only used to award bonuses of between 10 and 20 percent of salary. Orbell said the improved bonus scheme was introduced to improve staffretention. “Retention of key people by direct compensation and/or otherequity is a key issue,” he said. “Cash is still king. It is very important that the annual bonus isflexible and linked to performance criteria.” Previous Article Next Article Related posts:No related photos.last_img read more

The drive in to work will become far more taxing

first_imgRelated posts:No related photos. The drive in to work will become far more taxingOn 10 Aug 2004 in Personnel Today HR Hartley – our irascible insider on… being driven to distractionA story that scared the bejesus out me hit the national headlines a coupleof weeks ago: car tax and petrol duty could be phased out within 15 years, butdrivers will have to pay for every mile they travel. It is proposed that two taxes will be replaced with a new system of roadtolls using satellite tracking of every vehicle on the road and motorists willapparently pay between 1p and £1.34 a mile, depending on how much congestionthere is on the road they’re on. Transport minister Alistair Darling proudlyannounced nationwide tolls could cut congestion by half. Now I am all for radical moves to bring some respite to the roads and aidsurvival of the planet. But this one would force me to give up my current job(that’s if I haven’t been hoofed out by then, of course). I have a 120-miledaily round commute. I choose to do it by car because (a) the train takes two-and-half-hours eachway as opposed to just over an hour by road, (b) it works out about £1,500 ayear cheaper than by rail, and (c) I get to sit down, instead of having tobalance on foot because the other couldn’t fit into an overcrowded carriage. Naturally, I would change my mind overnight about taking the train if ourcreaking rail system was brought up to scratch. I would also choose to worklocally if the towns and cities near to my home offered good employmentopportunities and decent salaries. Like many workers, family commitments bind me to living where I do. Yet inthe overcrowded South East, it seems that only Londoncan offer me real career opportunities and the right wage to support myfamily’s living costs. If the Government goes ahead with these plans I’ll be up the Thameswithout a paddle. So will a lot of other workers. Prepare for a problem, HR.Hartley is an HR director at large Comments are closed. Previous Article Next Articlelast_img read more

Covid-19 vaccine won’t be immediate cure for office market

first_imgTagsCommercial Real EstateCoronavirusoffice marketWeWork Share on FacebookShare on TwitterShare on LinkedinShare via Email Share via Shortlink Share via Shortlinkcenter_img Covid-19 vaccines are being distributed across the country, but won’t be an instant panacea for office landlords. (iStock)It’s been a rough year for the office market — and it’s unlikely that the first half of next year will be much better.Even though Covid-19 vaccines are being distributed across the country, public health and real estate experts believe that a return to the office likely will not happen until late spring or early summer, the Wall Street Journal reports.Experts say that it will take months for the vaccine rollout to become effective and for employees to reach herd immunity, meaning remote work will continue in the next year and office rents will continue to drop.The real estate firm CBRE projects that office rents could fall by as much as 8 percent in 2021.ADVERTISEMENTIn the meantime, landlords are dealing with mostly empty offices. An average of about 23 percent of workers in 10 cities had returned to the office the week of Dec. 16, according to Kastle Systems, which tracks access-card swipes. The highest rate since the pandemic was 27.4 percent in mid-October, Kastle said.Some companies are planning their return to the office in light of the promising vaccine news. In New York, 25 new tenants per week were searching for office space in the first two weeks of December, up from 20 per week in November, according to the data firm VTS.Many of these companies are considering leasing space from co-working operators such as WeWork and Industrious, according to the Journal.[WSJ] — Keith Larsenlast_img read more

Affordable, market-rate apartments surge 40%, but remain rare

first_img Email Address* Essential workers, who range from grocery store clerks to teachers, make an average of about $56,000 a year. An affordable rent is defined as no more than 30 percent of gross income, or approximately $1,400 a month for those workers.Of course, about half of the city’s rental units are rent-stabilized, which economists say distorts the city’s rental market and makes market-rate housing more expensive. Turnover and vacancy rates for the city’s 900,000-plus rent-regulated units tend to be very low, and evidence suggests those rates haven’t increased as much during the pandemic as they have for market-rate units.In January, the median monthly asking rent in Manhattan was $2,750, a 15.5 percent drop from a year earlier and the largest year-over-year decline since 2010. Brooklyn and Queens median rents each had record decreases as well, falling by 8.6 percent to $2,395 and $2,000, respectively.[NYT] — Sasha JonesContact Sasha Jones Share via Shortlink From mid-March to the end of 2020, only 11,690 units citywide were affordable to essential workers (iStock)Rents have fallen across the city, but most market-rate apartments are still out of reach for essential workers.From mid-March to the end of 2020, only 11,690 units citywide were affordable to essential workers — 40 percent more than during the same period the year prior, but still a pittance, according to a StreetEasy study reported by the New York Times.The apartments represented just 4 percent of the city’s market-rate rental inventory.“It sounds like a really compelling stat,” StreetEasy economist Nancy Wu told the Times of the 40 percent increase. “But at the end of the day, about 96 percent of apartments on StreetEasy are still unaffordable to them.”Read more2021 poised to be good year for townhouse salesManhattan’s luxury market sees best week since 2016Manhattan and Brooklyn renters sign leases in record numbers Share on FacebookShare on TwitterShare on LinkedinShare via Email Share via Shortlink Message* Tags Full Name* Home Pricesrent regulationRental MarketResidential Real EstateStreetEasylast_img read more

An intercomparison of ground-based UV-visible sensors of ozone and NO2

first_imgAn intercomparison of zenith-sky UV-visible spectrometers was held at Camborne, UK, for 2 weeks in September 1994. Eleven instruments participated, from nine different European institutes which were involved with the Second European Stratospheric Arctic and Mid-latitude Experiment (SESAME) campaign. Four instruments were of the Systeme d’Analyse d’Observations Zénithales (SAOZ) type, while the rest were particular to the institutes involved. The results showed that the SAOZ instruments were consistent to within 3% (10 DU) for ozone and 5% for NO2. For ozone the results from these instruments agreed well with total ozone measurements by Dobson and Brewer spectrophotometers and integrated ozonesondes when the air mass factors for the SAOZ were calculated using the ozonesonde profiles. Differences of up to 10% in ozone and 30% in NO2 were found between different instruments. In some cases these differences are attributable to the different absorption cross sections used in the analysis of the spectra, but other discrepancies remain to be investigated. A prominent source of error identified in the campaign was uncertainty in the derivation of the amount of absorber in the reference spectrum, which can contribute an error of up to 3% (10 DU) in ozone and 1.5×1014 molecules cm−2 in NO2.last_img read more

The cost and benefits of territorial tenure, and factors affecting mating success in male Antarctic fur seals

first_imgThe timing, location and duration of territorial tenure, and the mating success and return rates of male Antarctic fur seals (Arctocephalus gazella) were measured over four consecutive breeding seasons (1984–87) on Bird Island (54°00’S, 38°02’W), South Georgia. Tenure duration (days) followed a heavily skewed, Poisson-like distribution (median 13.08 days, maximum 75 days) and was positively related to the number of years of tenure (rs= 0.52, P < 0.0001). Mating success was also biased to a few individuals and was positively correlated to both duration of tenure (days) and the previous number of years in which tenure was achieved (P 0.05 in both cases). The probability of a male returning to hold a territory in the next year was not related to the number of years tenure that had been achieved (P > 0.7) or to the level of mating success in the current year (P > 0.15). It was, however, positively related to the duration of tenure in the current year (P < 0.0001). The overall annual return rate was 43% which is not significantly different from the survival rate for the general male population and suggests that territorial tenure does not contribute to increased mortality in male Antarctic fur seals.last_img read more

Sensitivity of modelled Antarctic climate to surface and boundary-layer flux parametrizations

first_imgThe Hadley Centre climate model version HadAM2 is used to study the sensitivity of modelled Antarctic climate to the parametrization of surface and boundary-layer heat fluxes under stable conditions. Specifically, the impact of changing the dependence of surface exchange coefficients and eddy diffusivities on the Richardson number is investigated. Three alternative parametrizations are implemented; in all of these the exchange coefficients decrease more rapidly with increasing stability than they do in the standard parametrization used in the model. When only the surface flux scheme is replaced by one of these alternatives, cooling is largely restricted to the surface, with some compensating warming occurring at the lowest atmospheric levels, and little change is seen in the low-level wind field over Antarctica. If alternative schemes are implemented both at the surface and in the boundary layer, widespread cooling occurs at the surface and at the lowest one or two atmospheric levels. The increased negative buoyancy thus generated causes significant increases in the speed of katabatic winds blowing down the coastal slopes of Antarctica. Colder and stronger offshore winds lead to increased cooling of the Antarctic coastal waters. In a coupled model, this could impact on the production of sea ice and ocean-bottom water. The modelled temperature changes appear to show both a direct response to changed boundary-layer heat-flux divergence and an indirect response as a result of the consequent changes to the low-level circulation.last_img read more

The importance of the Patagonian Shelf for top predator species breeding at South Georgia

first_img1. The rich zooplankton, fish and squid resources on the Patagonian Shelf sustain substantial populations of largely resident seabirds and marine mammals, These habitats are also visited seasonally by similar species from elsewhere but few data exist on their status and origin. Recent studies, using satellite-tracking to determine foraging ranges and feeding areas of seabirds and am marine mammals breeding at South Georgia, have shown that several species make substantial use of the waters of the Patagonian Shelf. 2. Wandering albatrosses use shelf-edge areas year-round with direct observations of both sexes of almost all age classes, including, breeding, pre-breeding and non-breeding individuals. White-chinned petrels and female Northern and Southern giant petrels mainly visit during incubation and post-breeding, particularly to the Falklands Current (White-chinned petrels) and to upwelling areas around the southern shelf-break from the Burdwood Bank in the cast to Staten Island and Diego Ramirez in the west (giant petrels). Northern giant petrel males during incubation and Antarctic fur seals in winter reach inner shelf habitats in the northern sector. In contrast, South Georgia populations of black-browed and grey-headed albatrosses do not appear to use the Patagonian Shelf at any stage of their breeding cycle. 3. Although the use of the Patagonian Shelf by visiting species is now best documented for South Georgia species, recent observational data confirm that seabirds from Diego Ramirez, Tristan da Cunha and Gough visit the southern and northern sectors, during both breeding and non-breeding seasons respectively. Several Antarctic species (notably Antarctic fulmar and cape petrel) winter in the region as do at least two albatross species from New Zealand; other species (especially Wilson’s storm petrels) use it as a staging ground on migration, as do several species of baleen whales and possibly other cetacean species. 4. Three of the seabird species which breed on the Patagonian Shelf are Globally Threatened; seven of the visiting species (and four baleen whale species) also have this status. The Patagonian Shelf is, therefore, not only of global importance for the diversity and abundance of its resident top predators but is just as critical for the survival of many visiting species, some of which are even more endangered. 5. Combining data from satellite-tracking with conventional mapping from direct observations offers the prospect of defining the foraging ranges (and the main feeding areas within these) of a range of key top predator species. Such data should be used, in conjunction with similar information of the distributions of fish, squid and zooplankton resources and of fishing effort, to identify critical marine habitats whose precautionary, multiple-use sustainable management will be vital to protect the interests of both commercial fishers and top predators.last_img read more