Infographic 1: UEFA 2020 expert group statement in elite football: Training day. Infographic 2: UEFA 2020 expert group statement in elite football: match-day. Infographic 3: UEFA 2020 expert group statement in elite football: Best of the rest—8 other key take-home messages. UEFA commissioned an expert group statement on nutrition in elite football.1 Gathering 32 global experts in football and nutrition research …

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

One of the National Football League's (NFL) Head, Neck and Spine Committee's principal goals is to create a 'best practice' protocol for concussion diagnosis and management for its players. The science related to concussion diagnosis and management continues to evolve, thus the protocol has evolved contemporaneously. The Fifth International Conference on Concussion in Sport was held in Berlin in 2016, and guidelines for sports concussion diagnosis and management were revised and refined. The NFL Head, Neck and Spine Committee has synthesised the most recent empirical evidence for sports concussion diagnosis and management including the Berlin consensus statement and tailored it to the game played in the NFL. One of the goals of the Committee is to provide a standardised, reliable, efficient and evidence-based protocol for concussion diagnosis and management that can be applied in this professional sport during practice and game day. In this article, the end-of-season version of the 2017-18 NFL Concussion Diagnosis and Management Protocol is described along with its clinical rationale. Immediate actions for concussion programme enhancement and research are reviewed. It is the Committee's expectation that the protocol will undergo refinement and revision over time as the science and clinical practice related to concussion in sports crystallise

Good nutrition choices can support optimal health and performance of footballers. The intake, type, quantity and timing of foods, fluids and supplementation can optimise preparation, performance and recovery of players within and between matches.1 In the fast-paced world of elite football, a one-stop shop resource gathering current best practice and research information would greatly benefit practitioners and players. Expert consensus statements are widely used to improve the quality of player care. Recently, a generic sports nutrition consensus was published1; however, football is different and somewhat unique, and specific nutrition guidelines have not been updated for over a decade.2 We believe that sports-specific recommendations are needed, and 10 years on we ask ourselves, are these guidelines relevant today? This editorial highlights (1) why an updated football-specific consensus is necessary and (2) how it can benefit the modern-day football practitioner and player. ### Research is moving faster than we can keep up Like many areas in sports-related research, there has been an exponential increase …

Bilateral rounding of the shoulders (laxity) associated with kyphosis of the thoracic spine causes costoclavicular venous compression and brachial plexopathy. This form of thoracic outlet syndrome is usually not amenable to surgical treatment in older patients, particularly in severe kyphosis of the thoracic spine. The objective of this presentation is to display the sites of landmark anatomy compressing the brachial plexus that decreases venous return to the nerves causing a shortage of oxygen and glucose needed for cellular metabolism causing fibrosis and scarring of the soft tissues marginating the brachial plexus. Magnetic resonance imaging (MRI) is the only modality that displays fibrosis and scarring of fascial plane anatomy obstructing venous and lymphatic return, not possible with Ultrasound and/or Computerized Axial Tomography (CAT).The longer venous obstruction, transient ischemia or permanent obstruction ischemia if unrelieved, progressively affect the nerve fibers in increasing numbers and to an increasing degree. Pathology develops with edematous swelling and vascular congestion. If the pressure is unrelieved and continues to increase, the nerve(s) suffer a first degree or a conduction block injury. Compression ischemia with degeneration and fibrosis develop. In absence of relief, the endoneurial tubes and funniculi atrophy and with increasing ischemia, fibrosis becomes marked.This presentation displays costoclavicular compression of the brachial plexus with fibrosis and scarring in two patients. One patient post resection of the scalene triangle complicated by laceration of the second division of right subclavian artery and the second patient with bilateral scalenectomy with incomplete first rib resection.Monitored bilateral MRI, MRA and MRV of the brachial plexus is the only modality of choice to display costoclavicular compression and fibrosis and scarring of the brachial plexus.

INTRODUCTIONThoracic Outlet Syndrome (TOS) patients are normally managed conservatively with physical therapy (PT) and may undergo scalenectomy and first rib resection without imaging. Bilateral multiplanar magnetic resonance imaging and 2D time of flight magnetic resonance angiography and venography (MRA/MRV) of the brachial plexus display costoclavicular compression of the draining veins within the neck, supraclavicular fossae, and neurovascular bundles as the diagnostic cause of thoracic outlet syndrome.METHODSBilateral MRI/MRA/MRV displays sites of obstruction of the draining veins of the neck and the subclavian and axillary arteries with binding nerve roots. Monitored multiplanar images are acquired on a 1.5 Tesla GE Signa LX unit, 44 cm field of view, 512 × 256 matrix with saline water bags to enhance signal to noise ratio.SUMMARYThe case selected for this presentation was diagnosed with left TOS and left pectoralis minor syndrome. Her surgeon convinced her that there was no need for imaging. However, she developed postoperative complaints and sought evaluation by a neurologist. Thereafter, bilateral imaging of the brachial plexus was requested displaying the surgical alteration of landmark anatomy, costoclavicular compression of binding nerves to the subclavian and axillary arteries, obstruction to venous drainage, scarring and fibrosis from the resected lymphatics marginating veins within the pectoralis minor muscle adhering the pectoralis major muscle to the anterior chest wall.CONCLUSIONNerves, arteries, veins and lymphatics are within the fascial planes marginating muscles. Health professionals should be aware that resection of the pectoralis minor muscle tendon (tenotomy) at the coracoid process disrupts lymph drainage precipitating fibrosis and scarring of those structures within. Baseline plain radiographs and MRI of the brachial plexus should be obtained prior to all surgical intervention.

Las dermatofitosis humanas son el grupo más extendido de infecciones causadas por hongos. Estos son capaces de invadir los tejidos que contienen queratina de los animales. Nannizzia nana (N. nana) puede causar tiña en cerdos y que de manera excepcional puede producir infecciones en humanos.Realizamos una búsqueda en PubMed de artículos publicados desde el 1 de enero de 1990 hasta el 31 de marzo del 2022 para identificar casos adicionales. Los términos de búsqueda empleados fueron «Microsporum nanum» y «Nannizzia nana».Tras la revisión bibliográfica identificamos un total 16 casos de dermatofitosis por N. nana desde 1990. En la mayoría de los pacientes, el diagnóstico clínico fue tinea corporis y los antifúngicos más utilizados fueron terbinafina y griseofulvina.N. nana es una especie de dermatofito aislada infrecuentemente en humanos, pero que representa una fuente potencial de dermatofitosis en personas que entran en contacto directo o indirecto con animales y con el suelo.Human dermatophytoses are the most widespread infections caused by fungi. These are capable of invading the keratin-containing tissues of animals. Nannizzia nana (N. nana) can cause ringworm in pigs and rarely cause infections in humans.We conducted a search using PubMed for articles published from January 1, 1990 to March 31, 2022 to identify additional cases. The search terms used were “Microsporum nanum” and “Nannizzia nana”.After reviewing the literature, we identified a total of 16 cases of dermatophytosis due to N. nana since 1990. In most of the patients, the clinical diagnosis was tinea corporis and the most widely used antifungals were: terbinafine and griseofulvin.N. nana is a dermatophyte species isolated infrequently in humans, but it represents a potential source of dermatophytosis in people who come into direct or indirect contact with animals and soil.

Knowledge of HIV status is an important step in prevention efforts especially for at risk populations like MSM. CDC recommends that MSM be tested at least annually. There is a limited information on the demographics and risk behaviors of MSM who never tested or test infrequently. This study examined the demographic characteristics, risk behaviors, and HIV status of African American MSM who reported never previously testing for HIV, testing > 12 months prior, or testing within the last 12 months from a testing evaluation study in Washington, D.C.Eligibility requirements were: 18–64 years old; Black/African American; biologically male; and self-reported oral and/or anal sex with a man in the past six months. Descriptive statistics and logistic regression analyses were used.Men who never tested had greater odds of being 25–34 years old, identifying as bisexual or heterosexual and reporting condomless sex with female and male partners. In the multivariate model, men who never tested or tested > 12 months prior to the study had a greater likelihood of having a BS degree, and being age 35 or over. Being newly identified as HIV-positive was associated with never testing and testing > 12 months prior, but was significant in the multivariate model only for never testing.Results suggest prevention strategies should target risk behaviors rather than orientation and engage older men. Future studies should identify factors associated with risky sexual behaviors for men who never test or test infrequently in order to inform prevention interventions.

ACKNOWLEDGEMENTS:Steven Do, Portia Daniels, David T. Nelson, UCLA Radiology Media Center.

INTRODUCTION. Costoclavicular compression of the brachiocephalic veins decreases vertebral vein drainage of the vertebral venous plexus / Batson's plexus of the vertebral column. This causes painful head and neck, upper extremity and sacral complaints. Bilateral MRI/MRA/MRV displays sites of venous, lymphatic, and arteries with binding nerve roots. METHODS and MATERIALS. Monitored multiplanar images with 2D Time of Flight MRA/MRV without contrast are acquired on a 1.5 Tesla GE Signa LX unit, 44 cm field of view, 512 x 256 matrix and saline water bags to enhance signal to noise ratio and Fast Spin Echo (FSE) to display lymphedema. RESULTS. Two patients were selected: one post trauma from utility wire exploration with anomalous course of the right axillary artery inferior to the vein and the other from repetitive stress injury with an enlarged thymus gland. CONCLUSIONS. MRI/MRA/MRV is the only monitored imaging modality that displays altered fascial plane anatomy of the brachial plexus. Health professionals need to know landmark anatomy to make an accurate diagnosis.

INTRODUCTION. A month‐old female infant was brought to the emergency room because she would not take in fluids. Her mother indicated the infant had a birth history of a traumatic brain injury stemming from a difficult instrumental delivery. A nurse assigned to care for the infant observed what appeared to be blood on the right ear. She immediately alerted the pediatrician on duty of a possible case of child abuse. The pediatrician concurred and ordered an anterior‐posterior chest radiograph and anterior posterior and lateral skull radiographs. RESULTS. The chest radiograph was interpreted by the hospital radiologist as being positive for fractures of the ribs and the skull radiographs as being positive for bilateral parietal bone fractures without soft tissue swelling. Three‐dimensional computerized axial tomography was then performed and interpreted as positive for bilateral parietal bone fractures. Although the infant was not in acute distress, she was hospitalized with the suspected diagnosis of child abuse. An outside radiologist was consulted finding no evidence of fractures and/or swelling over the sites dictated by the hospital radiologist. The outside radiologist found an anomalous parietal bone suture misinterpreted as the parietal bone fracture. CONCLUSIONS. The purpose of this presentation is not to review the division of the parietal bone but to inform physicians and health professionals that anomalous parietal bone sutures are rare and often misdiagnosed as fractures.

Indonesia has many cultures. One look through the diversity of Indonesian culture, which is one of the region is Maros, South Sulawesi. In addition, Indonesia is also renowned as one of the nation that has a high enough rank of complexity. Indonesian complexity appears in profile in Indonesian language. This article will look at the diversity of Indonesian based on ancient human migration patterns in the archipelago. In addition, it will also be reviewed on the role of the only language that has managed to unite the cultural diversity of ethnicity, and languages in Indonesia. The existence of a national language in Indonesia only because of the already established agreements among Indonesian people to their social ties. The agreement occurred cumulatively. Many factors affect the diversity of languages that exist in Indonesia. Among the factors that generate the linguistic diversity is a factor of two ancient human migration, the migration of Austronesian and Australo-Melanesian. Two current distribution of the prehistoric human remains influential in the formation of culture and language in the archipelago until now. All indigenous languages in Indonesia generated from two groups of ancient languages, the Austronesian language family and the Papuan languages family. Austronesian language family moved in the archipelago around 4,000 years ago. Meanwhile, Papuan language families move in the archipelago since 40,000 years ago. Thus it can be said that the diversity of language in contemporary Indonesia should be associated with the migration factor and several other factors. Other factors, among others, such as migration, the geography of the archipelago with many islands and mountains, and social factors and communication. Seeing these things, it can also noted that Indonesia has a very diverse languages. Unlike delivered Indonesia has only two varieties in language, namely formal and non-formal varieties. It would be flawed if it still considers Indonesian has only two varieties from the 250 speakers.

INTRODUCTIONObstruction of the thoracic duct(s) causes chronic upper extremity lymphedema. Lymphatics have bicuspid valves like the venous system. Metaplastic fibrosis resulting from obstruction of lymph drainage in the upper extremities impedes vertebral venous plexus / Batson's plexus circulation. The upper limb undergoes painful swelling into the axilla and compresses the brachial plexus. Patients present with tingling/numbness and weakness of the affected arm; lightheadedness; blurred vision and floaters in the visual fields, and tinnitus with whooshing sounds in the ear on the affected side and increased hair growth and nail changes in the affected limb.METHODSBilateral MRI/MRA/MRV displays the sites of obstruction of lymphatics, draining veins of the neck and the subclavian and axillary arteries with binding nerve roots. Monitored multiplanar images are acquired on a 1.5 Tesla GE Signa LX unit, 44 cm field of view, 512 × 256 matrix and saline water bags to enhance signal to noise ratio and Fast Spin Echo (FSE) to display lymphedema (JNMA 1999; 91:333–341).RESULTSTwo patients were selected: one with acquired obstruction of the thoracic lymph duct with lipoma extending into the left hemithorax, the other with developmental fibrosis of the right thoracic duct complicated by pulmonary emboli. Cannulation of the lymphatics could not be performed because of obstructed lymphatic flow.CONCLUSIONSMRI/MRA/MRV is the only alternative to lymphangiogram in patients with obstruction to lymph flow.

Sickle cell disease (SCD) is found in many ethnic groups, with the highest prevalence of heterozygote carriers (sickle cell trait [SCT]) in African Americans. SCT is associated with an increased risk of fatal exertional heat illness, renal papillary necrosis, and splenic infarction. Since 2006, all infants born in the United States are required to be screened for hemoglobinopathies as part of newborn screening (NBS). In 2010, as part of a legal settlement, the National Collegiate Athletic Association (NCAA) implemented SCT screening in division I athletes.

Although blacks are at higher risk for obstructive sleep apnea (OSA), they are not as likely as their white counterparts to receive OSA evaluation and treatment. This study assessed knowledge, beliefs, and attitudes towards OSA evaluation and treatment among blacks residing in Brooklyn, New York.Five focus groups involving 39 black men and women (aged .18 years) were conducted at State University of New York (SUNY) Downstate Medical Center in Brooklyn to ascertain barriers preventing or delaying OSA evaluation and treatment.Misconceptions about sleep apnea were a common theme that emerged from participants'f responses. Obstructive sleep apnea was often viewed as a type of insomnia, an agerelated phenomenon, and as being caused by certain bedtime activities. The major theme that emerged about barriers to OSA evaluation was unfamiliarity with the study environment. Barriers were categorized as: problems sleeping in a strange and unfamiliar environment, unfamiliarity with the study protocol, and fear of being watched while sleeping. Barriers to continuous positive airway pressure (CPAP) treatment adoption were related to the confining nature of the device, discomfort of wearing a mask while they slept, and concerns about their partner'fs perceptions o treatmentResults of this study suggest potential avenues for interventions to increase adherence to recommended evaluation and treatment of OSA. Potential strategies include reducing misconceptions about OSA, increasing awareness of OSA in vulnerable communities, familiarizing patients and their partners with laboratory procedures used to diagnose and treat OSA. We propose that these strategies should be used to inform the development of culturally and linguistically tailored sleep apnea interventions to increase awareness of OSA among blacks who are at risk for OSA and associated comorbidities.