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Effect of excitatory amino acids on serum TSH and thyroid hormone levels in freely moving rats.

The actions of glutamate (L-Glu), and glutamate receptor agonists on serum thyroid hormones (T4 and T3) and TSH levels have been studied in conscious and freely moving adult male rats. The excitatory amino acids (EAA), L-Glu, N-methyl-D-aspartate (NMDA), kainic acid (KA) and domoic acid (Dom) were administered intraperitoneally. Blood samples were collected through a cannula implanted in the rats jugular 0--60 min after injection. Thyroid hormone concentrations were measured by enzyme immunoassay, and thyrotrophin (TSH) concentrations were determined by radioimmunoassay. The results showed that L-Glu (20 and 25 mg/kg) and NMDA (25 mg/kg) increased serum thyroxine (T4), triiodothyronine (T3) and TSH concentrations. Serum thyroid hormone levels increased 30 min after treatment, while serum TSH levels increased 5 min after i.p. administration, in both cases serum levels remained elevated during one hour. Injection of the non-NMDA glutamatergic agonists KA (30 mg/kg) and Dom (1 mg/kg) produced an increase in serum thyroid hormones and TSH levels. These results suggest the importance of EAAs in the regulation of hormone secretion from the pituitary-thyroid axis, as well as the importance of the NMDA and non-NMDA receptors in this stimulatory effect.

Animals↗

Powerful allele sharing statistics for nonparametric linkage analysis.

Nonparametric linkage analysis is widely used to map susceptibility genes for complex diseases. This paper introduces six nonparametric statistics for measuring marker allele sharing among the affected members of a pedigree. We compare the power of these new statistics and three previous statistics to detect linkage with Mendelian diseases having recessive, additive, and dominant modes of inheritance. The nine statistics represent all possible combinations of three different IBD scoring functions and three different schemes for sampling genes among affecteds. Our results strongly suggest that the statistic T(rec)(blocks) is best for recessive traits, while the two statistics T(kin)(pairs) and T(all)(kin) vie for best for an additive trait. The best statistic for a dominant trait is less clear. The statistics T(kin)(pairs) and T(all)(kin) are equally promising for small sibships, but in extended pedigrees the statistics T(dom)(blocks) and T(dom)(pairs) appear best. For a complex trait, we advocate computing several of these statistics.

Alleles↗

Assignment of mouse Gfra1, the homologue of a new human HSCR candidate gene, to the telomeric region of mouse chromosome 19.

Glial cell line-derived neurotrophic factor (Gdnf) and its alpha receptor (Gfra1) interact with the Ret receptor triggering its tyrosine kinase activity. As Gdnf and Ret have been linked to the development of Hirschsprung disease (HSCR), it seems likely that Gfra1 could also be a susceptibility gene for HSCR. A further HSCR candidate gene is represented by the human homologue of the Dom (Dominant megacolon) mouse mutation, mapped to Chr 15, for which the gene has not yet been identified. In order to test if Gfra1 could be the Dom gene or if it represents a new possible HSCR locus we have undertaken the mapping of the mouse Gfra1. Using specific PCR primers on a somatic cell hybrid mapping panel and fluorescence in situ hybridization with an expressed sequence tag (EST) cDNA clone corresponding to the mouse Gfra1, we mapped the gene to mouse chromosome 19D2-D3, a region with known homology with human chromosome 10q24-->q26.

Animals↗

Potency assessment of topical corticoids in the vasoconstrictor assay and on tuberculin-induced inflammation.

The topical anti-inflammatory activity of potent and very potent corticoids was studied in normal and inflamed skin using the vasoconstriction assay and tuberculin-induced inflammation in four double-blind intraindividual comparison trials. Instrumental techniques in addition to visual scores and several time points were applied to get better insight into the reliability of the models and the sensitivity of the different variables. Beta-methasone-17-valerate and two concentrations of prednicarbate were used as potent corticoids, clobetasol-17-propionate, betamethasone-17,21-dipropionate and different biopharmaceutical forms of desoximetasone (DOM) as very potent corticoids. Visual scores, the reactive skin hyperemia after arterial occlusion and skin colorimetry were used to quantify vasoconstriction; erythema scores, surface area of infiltration and changes in skin colorimetry, skin blood flow and skin temperature for the tuberculin reaction. The time courses of blanching (n = 20) and of the tuberculin reaction (n = 10) were described by orthogonal polynomials and the coefficients were statistically analyzed by nonparametric tests, the discriminative variables in tuberculin inflammation in addition by the parametric multiple analysis of variance. Important differences in the release rates of corticoids demand several assessment times and not just one as often used. The potency ranking may otherwise be misleading. In general, ointments released corticoids slowlier than the cream which in turn liberated slowlier than the gels. The DOM gel declined rapidly after an apparent peak at 5.5 h in terms of its blanching effect, but was nevertheless comparable after once-daily application to other very potent corticoids in its activity against delayed-type inflammation. Such differences may explain discrepancies found for some corticoid preparations between their blanching response and clinical efficacy. The more potent a corticoid the more the erythema is reduced, the less pronounced the cell infiltration and the more delayed the peak seems from 24 to 48 h in the tuberculin reaction. The inflammatory response is diminished in the following manner: very potent greater than potent corticoids; erythema greater than infiltration. Visual scores were the most reliable parameters in normal and inflamed skin and they correlated well with skin colorimetry which shows greater variability. Reactive hyperemia after arterial occlusion gave poor results in terms of ranking in the vasoconstriction assay as did resting skin blood flow in inflamed skin. Changes in the temperature of inflamed skin are sensitive enough to discriminate the active drugs from the controls, but have a somewhat different time course, reflecting perhaps a higher impact of the amount of mediator release in the early phase relative to the cell invasion in the later phase.

Administration, Topical↗

Technical development of PubMed interact: an improved interface for MEDLINE/PubMed searches.

BACKGROUND: The project aims to create an alternative search interface for MEDLINE/PubMed that may provide assistance to the novice user and added convenience to the advanced user. An earlier version of the project was the 'Slider Interface for MEDLINE/PubMed searches' (SLIM) which provided JavaScript slider bars to control search parameters. In this new version, recent developments in Web-based technologies were implemented. These changes may prove to be even more valuable in enhancing user interactivity through client-side manipulation and management of results. RESULTS: PubMed Interact is a Web-based MEDLINE/PubMed search application built with HTML, JavaScript and PHP. It is implemented on a Windows Server 2003 with Apache 2.0.52, PHP 4.4.1 and MySQL 4.1.18. PHP scripts provide the backend engine that connects with E-Utilities and parses XML files. JavaScript manages client-side functionalities and converts Web pages into interactive platforms using dynamic HTML (DHTML), Document Object Model (DOM) tree manipulation and Ajax methods. With PubMed Interact, users can limit searches with JavaScript slider bars, preview result counts, delete citations from the list, display and add related articles and create relevance lists. Many interactive features occur at client-side, which allow instant feedback without reloading or refreshing the page resulting in a more efficient user experience. CONCLUSION: PubMed Interact is a highly interactive Web-based search application for MEDLINE/PubMed that explores recent trends in Web technologies like DOM tree manipulation and Ajax. It may become a valuable technical development for online medical search applications.

Consumer Behavior↗

Ultrafast-laser-radiation transfer in heterogeneous tissues with the discrete-ordinates method.

Here light propagation and radiation transfer of ultrafast laser pulses in heterogeneous biological tissues are simulated by use of the discrete-ordinates method (DOM). Formulations for solving the time-dependent radiation-transfer equation are deduced for three-dimensional geometries incorporating the Fresnel specularly reflecting boundary condition and characteristics of ultrafast laser pulses. The present method can treat both the incident laser intensity and the scattered radiation intensity from the walls of the targeted tissue as two components, i.e., a diffuse part and a specular part. Reflectivity at the tissue-air interface is calculated by use of Snell's law and the Fresnel equation. The high-order S10 DOM method is found to be adequate for describing the propagation and transfer of ultrafast laser radiation in heterogeneous tissues. The time-dependent radiation field in the tissue as well as the temporal radiation intensity profiles at the boundaries can be obtained simultaneously. The absolute values of the logarithmic slope of the temporal reflectance and transmittance at various detector positions are found to converge to a constant value in a homogeneous tissue model. With the inclusion of a small inhomogeneity, such a value will change in line with the property of the embedded inhomogeneity. The orientation of heterogeneity of the tissues also substantially affects the radiation intensity at the boundaries. The effect of the Fresnel boundary in the modeling is pronounced. The simulated transmitted signals are broadened and amplified under specularly reflecting boundary condition as compared with those under diffusely reflecting boundary conditions.

Animals↗

Continuous hyperspectral absorption measurements of colored dissolved organic material in aquatic systems.

The majority of organic carbon in the oceans is present as dissolved organic matter (DOM); therefore understanding the distribution and dynamics of DOM is central to understanding global carbon cycles. Describing the time-space variability in colored dissolved organic matter (CDOM) has been difficult, as standard spectrophotometric methods for CDOM determination are laborious and susceptible to methodological biases. Previously, measurements of CDOM absorption in discrete water samples by use of a liquid-waveguide capillary cell (LWCC) compared favorably with measurements made with a benchtop spectrophotometer. Given this, we focused on automating the LWCC technique to improve our spatial and temporal sampling capabilities for CDOM. We found strong correlations between CDOM absorption spectra collected from discrete water samples using standard methods and selected corresponding CDOM spectra collected by the automated LWCC system. The near-continuous measurements by the LWCC system made it possible to map the temporal, spatial, and spectral variability of CDOM absorption along the ship track.

Color↗

Comparison of the auxiliary function method and the discrete-ordinate method for solving the radiative transfer equation for light scattering.

Two methods for solving the radiative transfer equation are compared with the aim of computing the angular distribution of the light scattered by a heterogeneous scattering medium composed of a single flat layer or a multilayer. The first method [auxiliary function method (AFM)], recently developed, uses an auxiliary function and leads to an exact solution; the second [discrete-ordinate method (DOM)] is based on the channel concept and needs an angular discretization. The comparison is applied to two different media presenting two typical and extreme scattering behaviors: Rayleigh and Mie scattering with smooth or very anisotropic phase functions, respectively. A very good agreement between the predictions of the two methods is observed in both cases. The larger the number of channels used in the DOM, the better the agreement. The principal advantages and limitations of each method are also listed.

Journal Article↗

The effects of yoga training and a single bout of yoga on delayed onset muscle soreness in the lower extremity.

The purpose of this study was to determine the effects of yoga training and a single bout of yoga on the intensity of delayed onset muscle soreness (DOMS). 24 yoga-trained (YT; n = 12) and non-yoga-trained (CON; n = 12), matched women volunteers were administered a DOMS-inducing bench-stepping exercise. Muscle soreness was assessed at baseline, 24, 48, 72, 96, and 120 hours after bench-stepping using a Visual Analog Scale (VAS). Groups were also compared on body awareness (BA), flexibility using the sit-and-reach test (SR), and perceived exertion (RPE). Statistical significance was accepted at p </= 0.05. A 2 x 2 mixed factorial ANOVA with repeated measures at 24 and 48 hours revealed a significant (p < 0.05) group main effect with VAS scores greater for CON than YT. Paired t-tests revealed that in YT, VAS scores were higher before yoga class than after yoga class at 24 hours (21.4 [+/- 6.9] mm vs. 11.1 [+/- 4.1] mm; p = 0.02). The SR was greater in YT than in CON (65.0 [+/- 7.9] cm vs. 33.3 [+/- 7.0] cm; p < 0.01); however, no differences were found between yoga and control in BA (94.0 [+/- 4.4] units vs. 83.8 [+/- 3.7] units; p = 0.21) or in RPE at 5-minute intervals (2.9 [+/- 0.3], 5.3 [+/- 0.8], 5.8 [+/- 0.9], and 5.2 [+/- 0.8] vs. 2.5 [+/- 0.3], 4.0 [+/- 0.5], 4.2 [+/- 0.3], and 4.9 [+/- 0.4]. Yoga training and a single bout of yoga appear to attenuate peak muscle soreness in women following a bout of eccentric exercise. These findings have significant implications for coaches, athletes, and the exercising public who may want to implement yoga training as a preseason regimen or supplemental activity to lessen the symptoms associated with muscle soreness.

Adult↗

Effects of deep heat as a preventative mechanism on delayed onset muscle soreness.

The effects of increased muscle temperature via continuous ultrasound prior to a maximal bout of eccentric exercise were investigated on the symptoms of delayed onset muscle soreness (DOMS) of the elbow flexors. Perceived muscle soreness, upper arm circumferences, range of motion (ROM), and isometric and isokinetic strength were measured over 7 days on 14 college-aged men (n = 6) and women (n = 8). Ten minutes of continuous ultrasound (ULT) or sham-ultrasound (CON) were administered. Muscle temperature was measured in the biceps brachii of both arms. Muscle temperature increased by 1.79 degrees +/- 0.49 degrees C (mean +/- SD) in the experimental arm of the ULT group. Muscle soreness was induced by a single bout of 50 maximal eccentric contractions. The ULT group did not differ significantly (p < 0.05) from the CON group with respect to perceived muscle soreness, upper arm circumference, ROM, and isometric and isokinetic strength. In conclusion, increased muscle temperature failed to provide significant prophylactic effects on the symptoms of DOMS.

Adult↗

The spatial distribution of optical properties in the ultraviolet and visible in an aquatic ecosystem.

In aquatic ecosystems, the UV and visible radiation environment is strongly influenced by variation in the chemical and physical parameters of the ecosystems. In shallow lakes, highly heterogeneous water characteristics produce a wide variety of optical environments. Such ecosystems require analysis approaches that consider a potential variability. In this study, 77 stations were used to characterize the optical properties of a shallow lake (open water surface 54 km(2)). The vertical attenuation of solar radiation at 305, 313, 320 and 340 nm and at photosynthetically active radiation was measured during the seasonal cycle. Dissolved organic matter (DOM), turbidity, fluorescence, pH, temperature, conductance and dissolved oxygen were simultaneously measured. The spatial variation of the extinction spectra of the dissolved fraction at each sampling station was also measured and analyzed between 270 and 400 nm. The spatial heterogeneity of the lake was examined by determining the distributions of the attenuation coefficients and biooptical parameters at high spatial resolution and describing the distributions in a series of maps. The methodology permitted a quantitative description of the interaction between solar radiation and aquatic ecosystems as well as a spatial classification of the dominating processes within the lake. This included the determination of the role played by DOM loading and changing chemical properties within the lake optical environment.

Ecosystem↗

Mineralisation assays of some organic resources of aquatic systems.

Assays were carried out to evaluate the consumption of dissolved oxygen resulting from mineralisation processes in resources usually found in aquatic systems. They were also aimed at estimating the oxygen uptake rate of each investigated process. Experiments were conducted using substrates from 3 different places. A fixed amount of substrate was added to 5 litres of water from Lagoa do Infernão that was previously filtered with glass wool. After adding the substrates the bottles were aired and the amount of dissolved oxygen and the temperature were monitored for 55 days. The occurrence of anaerobic processes was avoided by reoxygenating the bottles. The experimental results were fitted to a first order kinetics model, from which the consumption of dissolved oxygen owing to mineralisation processes was obtained. The amount of oxygen uptake from the mineralisation processes appeared in the following decreasing order: Wolffia sp., Cabomba sp., Lemna sp., DOM (Dissolved Organic Matter), Salvinia sp., Scirpus cubensis, stem, Eichhornia azurea, sediment and humic compounds. The deoxygenation rates (day-1) were: 0.267 (humic compounds), 0.230 (Lemna sp.), 0.199 (E. azurea), 0.166 (S. cubensis), 0.132 (sediment), 0.126 (DOM), 0.093 (Cabomba sp.), 0.091 (stem), 0.079 (Salvinia sp. and Wolffia sp.). From these results, 2 groups of resources could be identified: the first one consists of detritus with higher amounts of labile (ready to use) compounds, which show a higher global oxygen uptake during the mineralisation process; the second one consists mainly of resources that show refracting characteristics. However, when the consumption rates are analysed it is noted that the mineralised parts of the refracting substrates can be easier to process than the labile fractions of the less refracting resources.

Absorption↗

Effects of dissolved organic carbon concentration and source, pH, and water hardness on chronic toxicity of copper to Daphnia magna.

The effects of pH (5.3-8.7), water hardness (CaCO3 at 25-500 mg/L), dissolved organic carbon (DOC) concentration (1.6-18.4 mg/L), and DOC source on the chronic toxicity of copper to Daphnia magna were investigated by using a multifactorial, central composite test design. Natural dissolved organic matter (DOM) was collected at three sites in Belgium and The Netherlands by using reverse osmosis. For a total number of 35 toxicity tests performed, 21-d no-observed-effect concentrations (NOECs) of copper based on reproduction ranged from 29.4 to 228 microg/L and 21-d concentrations of copper causing 50% reduction of reproduction (EC50s) ranged from 41.5 to 316 microg/L. Statistical analysis revealed that DOC concentration and pH had a significant effect on copper toxicity but hardness (at the levels tested) did not. In general, an increase in pH or DOC resulted in a linear increase of 21-d NOEC and EC50 values. All DOMs (originating from three different sources) reduced copper toxicity to the same extent. Multiple linear regression analysis on the results of all 35 toxicity tests revealed that DOC concentration is the most important factor for chronic toxicity of copper to D. magna, explaining about 60% of the observed variability, whereas pH only explained about 15% of the observed variability. Regression models were developed (with DOC and pH as parameters) that were capable of predicting NOECs and EC50s within a factor of 1.9 from observed NOEC and EC50 values obtained with eight natural surface waters spiked with copper. Until future research further elucidates the mechanisms underpinning the observed bioavailability relations, these empirical regression models can become a first simple tool for regulatory applications.

Animals↗

Phase distribution of synthetic pyrethroids in runoff and stream water.

Synthetic pyrethroids (SPs) are a group of hydrophobic compounds with significant aquatic toxicity. Their strong affinity to suspended solids and humic materials suggests that SPs in natural surface water are distributed in solid-adsorbed, dissolved organic matter (DOM)-adsorbed, and freely dissolved phases. The freely dissolved phase is of particular importance because of its mobility and bioavailability. In the present study, we used solid-phase microextraction to detect the freely dissolved phase, and we evaluated the phase distribution of bifenthrin and permethrin in stream and runoff waters. In stream water, most SPs were associated with the suspended solids and, to a lesser extent, with DOM. The freely dissolved phase contributed only 0.4% to 1.0%. In runoff effluents, the freely dissolved concentration was 10% to 27% of the overall concentration. The predominant partitioning into the adsorbed phases implies that the toxicity of SPs in surface water is reduced because of decreased bioavailability. This also suggests that monitoring protocols that do not selectively define the freely dissolved phase can lead to significant overestimation of toxicity or water-quality impacts by SPs.

Adsorption↗

Speciation of aqueous methylmercury influences uptake by a freshwater alga (Selenastrum capricornutum).

Uptake of methylmercury (MeHg) by the alga Selenastrum capricornutum was measured in freshwater batch culture bioassays. The concentration of MeHg in the alga increased rapidly (within 15 min), reached a maximum by 6 h, and then declined because of growth dilution. The alga's rapid growth rate (doubling time, approximately 10 h) contributed to the importance of growth dilution. Conditional first-order rate constants were calculated for uptake (k1 = 6.95 x 10(-9) L/cell/h) and growth (kG = 0.07/h). A competitive synthetic ligand, disodium ethylenediaminetetra-acetate, formed strong complexes with MeHg and reduced MeHg uptake, consistent with the biotic ligand model. A conditional equilibrium formation constant (K) for the MeHg-algae complex was estimated to be approximately 10(16) and was used to model the influence of natural ligands on MeHg bioavailability. Model results suggested MeHg would be most bioavailable at concentrations of dissolved organic matter (DOM) less than 10 mg/L and increasingly unavailable at higher DOM concentrations for the specific humic acid modeled. Similarly, at molar concentrations of sulfide (and, possibly, metal-sulfide clusters) equal to approximately half the MeHg concentration, MeHg was predicted to be unavailable to algae because of the formation of strong 2:1 MeHg-sulfide complexes.

Biological Assay↗

Cadmium binding by fractions of dissolved organic matter and humic substances from municipal solid waste compost.

The agricultural practice of amending soils with composted municipal solid waste (MSW) adds significant amounts of organic matter and trace metals, including Cd. Under these conditions, soluble organic complexes of Cd formed in the compost may be more significant than previously thought, due to Cd bioavailability and mobility in the soil environment. To study the relative importance of different types of organic ligands in MSW compost for the binding of Cd, six fractions of the dissolved organic matter (DOM) in addition to humic acid (HA) and fulvic acid (FA) were extracted and their complexation of Cd quantified at pH 7 using an ion-selective electrode (ISE). The highest complexing capacities (CC) for Cd were found for the most humified ligands: HA (2386 micromol Cd g(-1) C of ligand), predialyzed FA (2468 micromol Cd g(-1) C), and HoA, a fulvic-type, easily soluble fraction (1042 micromol Cd g(-1) C). The differences in CC for Cd of the various organic ligands were not directly related to total acid-titratable or carboxylic groups, indicating the importance of sterical issues and other functional groups. The strength of association between Cd and the organic ligands was characterized by calculating stability constants for binding at the strongest sites (pK(int)) and modeling the distribution of binding site strengths. The pK(int) values of the DOM fractions ranged between 6.93 (HiN: polysaccharides) and 8.11 (HiB: proteins and aminosugars), compared with 10.05 for HA and 7.98 for FA. Hence, the highly complex and only partially soluble organic molecules from compost such as HA and FA demonstrated the highest capacity to sequester Cd. However, strong Cd binding of organic ligands containing N-functional groups (HiB) in addition to a high CC of soluble, humified ligands like HoA indicated the relevance of these fractions for the organic complexation of Cd in solution.

Biological Availability↗

Transport of di(2-ethylhexyl)phthalate (DEHP) applied with sewage sludge to undisturbed and repacked soil columns.

Municipal sewage sludge is often used on arable soils as a source of nitrogen and phosphorus, but it also contains organic contaminants that may be leached to the ground water. Di(2-ethylhexyl)phthalate (DEHP) is a priority pollutant that is present in sewage sludge in ubiquitous amounts. Column experiments were performed on undisturbed soil cores (20-cm depth x 20-cm diameter) with three different soil types: a sand, a loamy sand, and a sandy loam soil. Dewatered sewage sludge was spiked with 14C-labeled DEHP (60 mg kg(-1)) and bromide (5 g kg(-1)). Sludge was applied to the soil columns either as five aggregates, or homogeneously mixed with the surface layer. Also, two leaching experiments were performed with repacked soil columns (loamy sand and sandy loam soil). The DEHP concentrations in the effluent did not exceed 1.0 microg L(-1), and after 200 mm of outflow less than 0.5% of the applied amount was recovered in the leachate in all soils but the sandy loam soil with homogeneous sludge application (up to 3.4% of the applied amount recovered). In the absence of macropore flow, DEHP in the leachate was primarily sorbed to mobilized dissolved organic macromolecules (DOM, 30.3 to 81.3%), while 2.4 to 23.6% was sorbed to mobilized mineral particles. When macropore flow occurred, this changed to 16.5 to 37.4% (DOM) and 36.9 to 40.6% (mineral particles), respectively. The critical combination for leaching of considerable amounts of DEHP was homogeneous sludge application and a continuous macropore structure.

Agriculture↗

Using recovery modalities between training sessions in elite athletes: does it help?

Achieving an appropriate balance between training and competition stresses and recovery is important in maximising the performance of athletes. A wide range of recovery modalities are now used as integral parts of the training programmes of elite athletes to help attain this balance. This review examined the evidence available as to the efficacy of these recovery modalities in enhancing between-training session recovery in elite athletes. Recovery modalities have largely been investigated with regard to their ability to enhance the rate of blood lactate removal following high-intensity exercise or to reduce the severity and duration of exercise-induced muscle injury and delayed onset muscle soreness (DOMS). Neither of these reflects the circumstances of between-training session recovery in elite athletes. After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between the training sessions of athletes. The majority of studies examining exercise-induced muscle injury and DOMS have used untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of elite athletes. Even without considering the above limitations, there is no substantial scientific evidence to support the use of the recovery modalities reviewed to enhance the between-training session recovery of elite athletes. Modalities reviewed were massage, active recovery, cryotherapy, contrast temperature water immersion therapy, hyperbaric oxygen therapy, nonsteroidal anti-inflammatory drugs, compression garments, stretching, electromyostimulation and combination modalities. Experimental models designed to reflect the circumstances of elite athletes are needed to further investigate the efficacy of various recovery modalities for elite athletes. Other potentially important factors associated with recovery, such as the rate of post-exercise glycogen synthesis and the role of inflammation in the recovery and adaptation process, also need to be considered in this future assessment.

Athletic Injuries↗