CREATE ONE Essay Example | Topics and Well Written Essays - 1000 words

CREATE ONE - Essay Example Rhetoric is also used to communicate about the services of the firm, especially special offer. For instance, there is an advertisement about a beer tap takeover. This advertisement says that â€Å"we want you to drink more beer† (Tryst Cafe and Pub). This has two main reasons for use. First, it makes the place look like one place that a customer can have all the fun they intend to have. This goes well with the culture of the area where Tryst is located. This is because Americans are known to be people who like having fun in a great way, without limitation. It also creates the impression that when one goes to spend some good time at Tryst, they will not have to worry about spending too much, they will be able to do s without hurting their pockets and wallets. Word choice has also been utilized to communicate the massage about the brand. The authors of the site try to portray Tryst as a place where anybody who love to have a good time should go. The text also identifies that Tryst is a place that one can get what they want because the products that they serve are not generic but are crafted to meet the needs of each customer. As a result, the author argues that when one goes to Tryst, they are able to express their personality by getting a product that best suits their tastes. Informal language is used in order to meet conform with the fact that Tryst is an informal pace. This is not a legal firm, it is an informal place where people go to lose themselves as they indulge in various fun activities. Because of this, the author then tries to make sure that the language that is used in the website is an informal one so that it goes along with the theme of the business. With regard to the color chosen, there are a number of factors that may have informed the choice of color. To begin with, there is the problem of having to conform to the colors of the business. Every business uses color as a branding tool. For Tryst, it has its own unique colors that define it. In

New Owner and Existing Business Case Study Example | Topics and Well Written Essays - 1500 words

New Owner and Existing Business - Case Study Example Although Anna was happy that this bargain will save her the costs of setting up a new business, legal proceedings, location, customers and suppliers but what she did not take into consideration were the risks and challenges of buying a business that is losing its pace. It is difficult to revive the image of a business that is already declining especially in relation to the customers who have switched to a better designer as well as suppliers who are enjoying the better relationship with others in the industry. Anna should have also considered the fact that obtaining loyalty and adaptability from existing business’s employees is a challenge. The financial and economic side of the existing business could pose threat because before buying Anna did not examine the details of the mentioned and trusted only on her abilities. Moreover, Anna should have given a deep look into the history of the existing business dealings with the stakeholders and ensured its good reputation. 2) It is believed that if a person has strong dreams and the ability and motivation to turn them into reality, no hurdle can suppress his powers. Same applies to entrepreneurs. It is a common trait of entrepreneurs that with their vision and constant enthusiasm, they can take a business to high levels of success. S Anil Kumar, S.C.Poornima, Mini K.Abraham, K.Jayashree (2003) states that entrepreneurs are intuitive and highly motivated from inside, they have a strong will and determination to achieve their goals. Shane Greenstein (2011) says that entrepreneurs are visionary, exceptionally energetic and have strong willpower. They know what their weaknesses are and ways to get over them. Anna bought the existing business because she knew that her powerful ideas and efforts could really make this business a big hit in the market despite the fact that she had not had good managerial skills. Anna did not let this weakness of her come in the way of her success. She knew that soft skills  could be learned at any point in life but the characteristics of being visionary and enthusiastic are permanently embedded in her personality and nothing can beat them.

Injury Risk in Elite Basketball Players

Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo Injury Risk in Elite Basketball Players Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo

Terrorism :: essays research papers

Over the past Century, terrorism has evolved from random killings to massive plans for terrorist groups. To understand terrorism you must first describe it. There have been many different definitions of terrorism. The one that truly describes it is; Terrorism can not specifically describe terrorism because people will interpret it differently. Many experts believe that terrorism is an abstract concept with no essence, a single definition cannot account for all the possible uses of the term, many different definitions share common elements, the meaning of terrorism derives from the victim of target. Even with no definite conclusion terrorism can be divided into 5 categories: Simple Violence or threatened violence intended to produce fear or change. Legal Criminal violence violating legal codes and punishable by the state. Analytical Specific political and social factors behind individual terrorist acts. State-sponsored Terrorist groups used by small states and the Communist bloc to attack western interests. State Power of the government used to terrorize its people into submission. With the definitions described one can now put a terrorist organization into a specific group. The Palestine Liberation Organization (PLO) is an analytical terrorist group, even though they can be part of each. The PLO was created in 1964 during a meeting known as the Palestinian Congress. This was an effort to give a voice to the many Palestinians that were located in refugee camps in Lebanon. The leader of the group is one of the most recognized terrorists in the world, Yasser Arafat. It did not take long for sub-divisions to break off of the PLO. Most of these groups felt they could better achieve Palestinian liberation. The most notable of these groups were the Popular Front for the Liberation of Palestine, Popular Democratic Front for the Liberation of Palestine, Popular Democratic Front for the Liberation of Palestine - General Command, and al-Fatah. The PLO changed its main theory to the destruction of the state of Israel in 1967. This caused massive terrorist acts against Israel, which resulted in hundreds of casualties on both sides. In 1974 the PLO changed into not just a terrorist group to a group which included political elements. Some members of the PLO did not like this idea and founded another sub-division called the Rejectionist Front. At this time Arafat took over all control of the PLO. Arafat provided support for highjacking a major cruise ship. With help from the PLF they took the passengers hostage.

Rhetorical Analysis Paper: Budlight Advertisement Essay

Budweiser is one of the best-known brands of beer in America. Their ads and commercials have always been known for being humorous and entertaining. Millions of people look forward to seeing the Super Bowl half-time commercials mostly because of Budweiser’s notorious commercials. Budweiser takes advantage of its reputation and makes commercials that are witty and fun for people to watch. They incorporate humor and a certain kind of sex appeal into their ads to sell their beer to men and send the message that there is nothing more pleasing in life than drinking Budweiser. The rhetorical appeals are included in the BudLight ad to persuade the audience to drink BudLight. This BudLight advertisement uses pathos to appeal to men’s emotions and make them want to buy their product. It uses sex appeal to make the advertisement more engaging to men. There are very few beer advertisements that do not include women in them. Budweiser uses a more mainstream and traditional sex appeal to sell their product to a certain type of client. The women in the picture are both Caucasian and the couple in the ad is a straight couple. In this ad, Budweiser is appealing to a certain type of American, a more traditional one. They make their product seem lavish and they appeal to a more high-class audience than other beer companies. Budweiser assumes that having these types of women in their advertisements helps their company sell more products. They are correct with their assumption because they have been very successful with their products thanks to all of their advertisements with beautiful women in them. They try to encourage beer enthusiasts to buy their beer instead of any other beer. See more: analytical writing Budweiser is infamous for its clever marketing skills and entertaining ads. This ad displays several aspects that portray a luxurious lifestyle. There are two young women and a young man on a yacht near a private island. All of them have huge smiles on their faces to show the audience how happy they are with their lives. This ad shows how these young people are enjoying their time on this luxurious trip mostly because they are drinking BudLight. The BudLight bottles are in the front, center of the ad to make sure that the audience can see the brand clearly so that they can remember the logo. Behind the beer bottles, there is a young man enjoying his time on a beautiful island with two attractive women and of course, BudLight. This ad makes the audience believe that this lavish lifestyle is possible as long as they have a BudLight with them. This picture gets imprinted into people’s minds and they are reminded of this ad every time they see a bottle of BudLight. The advertisement’s name is Port Paradise III. This title shows that this is just one of many places where one can go and enjoy a BudLight in the company of beautiful women. If this is Port Paradise Three, then this means that there has to be a One and Two as well. With this title, the audience realizes that the fun never ends as long as they drink BudLight. It is incredible how advertisements can lure an audience into trying out their products. Certain advertisements and commercials may seem simple, but at the same time, those are the ones that people remember and talk about. When people think about beer advertisements, they usually remember the ones like this one because it demonstrates things that people want. This advertisement shows how BudLight is interconnected with Paradise and makes people remember the picture. The luxurious aspect of this ad and the sex appeal used catches the viewers’ attention and makes them remember the product. The next time one of these men goes to the market to buy beer, they will glance through all of the different brands and they will see a familiar brand, BudLight. They will remember the logo that they saw in the ad and associate it with luxury because of the private island and yachts that were in the advertisement. This masterful marketing is what makes Budweiser so successful.

Dramatic devices Essay

Arthur Miller wrote â€Å"The Crucible† for his beliefs in McCarthyism, rampant at that time. He was against it – being a hunt of the communist figures, no matter how questionable they being communist in the slightest. It was sparked by a fear that Russia was going to take over the world. Making people scared and suspicious, Miller had to be subtle in expressing his anti McCarthyist views, so he used an allegory – a play. This play used the Salem witch hunt, similar because of the unsupported accusations, the people encouraged to denounce their friends, and fear and suspicion. The Salem witch hunt was more brutal, with the â€Å"witches† being killed, with only people’s accusations as evidence. Miller had to recontextualize the story, to stop accusations against him. The first words spoken being â€Å"My Betty be hearty soon?†. The title is fitting as a crucible is a container where metals are purified after heating. It reflects how Proctor has been heated by his ordeal and came through to die, his conscience clear – purified. I will explore the techniques used in creating the play, to create various moods in the mind of the audience, in Act I. In Act I we find Parris’s and Mrs. Put’m’s children – Betty and Ruth, inanimate on their beds. People are jumping to the Devil and Parris is putting that off, scared for his name in the village. We find that Abigail and friends had been dancing in the woods. We do get clues that the girls are faking their illness, as Betty wakes up when Parris leaves the room, we find Abigail quickly becomes the leader; an expert is called in – Mr. Hale. Abigail takes the chance to talk to John Proctor, who becomes the main character. Tituba. Parris’s slave, as usual is blamed for witching the two children in the woods. This cause a lot of the girls to say they saw each other with the Devil. In terms of this plot tension is created within the audience. The secrecy and mistrust creates this. Talking behind people’s backs and the ducking and diving which takes place is the cause. How the plot thickens so quickly would make the audience more uneasy. The dramatic irony with the talking behind each others backs creates tension, and involves them more; they want to see what happens. The techniques used to create meaning for the reader, is the overture and the prose on the characters. The reader trusts the prose and they give information on the characters, they are there because there can be no nuances or subtext in the speech, creating a fast story, the prose slows it down, getting the reader more involved.  An audience wouldn’t have these to guide them, it would be up to the actors to read the prose and interpret them in their acting. The play was performed when McCarthyism was at its peak, so it would be blindingly obvious to the American audience what it was about. The allegory would mean the audience would relate to it, creating tension when they think it’s about 1 thing, then realize it’s about something else. The time the story is set in is a somber time, spooky because of the black garments and archaic speech, immediately making the audience uneasy, the first words spoken being â€Å"My Betty be hearty soon?† This inverted language makes it seem more Biblical and legal, heightening the impact they have as does the syntax. The older time distances us, making the characters seem austere and quite oppressive. The double-negative furthers the tension by adding confusion, making it more farcical, which further distances us. Claustrophobia, furthers the tension as there is no escape for the characters, they are trapped which makes the audience feel trapped as well. The first thing we find is that Parris’s room is small, with narrow windows and leaded panes like a prison – this creates claustrophobia. Parris is trapped, making the audience more susceptible to panic. He is also kneeling – he is suppressed by God, it bears down on him. Laws and limitations create claustrophobia as well. â€Å"Not have permitted anyone to read a novel† This shows how small minded the laws were, consequently making the people small minded. Not being able to explore themselves and their emotions, making them bland with no escape from reality. â€Å"Their creed forbade †¦ vain enjoyment† Shows how religiously they stuck to their beliefs, making their lives bland and boring, and possibly more excitable over the out-of-the-ordinary. â€Å"The edge of the wilderness was close by† The wilderness was the Devils land, they were locked in their town nothing else existed. â€Å"It stood dark and threatening† How they were held in place, scared to go further. â€Å"They believed†¦they held†¦the candle that would light the world† Shows how small minded they were; the Devils land was irrelevant. Parris makes the audience feel angry and frustrated by the fact that he is supposed to be a leader. He is pompous – â€Å"then the Doctor must search on†, unpopular and paranoid – â€Å"a faction to drive me from pulpit†, unjust – â€Å"Out of my sight!†, ambitious – â€Å"do not preach for children†, cowardly – â€Å"they will hound me out of Salem†, greedy – â€Å"not used to this poverty†, hypocritical – in defense of Abigail he calls others witches, overly pious – â€Å"send for Reverend Hale†, dishonest and vain in covering truth – â€Å"Uncle the rumour of witchcraft is all about†. So he is not a particularly pleasant person. If he denies witchcraft in his own home it could seem dishonorable and suspicious so he doesn’t. Even so the audience would realize his difficult position, and give him room to breathe. Abigail is a big character, she schemes her way to becoming the leader of the witches – â€Å"Now look you, all of you†. She is fearful of her name in the village – â€Å"Not I, sir – Tituba and Ruth† This gives her a good position, she can scheme to save herself and being manipulative – â€Å"Now if they be questioning us†¦Ã¢â‚¬ . The audience can relate to her to an extent, everyone can be a leader and scheme; this also makes her the â€Å"baddie† the audience will be interested in knowing what happens to her. Proctor is the character to which we can relate to, the main one. Through Proctor we have a medium in which we can see something and consider ideas. As does Hale, it put us in their shoes. Proctor sees Abigail as a child, strengthening our bond with him. He also sees through Parris, who we find being very greedy with his fire – wood money. Also Giles sued him and he paid up although Giles just misheard him – â€Å"I’ve paid you for it† Proctor is very honest and just wants to get on with his life. The audience will have an affinity with Proctor. Conflicts between characters – Abigail and Elizabeth both love Proctor, Proctor and Parris: Parris isn’t godly and is a hypocrite etc. these conflicts are like smaller plots in their own way and add to the audience’s excitement, also annoying us when they don’t resolve, theocracy religion says the you cant, but they want to.  The structure is broken up with the overture and prose which the actors interpret and use the instructions to show it to the audience. This adds an extra dimension to the play, incorporating the prose, with its history and explanations. Intertextualism, the themes that link Salem and McCarthyism, spark questions – it is years since the Salem trials but we still haven’t learnt, human character prevails. The questions – dramatic devices that go unanswered, especially at the end with Proctor being hung, should he have been? He doesn’t want to go back to the same society that tried to hang him – a dramatic device, people are ready to persecute when that is what they are trying to escape – irony. The irony, people went to America to escape and be free, supposed to have got better – satiring the American Dream. These themes mean more to a 1950’s audience, with the exact same one present.

Order Writing A Thesis Proposal Here

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Internet Initialisms

Internet Initialisms Internet Initialisms Internet Initialisms By Maeve Maddox Although I’ve adopted a few initialisms such as BTW, LOL, and IMHO in my own informal writing, I’m mostly ignorant of the alphabet soup current on Twitter and other social media sites. When a reader recently introduced me to the combination DRTL, I realized that this new language represents not just a kind of shorthand, but also a new philosophy of written language. This particular construct, DRTL, seems to me to symbolize the new philosophy: DRTL = Didn’t Read, Too Long. Note: A more common version of DRTL is TLDR or tl;dr, meaning too long; didnt read. Strings of commonly understood letter combinations such as FYI (For your information), TGIF (Thank God it’s Friday), and ASAP (As soon as possible) pre-date the Internet, of course, but they never occurred in the profusion that exists now. Readers who share my lack of currency in Abbreviation-Speak may find the following list useful. AFAIK: As far as I know AIUI: As I understand it BTDT: Been there, Done that BTW: By the way F2F: Face to face FOAF: Friend of a friend FWIW: For What it’s worth GAL: Get a life GIGO: Garbage In, Garbage Out HTH: Hope that helps IANAL: I am not a lawyer ICYMI: In case you missed it IIRC: If I recall correctly IMHO: In my humble opinion IMO: In my opinion IRL: In real life ISTM: It seems to me JK (also J/K) Just kidding LOL: Laughing out loud OMG: Oh, My God OTOH: On the other hand OTT: Over the top STW: Search the Web TIL: Today I learned TMI Too much information TTYL: Talk to you later WYSIWYG: What you see is what you get Of course this list is a mere scratching of the surface. And I’ve deliberately left out the ones that contain a gratuitous F. Nevertheless, even a short list may help a few codgers navigate Twitter with a little more comprehension. HTH. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:When to Capitalize Animal and Plant Names8 Types of Parenthetical PhrasesUsing "zeitgeist" Coherently

Budgeting For a Family Vacation to Disney World

Disney World is a magical and interesting place for the family of four people. A passionate voice infiltrated the air, the children flew and waited for Disney to start the day. But as we know, going to Disney is not that simple. You need to travel to Disneyland on a budget. Savings and planning is your top priority. How do you get there, when you go to Florida, where do you go. Most importantly, it is good for children, Disneyland and anyone. Over the years, when we went to Disney World, our family learned and we stayed at Disney World. Disney World Hotel has more than 25 unique resorts, each with a vacation destination from place of budget to facility. The question remains Why is our family not staying outside the hotel, but staying at the Disney World Resort? When you go to Disney, you want to be a Disney ... forever and ever! This means staying at the Disney World Resort. Just because you left the park at the end of the day does not mean that the magic ended when you stayed in a r esort owned by Disney. I do not know you, but I never went to Disney as I thought, so I wanted 24/7 Disney when I was there. From unique theme to hidden Mickey, Disney Resort does its best to keep the magic of traveling. As of last week, my husband and son have never been to Disneyland. On the other hand, I repeat - a combination of family vacation and school trip. Whenever I asked my husband to plan a trip to Disney, his answer ranged from Meh to No, thanks, Absolutely No. But, if you've ever been to Disneyland before, you will know that it is worth it (and I really dislike excitement). According to the story of animation, it is not attractive for my husband to roam around the imitative country and sit on a musical or intensive version of the movie. Perhaps one day ... when we have children, he always told me before his son was born. As you can see, Disney World Resort Villas can save your family's Disney World holidays. You will never feel connected to the 'hotel container'. In ad dition to this container, please imagine. And at Disney World, please reserve a cheap villa to save time and money. When you go to Disney F1, they are a wonderful way to save lots of money.

What factors contributed in the stuggle against the Mafia in Sicily Essay

What factors contributed in the stuggle against the Mafia in Sicily - Essay Example Cosa Nostra (Mafia) criminal syndicate emerged in mid 19th century and all cosca aimed at controlling a particular territory (Blok 2001). In 1870s, Romans officials invited Sicilian Mafia clans to help in fighting dangerous independent criminal organisations and protect the land owners (Blok 2001). The Mafia and state had entered in to partnership that allowed the Cosa Nostra to perform the functions that state could inefficiently perform. Factors that contributed to struggle against Sicilian Mafia The mafia and state enjoyed cordial relationships with the Mafia without any disruptions for several years. However, the relationships started tumbling in 1960s after Mafia acquired wealth and threatened the balance of power between the state and Mafia (Blok 2001). Accordingly, the methods of Mafia in acquiring power changed to threatening, extortion and criminal activities thus threatening the State power (Blok 2001). Mafia acquired considerable financial resources through ensuring close working ties with Christian Democratic Party and obtaining guarantees on construction contracts (Allum and Renate2003). In recognition of Mafia’s growing influence, the state decided to withdraw from the relationship with Cosa Nostra (Seindal 1998). Again, Mafia criminal empire expanded in 1970s to become a key network in inter-continent crimes such as money laundering and drug-trafficking. Mafia was initially used to define Sicilian phenomenon, but it is currently used to define any organised criminal organisation especially in Italia (Seindal 1998). In the recent past, Sicilian mafia has expanded to European and international level and has committed other crimes such as money laundering and drug trafficking in countries like Middle East, Latin-America and Switzerland. According to Italian anti-Mafia law of 1982, mafia organisations use intimidation powers and have organised criminal structure that plan its criminal activities. Sicilian mafia has a long history of corruption , murder and extortion (Blok 2001). In early 1980s, Mafia violence was directed at assassination of judges, prosecutors and political authorities. Corleonesi assisted in instigating the Second Mafia war and led a brutal Luciana Leggio against the state authorities in the ‘First Mafia War’. After the Mafia Trials of 1960s, few individuals were convicted of criminal activities and Mafia resumed back to illicit business activities. Control for family dominance within the Mafia organisation resulted to the Second Mafia wars since Corleonesi believed that some families had benefited more from the illicit drug profits and desired to dominate the Mafia through use of violence. Several Mafia families regrouped and started killing specific state figures such as Colonel Giuseppe Russo and several police chiefs (Seindal 1998). Organisations that struggled against the Sicilian Mafia Magistrates Giovanni and Paolo Borsellino The climax of Mafia brutality highlighted the need of the state to curb the organisations criminal activities and several individuals within the state started fighting against the impunity of Mafia (Scheider and Peter1998). In late 1980s and early 1990s, Sicilian prosecutors like Paolo Borsellino and Giovanni Falcone work unearthed the hierarchical structure of Sicilian Mafia organisations. The two prosecutors asserted that they would

Managing risk in construction project in developing countriess Ghana Essay

Managing risk in construction project in developing countriess Ghana - Essay Example t the major risks associated with the construction sector include risks logistical delays , political influences , extensive procedures for approval , improper construction designs , financial constraints , etc . To study the impact of these risks on the construction projects in Ghana , a quantitative survey has been conducted . The data collected by the quantitative questionnaire , has been statistically analysed . The statistical measure used for the analyses include mean , tally , histogram and pearson’s correlation . The software tools used in the research include Excel spread sheet for data representation and MINITAB for statistical analyses . Based on the results of the statistical analyses , the research has suggested a set of strategies for risk management in the construction projects in Ghana . I --------------------------------------- , wish to acknowledge the following personnel who gave their valuable assistance and guidance for me to complete this research work successfully . Without their cooperation , the development of this research and publication would have been difficult I -------- wish to dedicate this research work Based on the Risk Management in Construction projects in developing countries like Ghana , to my --------------- who had always been my ----------------- and I also dedicate this research work for the benefit of the people involved in the construction sector . The history of the construction industry dates back to many centuries , when human beings left the caves and started living in houses . The architectural and engineering aspects of the construction industry started emerging since the construction of the pyramids . Construction could be described as a process of building the infrastructure and involves a fleet of multi tasked activities . Any construction project includes the involvement of design engineers , architects , civil engineers , project mangers , etc . The successful completion of any

Film Franchises Essay Example | Topics and Well Written Essays - 2250 words

Film Franchises - Essay Example The Harry Potter (#5,7,11,14) film franchise, meanwhile, is a pentalogy while the Star Wars series (8,17,20) is an octology (IMDb. All-Time Worldwide Box Office). It is worthwhile to mention that the James Bond film franchise, which consists of a series of 23 films ranks first The hereinabove data is a potent proof of the reality that in the movies, moviegoers would rather prefer to patronize movies which they are familiar with in terms of the characters and the story lines and which they know beforehand that there is a high possibility of them enjoying the movies to the hilt. They would rather not risk their money and time with films which they are not so sure whether the quality, the acting and the direction and the story would be to their liking. Like in books, comic strips, TV serials, one good thing must lead to another. are a ready, hard-core audience, a marketing hook and a possibility of generating new fanatics by simply improving the visual quality of the succeeding serials through the taking advantage of advances in cinematic technology especially the special effects phase of film making. Sadly though, many movie producers fail to sustain the movie going public's interest in their purported movie franchises, inevitably run out of steam and end up only in the sequel stage. Others run short of ideas and need the most opportune time to stage another reboot or even a prequel to continue the movie franchise undertaking. An example of this is The Chronicles of Narnia which had already netted more than $1.168 billion but is at the moment stymied in its production of a third serial, The Voyage of the Dawn Treader, due to a finalisation of a more convincing and appealing screenplay (Sammons 2004, p.48). The most crucial challenge to all though, would be how to vigorously maintain the franchise's commerc ial appeal and potential and yet make it firmly self-contained as a narrative so that it will not end up churning a "series that outstays its welcome" (Thompson 2008, p.7). History of Film Franchises The movie world took a while to discover the magic and the marketing power of film franchises. Since the birth of cinema on December 28, 1895 when French

Evaluation of Current Trends in the Music Industry Essay

Evaluation of Current Trends in the Music Industry - Essay Example Evaluating the current trends in the music industry can help those in this business to have a more substantial response to demands within the environment. Globalization and technology are the two trends that are continuing to change the ability to produce and distribute music within the industry. Live promoters and recording studios are both being affected by this by the growing opportunities for indie artists as well as the changing demands from fan bases. Creating a business environment that fits with the specific needs within the newer music industry can then provide a better response to those that are interested in music as a business. It can be seen from this specific report that innovation, creativity and building new approaches to using technology will help to sustain those that are a part of the music environment. The current trends that are in the music industry are creating significant differences in how musicians and artists are able to promote and record their music.

Improwing Service Delivery in University of Derby Research Proposal

Improwing Service Delivery in University of Derby - Research Proposal Example University collaborations at all levels are important to delivering world-class research and strengthening the overall contribution of the laboratories to the nation's research enterprise. In addition, the interaction with university researchers increases the quality and impact of the user facilities and helps to improve them. b.) Project the necessary security facilities and assistance that the university can provide to foreign and local students. Other helpful facilities can include a university cafeteria, cultural book shop, mini grocery, wi-fi zones, sport facilities, and parking spaces. Since the investment is financially feasible, the dormitory could be built in the future. (i)To evaluate the benefits or otherwise of these facilities provisions to both the university and students' communities. (ii)To critically analyse the effectiveness of these facilities in the university communities. (iii)To suggest guidelines for improving and enhancing these services. Forte (2003) stated that some US colleges have adopted SEVIS in order to monitor and access current information on nonimmigrant students which is a way of protecting the safety of the student body. Charles Fletcher Jr (2005) stated that the University of Delaware has built a comprehensive identity management infrastructure using Siemens' HiPath Security solutions. The users adopt a credit card-sized SIcurity smartcards which manages the students' access to both physical facilities and information systems. Another system, the MetaDirectory coordinates with on-campus database applications to ensure that identity information such as electronic access credentials, is always current. The system provides a single point of access that processes requests when enabling and revoking users' security privileges. The smartcards provide tamper-proof storage for passwords and account numbers. With a single sign-on process, any student with an authorized ID and password can use the card to access t he internet and applications on school computers.Coppola et.al., (2001) discussed the establishment of the department of corporate security services for John Hopkins Medical Center in 1994. This in-house security team did a thorough