journalofsportsmedicine

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Re-Admission to Orthopaedics Department in Salford Royal Foundation Trust Hospital Results of Local Audit-Juniper Publishers

Introduction

The NHS Organizations produced a system called “Clinical Governance” through which the NHS organization is responsible for continuously improving the quality of their services and safeguarding high standards of care. An important element of the system is better known as the “Clinical Audit”, that is a process that seeks to improve the overall patient care and outcomes through a systematic review of care against explicit criteria and the implementation of change, as it provides the mechanisms to review the quality of care provided, and further offer mechanisms to address such issues, as well as the formation of plans to improve practice. A further process better known as “Recycle the Audit” that aims to re-assess the same issues after a period to ensure plans have been practiced. This process should be closed after implying all the action plans for improvement as described in (principle of best practice in clinical audit) [1]. The Orthopaedics Department is considered very active compared to other specialties, and through the development of medical practice as well as the new techniques of quality of care, patient full recovery rate is higher than previous years. Readmissions after Orthopaedics operation emergency or elective are common and can indicate that patients are either not fully recovered or have developed postoperative complications. However, these re-admissions increase the risk of other complications, such as prolonged hospital stay, infections, and thromboembolic complications, as well as very high costs to readmission. After new policies of trust, readmissions of these patients indicate failure of treatment and subsequently losing the cost of primary operation. As a result, this new policy adds an extra burden on the department to find proper mechanisms and better overall care to avoid these expenses. Thus, all medical centers have targeted reducing readmission as a step to improving health care and reducing costs. In Orthopaedics Surgery, many factors are essential for patient full recovery, following operations which include pre-operative planning, recognition of patient early and late complications, and post-operation non-surgical care, as most of these patients have a background of medical problem that increases the risk of post-operation complications. The most common post-operation complications include infections, respiratory and wound infections, pain, ischemic, deep venous thrombosis, pulmonary embolism, and urinary retention [2]. The paper will be addressing the Readmission Audit that was undertaken at Salford Royal Foundation Trust at the Orthopaedics Department, as admissions reached up to five thousand cases annually in the last few years (which subsequently increased readmission rates) with different Orthopaedics problems, both elective and emergency. As a result, the increase of pressure on the trust to reduce readmission rate for both clinical and financial reasons, resulted in an increased awareness to conduct an audit to assess readmission in this department and provide mechanisms to reduce future readmissions. During the last year, a similar audit that was previously conducted had limited changes that did not completely address the main issues of the problem. The aim of this audit is to focus directly on the issues observed from the previous patient data readmitted to the Orthopaedics department via:

a. Assessing readmission rate to the Orthopaedics department for both elective and emergency patients.

b. Identifying patterns of readmission in causes.

c. Evaluating patients at high risk of re-admission.

    Literature Review

However, most of the literature conducted to find the main reason for readmission, though in reviewing most of these papers it was difficult to find fixed reasons associated with all readmission as it revealed [2] published a paper study the risk factors of readmission. It was a retrospective cohort study examining 3264 Orthopaedics admissions in a total of 2 years’ time. Using patient data recorded in their admission, the study recognized two main associated risk factors of readmission are multiple co-morbidities and associated social-economic state of patients. Other reasons shown in the results of the study was a high rate of surgical site infection as it accounted for 34% of the readmission. Furthermore, [3] published a study examining hospital readmission after discharge for patient with hip fracture: Surgical and nonsurgical causes and their effect on the outcome of operations. It was prospective, multisite, observational cohort study, 562 patients in one-year time between 1997 and 1998, the study examined the main causes of hospital readmission after hip Operation the results of the study showed surgical complication accounted for 11% of all readmission. While the highest causes of both surgical and non-surgical readmission were infection by 25%. The non-surgical causes were higher especially for chest and heart problem by 16% of the 2 causes together. Another study examining readmission after total hip replaced took place in Stepping Hill Hospital [4] as they looked at specific post-operative complication and compared their numbers to the national rate. Their study showed the highest rate of readmission recorder to dislocation, swelling of the legs, and infection. However, most of the data showed incorrect coding and the complication rate are as expected from a similar operation. These literatures indicate the possibility of variation in readmission causes and complication ratio by time, place of study, and variables considered by the researcher [5].

    Methodology

Medical practitioners at the Department of Trauma and Orthopedics at Salford Royal Foundation Hospital performed the audit. Strategies of collection and methodology were developed from methodology guidance recommended by NICE guideline. Furthermore, audit tools were formed after reviewing the most common causes of complication that might have led to readmission, in addition to reviewing the data to find the most common causes shared between these readmissions. The target of the audit was recommended by the management team at the Orthopaedics Department in order to establish minimal bias that might affect the outcome of the audit. Moreover, this audit is considered prospective as the number of the patients was selected in advance following a period. The numbers and the period selected after the changes applied from the first audit, a total number of 82 patients were randomly selected who were readmitted to the Orthopaedics Department at Salford Royal Foundation Trust during a total of six consecutive months, which began in April 2012 and lasted until October 2012. Moreover, the sample size and the time scale were decided for the minimum population needed to show changes to the practice if needed. The data collected are quantitative as it dealt directly with incidence and rates of the events following the operation from patient notes and outcomes following the admission and readmission. Out of those 82 patients, 28 of them had elective operation, while the remaining 54 were readmitted after an emergency operation. All sources of readmission were accountable including accident and emergency, general practice and outpatient department. The data sources were collected from patient notes (electronic notes), electronic discharge records, general practice letters, and medication prescription and PACK system “Electronic radiology investigation results used in Sanford Royal Foundation Trust Hospital”. The data collection form has been designed to include data from both the first and the second admission and included the generally known causes of both admissions. The first reason of admission was recorded and included the length of stay and any events noticed while the patient was at the hospital. However, the reasons for readmissions were divided into three major categories in order to simplify the analysis of the data:

a. Patient readmitted due to major Orthopaedics complications that’s to say musculoskeletal problem which is related to the 1st admission as unresolved primary problem or development of complication.

b. Post-operation complication related to primary operation and stay at hospital but non-Orthopaedics like chest, urinary infection or ischemia (it will be discussed in detail in the next paragraph).

c. Other non-related causes not due to the first admission or operation as it could be due to patient medical background or other co-incident of different illnesses.

a. In the first category which includes specifically Orthopaedics complication data sheet included the search of the well-known common complications following major Orthopaedics operation, include:

b. Bleeding and hematoma

c. Infections like wound, joint and metalwork infections

d. Pain-related to the operation site or patient position during operation out of the usual and uncontrolled.

e. Nerve injury or compression.

f. Same Orthopaedics problem of the primary admission or worsening.

g. Miscellaneous or unusual complications. The second category including post-operatio

n complications for non-Orthopaedics are (most common):

a. Respiratory infection like hospital acquired pneumonia, respiratory distress or exacerbation of chronic obstructive pulmonary disease

b. Urinary tract infection and urinary retentions. c. Dehydration

d. Thromboembolism like pulmonary embolism, myocardial infection and strokes

e. Medication overdose like Analgesia.

In addition to the recognized type of complications, the audit attempts to identify the patients with high risk of readmission by categorizing them according to their age, gender, patients with multiple co-morbidities before the acute problem, from previously recorded notes. As well, the datasheet included postoperative complications during the 1st admission and sources of the re-admission. Other variables that monitored to identify possible relations to the readmission, included patients’ length of stay during the first and second admissions, and the route of the second readmission. The form was arranged in a separate sheet first including all the variables mentioned above in the methodology. The form has been revised by the specialist supervisor and some changes have been applied according to his advice. After filling the form, all data were transferred to an excel sheet for easier calculation and statistics. The form filled in a confidential way showing patients in numbers and all data were kept in a safe place at the hospital during data collection and permission obtained earlier and registered at the hospital online electronic form. All data collected and revised and then interpreted into descriptive statistics using ratios and percentages for all results, in addition to different graphs used to make results easy to understand, which includes bar charts, histograms, graphs, and pie charts.

    Results

The results will show all the variable risk factors and complication rates indicated in the collecting sheet mentioned earlier in the methodology First: Patient risk factors for readmission reveals:

Patient aged more than 65 years were most of the readmissions as the data shows 46% of readmission were between ages 65 and 98 years; while 28% were between 50 and 65 years and 26% between 16 and 50 years of age Figure 1. While gender distribution shows’ 56 %female and 44 %Male from the second admission.as shown in Figure 2. Co-morbidities as the par chart shows the 52%of the patient readmission had multiple comorbidities in compared to their 25% with the chronic problem. Emergency operations have higher re-admission rate in compared to elective, 34% elective 66% emergency shows in Figure 3. According to the type of operation readmission distribution according to the pie chart shows, total knee replacement had 23% readmission, total hip Replacement had 19% of the admission and the rest of the operation distributed equally between 8% to 12% which are statically not important please see Figure 4 and Figure 5. Data calculation results for the reasons of the second admission according to the classification discussed in the methodology into three major categories results distribution shows in Figure 6.  

a. Due to major Orthopaedics problem accounted for 59% of all the second admissions

b. Post-operative complication “non-Orthopaedics” resulted in 24% of readmissions

c. The other readmissions, which is not related to the first admission accountant 17% of all the readmissions.

And to look in details of the readmissions first category causes of Orthopaedics complication of the 59 are:

 a. Wound or operation site infection 24%

b. Same as the primary complaint “unresolved problem 8%

c. Pain at operation site 4%

d. Post-operative bleeding 2%

e. Swelling at site of operation or operated joint 1%

f. Nerve injury or compression due to the operation or the patient position 3%

g. Other miscellaneous 5%

h. Re-admitted for another elective operation 2 %

In the second categories of non-Orthopaedics complications are Figure 7.

a. Respiratory infections like pneumonia or exacerbation of COPD 8%

b. Urinary tract infection and urinary retention 5%.

c. Dehydration thromboembolism 3%.

d. Analgesia overdose 1%

The root of the readmission data shows the main root of the readmission found to be accident and emergency contributed to 67 percent of all the readmissions followed by the general practitioner’s 17 percent and outpatient department 6 percent other 10 percent found to be patient admitted to other specialties then transfer to Orthopaedics for postoperative complications Figure 8.

In order to assess genuinely all the readmissions, the result has been calculated the only the patient who had active management during the second readmission Figure 9. As this patient needs to be assessed in detail due to their importance when applying the changes in the future as it shows 35% of patient readmitted needed intravenous antibiotics 38%went to the theatre for operation 27% of the patient treated conservatively or monitored. The length of stay did not show any patterns in compare with the first admission Figure 10.

    Discussion

Several factors have contributed to the readmissions following Orthopaedics operation. These factors and complications are well recognized and can be prevented in shortand long-term planning. “Details of recommendations for future proper action to ensure improvement in long- and short-term outcomes will be further discussed below”. Regarding the general risk factors of the admission, it has shown that patients aged 65 years old have a higher rate of readmission (46%) compared to other groups. Consequently, this age group might suffer from higher co-morbidities, which is supported by our findings that showed 52% of patients were readmitted due to comorbidities. Generally, it has been well established that patients who had emergency operations are at higher risk of complications than those with elective operations. Even though, all these recognized risk factors are fixed to change, as the results have revealed the importance of these factors into consideration for more precise review to address any further concerns, as well as to ensure that other medical problems are stable before planning for discharge. Such an approach might help to somewhat lower the re-admission percentage, but with the intention to correct other risk factors and preventing complications, the readmission rate can be reduced significantly. By analyzing other causes of re-admission, it was found that 17% of patients were not true Orthopaedics related, while 24% of patients admitted with non-musculoskeletal post-operative complications. These complications should be recognized earlier before discharging patients from the hospital. They require careful and thorough review of the patients in the hospital, along with frequent assessment and referral to the related specialty Figure 11 & 12.

Meanwhile, patients with second admissions should be under the care of other specialties, as they do not require Orthopaedics care due to the origin of their problem. Our data indicated that 40% were readmitted due to respiratory problems, such as hospital-acquired pneumonia, lung collapsed and exacerbation of chronic obstructive pulmonary disease. In addition to a further 25% due to urinary tract infection and urinary retentions; 15% due to dehydration, as well as 15% due to thromboembolism and ischemia, and 5% due to analgesia overdose. Even though the rate of above postoperative complications might be within the expected rate, however, they show the significance of forming a formal full examination and infection screen before discharging along with physiotherapy recommendations and exercise in order to reduce the risks to the minimum. True Orthopaedics readmissions accounted for approximately 59% of all patients readmitted. It was found that 50% of these patients were admitted due to wound, joint or metalwork infections. However, while the numbers are within the expected national rate of postoperative infection, it might be worthy to further study the audit in order to find the best approach to decrease the numbers of readmissions in the future as there are earlier symptoms that can be noticed from patients and signs to reach excellence in patient care and insure full recovery following operation. Furthermore, our data revealed that the second most common cause of the readmissions was due to unresolved primary problem which accounted for 17% of the patients. While post-operative pain is the third common cause (9%), pain could be that of uncontrolled usual postoperative pain and the patient might discharge without enough analgesia or the pain worsening due to the development of other complications. Since pain is resolvable and manageable, such patients require genuine pain review in order to allocate a plan prior to discharge, which can subsequently reduce readmission due to pain. Such plan should involve the pain management team in the discharge, as well as the pain specialist nurse for post-discharge, follow up and managing uncontrolled pain not related to other postoperative complications. Finally, out of all readmissions, it has been found that the accident and emergency department had the highest rate route of readmission (67%), followed by the general practitioners and outpatient department. Even though most of the patients are true admission, however, the minorities of patients who do not need admission have been readmitted through A&E.

An attempt to reduce the number of these patients attending accident and emergency should be set up in order to filter them before arrival to the A&E department. Such plan can be achieved through assembling a helpline to those patients with more specialist team to manage them accordingly, and that will lead to shorter time management, as well as less costs in the future.  

    Limitations

a. First, the audit was general and lost the ability to focus on specific complications related to the common Orthopaedics operation like total hip replacement, which could give a more specific plan and therefore better future management.

b. Second, all the readmissions assessed were admitted to Salford Royal Foundation Hospital, while not taking in consideration proper follow-up for all patients who had the primary operations at this hospital as some patients could be admitted to other departments or even another hospital.

c. Third, it might be important to consider the social circumstances of the patients and their abilities to have good care after discharge from the department as it might implicate on the risk of complication and readmission.

d. Finally, even if the data were enough to show sides of patient care that need addressing; however, these numbers can be affected if we take it in high scales, especially if we take elective operation in separate to emergency operations.

    Summary

Patients aged more than 65 years and with co-morbidities are at higher risk of readmissions. The most common cause of postoperation complication that might lead to further admission is infections, generally. Moreover, patient discharge planning and proper through review before discharge can affect highly if these complications were recorded earlier. Formation of team to follow up these patients in the first 28 days after operation and guidance for better management and earlier treatment could reduce these admissions and provide better short- and longterm care for these patients.

    Recommendations

Many factors usually affect the rate of readmissions ,common factors includes quality of post-operative care ,proper followup ,social services interference and ensure safe environment to the patient post-discharge ,and to ensure improvement in readmission rate a well-planned system of communication and collaboration between all these factors can play a rule to reach the goals to resolve the issues. To reduce cost and improve the overall care of the patient rapid applying to changes and taking plans are the main stone of resolving the issue, as the outcome of this audit will recommend.

a. Prior to discharge: Appropriate post-operation assessment and thorough examination before discharge can pick up early complication and better management of the problems.

b. Assess comorbidity: Patients with high risk of complication at easy admission and before discharge.

c. Making a form to tick and assess these patients will make a documentation and follow up of original problems.

d. Ensure correct coding of readmission and prevent unnecessary data error for future studies and audits.

e. Improve Orthopaedics post-operation patient access through allocated team to triage these patients and provide quick help to avoid unnecessary readmission from A&E or GP.

f. Continuous collection of data and having more audits on a larger scale to show forth patterns in readmission and possible improvement following recommendation and changes applied to the practice.

An audit will be recommended in the following areas:

a. Pain management of patients following operation and after discharge.

b. Infection rate following common Orthopaedics operation and protocols used to manage these patients.

c. Appropriateness of the discharge planning and if needed, further improvement in the future.

Allocate pain management team to assess patient pain control post-operation and prior to discharge, make an easy contact point, such as a specialist nurse to provide help lines with further post-discharge help for patients if needed.

[journalofsportsmedicine]

Queer in Sport: A Report About the Case of Tifanny Abreu-Juniper Publishers

Introduction

What sparked interest in conducting the study was the fact that Sport is seen as a social phenomenon that reaches fans and viewers from around the world, widely portrayed by the press through the dissemination of images that impact the reader and practitioners who admire it and identify with the sports modalities. Falling into society as a prominent role, Sport is recognized as a male reserve space, a generalized and generalizing field, marked by gender differences that (re)produce inequalities and which are reinforced due to the wide experience and appreciation of the binary hegemonic division between man/woman, male/female [1]. As with other social practices, it is configured as “[…] a place for knowledge and power disputes that define and delimit normality standards on the appearance of bodies, the exercise of sexuality and experimentation of gender representations”.

Several studies have already problematized Tifanny’s participation in high performance sports [2-10]. In this scenario, what drew our attention to detail the case of athlete Tifanny Abreu is the representativeness she has as the first Brazilian trans athlete to receive authorization from the Fédération Internationale de Volleyball (FIVB) to perform among women. Aware of the adversity that transgender and / or transgender subjects face in the social molds today, our study was justified by presenting an anthropological understanding of the theme, as well as identifying these manifestations of exclusion, adding positively to the critical studies of Gender, Sexuality and Queer in Physical Education and Sport. The participation of athletes who defy the norms of sport, who are eccentric, dubious, provocative, questioning and decentralized seems to subvert, or even displace, the meanings that are used in the sports sphere and that support their premises according to biological determinism and male/female binarism. This unfolding of new senses and meanings is made possible by the presence of a dissonant body, a body that does not fit the pre-established models and does not seem to have classification in sports practice. This queer corporality, when it moves between sport polarities and is inserted in the modern sport of traditional order, allows the amplification of horizons that deal with the limits of the body, its plurality and ambivalence. Still, it allows us to question the biomedical discourse that distinguishes and hierarchizes subjects in normal and pathological, and which is the basis of the main arguments against the presence/existence/recognition of queer corporealities [8,9]. Based on these assumptions, we aim, therefore, to describe and analyze, under the queer perspective, the trajectory (insertion, permanence and performance) of athlete Tifanny Abreu in high performance volleyball and its resignification process in sport.

    Methodology

Initially, we did exploratory research on the subject in the literature, as well as approached the news about Tifanny Abreu and her performance in foreign and Brazilian clubs. At this time, we also contacted the player to inform of the study and request her collaboration, receiving it promptly. Methodologically, we chose to conduct a descriptive and qualitative research, configuring a case study based on the athlete’s Oral History. We have prepared an interview script containing the following questions:  

 a) Tell us about your personal life story;

b) How do you see your route and how do you recognize yourself today?

c) When did you start to practice sports?

d) How was this insertion?

e) How was your relationship with the family and the social environment in this process?

f) How was your process of identity reframing, both in sports and outside?

g) Did you receive support during this time? How was it?

h) How is the relationship of clubs, fans and media with your situation?

i) Have there been changes in treatment and/or prejudice as a result of your trajectory?

j) What are your personal goals from now on?

k) Do you believe your case can inspire future players?

l) What contribution do you believe to promote in sports?

m) What are the main difficulties that you faced or face?

n) Would you like to make other considerations?

 Due to the unavailability of presenting in person due to the schedule of games and training at the time of the interview, the athlete agreed to participate in the study virtually after receiving, completing and returning the Informed Consent Form through digital mail. Thus, the interview was conducted via the Internet, using video connection through Skype software, and recorded through Free Video Call Recorder for Skype. In possession of the recorded interview, all recorded material was transcribed to be analyzed using the content analysis technique. We categorize our findings into large blocks based on the relevance of the athlete’s speech, following two steps, as Minayo [11] the first, of an analytical order, was delimited through the establishment of keywords that acted as pillars for conceptual reflections. In the second, of empirical order, we delimit categories of selection, organization and systematization of our interpretations, enriching our analyzes according to data present in the scientific literature. Thus, we categorize all in 7 discussion blocks, as follows:

a) Identifications;

b) Family support;

c) The trajectory in sport;

d) The media, the clubs, the fans;

e) Lgbtophobia;

f) Locker room and;

g) Return to Brazil.  

 From there, we weave our problematizations together with the data present in the scientific literature. The final research paper contained a total of thirty pages, which motivated us to reorder the discussions and thus make the most of the information and insights that the project promoted. Thus, we divided our discussions into two distinct works that, although similar, were divided into: 1- detailing and analyzing the athlete’s personal life trajectory [8] and; 2- describe and analyze her sporting trajectory in high performance volleyball [9]. Still, we use some data to formulate a third text, thus taking maximum advantage of the information obtained in the interview. In this report, we are making the results generally available, since their branching (as done in the making of articles) would exceed the minimum allowable limit for the report’s formulation. Also, the athlete’s speeches were mostly suppressed here for the same reason, however, they are allocated according to each discussion block in the three final articles produced.

    Results and Discussion

In the transcript of the interview, we had 16 sheets to analyze according to the answers given by Tifanny Abreu. Already mentioned above, we ordered our findings in 7 categories according to the qualitative and quantitative relevance in the athlete’s speech, that is, by the amount of times and richness of detail with which they were glimpsed and/or unveiled, as follows:

a) Identifications;

b) Family support;

c) The trajectory in sport;

d) The media, the clubs, the fans;

e) Lgbtophobia;

f) Locker room and;

g) Return to Brazil.

In category 1 Identifications: Tifanny makes it very clear how she likes to be treated through the use of feminine pronouns. Currently, the athlete recognizes herself as a transsexual woman. She reveals that since childhood she felt like a girl. However, reports that only after the use of hormones did your body react physiologically as such, a process that occurred in Europe. Tifanny has always dreamed of owning her own home, being financially self-reliant, and having sex change procedures. For the athlete, having money to meet her own costs would prevent her from hearing any comments about her actions involving biological sex. This thought can be triggered by the greater inclination of transsexuals to situations of extreme social vulnerability [12]. Sport in this process was of fundamental importance, because according to the athlete, she was always labeled with pejorative adjectives, but when she became a good player, she acquired more respect and the labels ceased: she was no longer the weirdo, but the good player. In this process, she had to overcome homophobia first and only then start his battle against transphobia. What made her choose to change, however, was not sport, but the social lifestyle. She reveals that she has always been in love with heterosexual men, which caused her great suffering because she was unrequited because they did not recognize her as a woman, a fact that changed after her transition process. This process was not so easy. Tifanny was afraid to suffer from street violence, but always accompanied by her teammates, she encouraged herself and let her hair grow to its first extension. The relationship with team members was not affected, and even improved. Her performance, however, changed: due to the use of hormones, Tifanny had a reduction in explosive strength and impulsion, which, she said, also occurred due to her age. After her mammoplasty surgery, she had a lot of pain, but she adjusted to the way she played and continued her path. In category 2- Family support, Tifanny was afraid to reveal her identity when younger, however, decided to do so for her happiness. At birth, she grew up in the small town of Conceição do Araguaia, a small municipality on the border of Pará with Tocantins, until she was 13, and then moved to Goiânia. It has always had the support of the family since childhood. The member who was most present was her sister since her youth, where Tifanny does not hide the emotion when reporting such appreciation. Family support is of fundamental importance in these cases; however, we rarely find positive reports involving transsexuals and their families. Situations involving the theme sometimes require breaking emotional ties between family members, in addition to feelings of fear and rejection by transgender subjects [12]. In category 3- The trajectory in sport, Tifanny says she always practiced a lot of physical activity. In childhood, she reveals that she always played everything, even in school PE classes. Accompanied by her sister, she was always present in football, basketball and other school games without any reprisal. Tifanny still claims to have good genetics for the sport, after all has always been a good player of the sports she was playing. However, it was in volleyball that she was able to gain a foothold, since football was very exclusionary and prejudicial to her because of her then homosexuality. [13] volleyball presents itself as a space made up of female and homoerotic sociability, favoring the manifestation of alternative masculinities by allowing displacements and transitivities between what is considered masculine and feminine: in common sense, “[...] volleyball is framed as a sport for homosexuals, a fagot sport” [14]. The case of Tifanny, who since the beginning of 2017, has defended the Italian team Golem Volley, made her the first Brazilian trans athlete to perform in high performance volleyball, which attracted the attention of the Brazilian media, further feeding the discussions. on the fertile terrain of volleyball that enables the deterritorialization of sporting conventions, the experimentation of alternative corporealities, the dislocation of hitherto unquestionable knowledge and the broadening of horizons of physical and bodily practices. When she entered volleyball, Tifanny, still male, was discredited for being too feminine. She constantly heard that she would not go forward because she was “very fussy” and late in the sport. Such denunciative speech corroborates the assertion that the sporting world, as well as its managers and actors are still very hostage to sexist and exclusionary standards regarding male and female binarism, coming to disregard the other bodies present, which end up having no space [15].

Such denials, however, gave Tifanny strength to move steadily toward her goal, where she reached the level of professionalism. Along the way, she reveals that some of the promising athletes didn’t even get out of the base categories, and those who did didn’t make it to the same level of prestige as her own. Your volleyball maintenance process was not easy. Constantly the main target on the court due to her sexuality, Tifanny had to fight her feminine side during the game. Although always focused, other players still presented themselves, such as her physical size - thin and not so high for the male suit - and her gender performativity within the courts, which dissociated the athlete’s sex and gender. Tifanny’s performativity, while acting in the male suit, admits shifts in the senses of sport, since it disarticulates signs, symbologies and meanings that are expected of the male athlete. Acting in a “feminine” way, in that context, seemed to make all the athlete’s talent and potential invisible, which needed to prove, albeit not so emphatically, a certain degree of masculinity. The absence, or even secondary participation of male attributes, aroused an inability to rise in sports career, which occurs, according to Tamagne [16] because homosexual athletes are interpreted as having a tiny, failed, insufficient virility, not corresponding to the levels minimums that are required for the universe of sport, recognized as the male reserve area and, therefore, of protruding classical masculinity.

Tifanny, male, played in the years 2007 and 2008 for Foz do Iguaçu, where she was featured in the Brazilian Superleague. In 2008, she went to play in the Portuguese league and from there she never stopped: in 2009 she moved to Spain, then France in 2010, returned to Portugal, went to Indonesia. In the latter country, however, I was already tired of volleyball. Her greatest desire was to become a woman, which she said was past time. Her transfer to Belgium took place in 2012, where after falling in love with a player, she began her transformation. Now definitely Tifanny, played in the Netherlands, returned to Belgium and remained there until 2016 defending a men’s third division team that gained access to the second in the local competition. At this point in her life, she claims to have done all the hormonal treatment. At the same time, the athlete also participated in the European gay tournaments, including Eurogames and Gay Games. She claims to be well known and considered queen by the other homosexuals, but according to her it only happens because she plays well.

At the time of the interview, Tifanny was still performing in Belgium among men. When asked about her willingness to play with women, she was emphatic that at first, she never considered this idea because it was forbidden to her, but when an entrepreneur told her she could help in this process, the athlete began to think about the possibility. Tifanny said she was not concerned about the criticism that might arise. According to her, dealing with criticism is commonplace in her life, and she needs to think about her financial side and career opportunities. Now a member of the Volleyball Bauru team, from the interior of São Paulo, the athlete stands out inside the courts for her skill, but also outside them for the discussions, decentralizations and reflections she promotes to the sport in general. Vigarello [17] states that corporeal metamorphosis challenges the gender norms that govern sport in a process called feminization of virility and masculinization of delicacy, opening doors for the reinvention of traditions and differences as well as their insertion in this scenario. Transsexuality in sport materializes something previously unimaginable, which transcends the ability to understand the aspects that underpin this global phenomenon. The trans athlete’s performativity enables the emergence of practices and understandings contrary to gender norms, making explicit the exclusionary character of binary identities and denying the explanatory precedence of the biomedical order [18]. We can understand them, therefore, as resulting from postmodernity, “[...] since they evoke an undefined state of questions and problems, which cannot be answered in the current sports system standardized by heteronormative logics” [19]. In category 4- The media, the clubs, the fans, Tifanny states that the press leads the opinion of the people. She complains about the way soap operas approach transsexuals on their show. The fact saddens her. For her, people who do not know a transsexual support the idea that this guy is “[...] a effeminate and crazy gay”. Still, many views them as men or gay, not respecting dissonant and / or non-binary gender identities. The athlete states that this thought extends even to the sports media, stating that this instance proves to be ignorant about the subject.

Studies on “Gender, Media and Sport” point to a different treatment between the representation of men and women. Portraying queer bodies or competitions does not seem to attract the attention and gaze of media artifacts [19], contributing to the invisibility, silencing and seclusion of these expressions in the sporting environment, which contributes to legitimize and crystallize the heteronormative precepts that permeate the sports organizations [2]. The factor of recognition becomes crucial not only in the media, but also among the clubs in which Tifanny has been circulating. According to the athlete, because they know her and live together, they always provided her with the necessary support through love, adoration and respect. This evidence is even supported when extended to the crowd. Tifanny says she has never heard of any offense in Europe during the games. She states that the most that happens is a strangeness of children, who are confused to see a woman among men, as well as expressions of surprise on the part of the fans. Although the behaviors of estrangement are triggered by Tifanny’s corporeality, she claims she has never received offenses acting on the European continent. Even if she heard such fears, Tifanny says she wouldn’t mind, because for her the role of the fans is to provoke and try to destabilize the player. However, it states that it would not accept the same kind of conduct off the court. In Category 5- Lgbtphobia, Tifanny claims to have never suffered any aggression of any kind while in Europe. She says that people, including children, are super respectful and always treat her as a woman on and off the court.

The athlete even mentions that after the games there are always jokes between the athletes of the teams, but none of them has lgbtphobic nature. Tifanny is still speaking about three cases that headlined the topic: Lilico, Alessia and Michael. She is incisive when commenting on the cut of the Brazilian team suffered by Lilico. For her, the fact that the athlete was declared homosexual compromised the way he was viewed, which would give him the label “The Lilico Player, such number of Brazil, gay ...”. The same thought extends to the case of transgender player Alessia and the complaints that are manifested due to her participation. In the case of Michael, Tifanny says that the athlete should not have listened to the fans, because the role of this was to destabilize him. For her, it is common homosexuals to hear insults from the stands in Brazil, but this is just an attempt to get the player out of the game. Studies that focus on homophobia in sport generally explore how it is triggered through modalities both on and off the court, as well as outside. [20] states that homophobia is institutionalized in sports due to the discourses that were established to build it, that is, based on the classical masculinity model that privileges the participation of “men with capital M”. In this imaginary, male homosexuality would direct gay athletes into physical and emotional disqualifications, culminating in the unworthiness of staying and belonging in the temple of sports practice [14,16]. [1] bring to light another type of phobia stemming from the participation of MMA trans fighter Fallon Fox: transphobia, which in short, maintains the same linearity as above: aversion and repulsion to those who subvert gender normalization and of sexuality. Soon, “[...] homophobia and transphobia easily emerge in situations in which the body gendersex-desire linearity is deconstructed, whether in the sports field or out of it.”

Understanding lgbtphobic manifestations in sport is a complex exercise that demands numerous semantic and polysemic factors. It is up to us to reflect, therefore, that the institutionalization and naturalization of discriminatory processes in sports spaces are close to other forms of prejudice and moral and physical aggressiveness that erupt in these territories. Understanding how these processes legitimize themselves is fundamental in order to envision new ways of interpreting these occurrences as broader social phenomena and present in layers other than those related to Sport [8]. In the 6- Locker room, Tifanny says that both masculine and feminine serve her, however, emphasizes the preference to enter the masculine, if she does not show her body to the other companions, being a matter of respect that is tied to the social moralism. The athlete says that in Europe she feels safe to do so, because her colleagues accept without any problem, which would not happen in Brazil: “Ah, in Brazil they would rape me inside the bathroom, you know.” This problem stems from the way bathrooms and changing rooms are separated. Through the distinction by sex, the concept of public and private isolation between men and women is established, so that the space destined for them is a temple of femininity, while the former is the public place for unloading and / or manifestation. of his manly and hegemonic nature. Thus, the locker room acts as body regulator and maker of subjectivities concerning the heterosexual world [21].

In any case, Tifanny shows a certain insecurity as she cannot enjoy the space in the same way - or other desirable ones - as her colleagues, still carrying a mix of doubts about the harassment that may occur through the fantasy / materialization relationship. driven by the locker room space. And in category 7- Return to Brazil, Tifanny was afraid because the country is not yet receptive to trans people. The athlete’s fear is supported by alarming indications of violence against LGBT subjects in Brazil. Although the scenario is not the best, Tifanny was excited about the possibility of acting in Brazilian lands and says between laughs: “[...] if you pay me, I’ll be beautiful!”. However, she recognizes that it would only come after its transition and to act professionally. The athlete also says that would not be well accepted by the other teams and their fans, but that their concern is only with the team that pays her at the end of the month. Finally, she argues that the repercussion of her case would be a breach of the considerable social paradigm, stating that it would occur in different ways if it acted in the feminine or masculine: in the first suit, there would be so much strangeness because the level of the other players would be equivalent to her and she would be recognized for her talent, but in the second Tifanny would draw more attention for her feminized body among other men.

In 2017, Tifanny ended her resignification process, receiving authorization from FIVB to play in women’s volleyball. She was hired by the Italian team Golem Volley, competing in the Serie A2 of the Italian league. After the competition ended, she returned to Brazil and joined the training team of the Bauru Volleyball team to reestablish and recover physically after surgery on her left hand. On December 5, 2017, she was officially hired by the team and her debut took place five days later, the 10th, in a match valid for the 2017/2018 Superliga of the national volleyball elite, against the team of São Caetano, which won the duel by 3x2. Tifanny’s participation has become a milestone for Brazilian volleyball, rekindling the discussions about queer in sports, vigorously destabilizing the heteronormative structures and premises that permeate this field and devising new horizons and (re)meanings of corporeality in practice. modern physical and sporting

    Conclusion

We infer that Tifanny Abreu’s trajectory in sports is closely linked to personal and social factors. The path taken to attain the status of representativeness and prestige that it exercises today proves to be unharmonious, full of barriers, obstacles and reluctances. Were it not for the willpower and ambitious profile of the athlete, allied to the opportunities and conditions necessary for this event to consolidate, we would hardly be discussing the effective participation of transsexuals in Brazil’s high sports performance and which developments are possible from this conjecture? Tifanny’s ancestry as a trans athlete in volleyball carries with it many oppressive and recriminatory processes, but also the recognition and legitimacy of her corporeality in the space in question. Even though this modality is notably recognized as a larger space for homosociality and better absorption of dissonant manifestations of heteronormativity [13,22], it is still immersed in the supreme universe of sport, which is very resistant to subversion and reexamination of its classical, longitudinal values. and thunderstorms.

The presence of homosexuals - a queer portion - is provocative, but when we have the transsexual insurgency another queer portion - the disturbances are even greater, perhaps because in the former, some linearity can still be identified. between sex and gender, a relationship exemplified through cisgenerity, which in the case of transsexuals presents ruptures and resignifications, becoming even more emblematic, challenging and problematizing the phenomenon of sport. Thus, even in the queer universe of sporting corporealities, it is possible to identify new postulations of power, privileges, disparities, recognitions, valuations and symbolisms which, it seems, continue to legitimize symptoms of compulsory heteronormativity through classifications, certifications, territorializations, borders. and hierarchical and power differences between queer subjects themselves. Finally, it is noteworthy that, although Tifanny’s case can be identified here and considered as suffering, but overcome, we do not deny the multiplicity of plots that can unfold in the sporting trajectory of queer athletes in varied contexts and scenarios, seeing countless and endless possibilities for realization beyond forced romanticization of overcoming and self-realization.

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Happy ThanksGiving Day

[journalofsportsmedicine]

Culturally Historical Origins of Concept “Physical Education”-Juniper Publishers

Introduction

The construction of a theory that objectively reveals the patterns of development of the field of activity of people associated with the use of exercise, the name of which in the broad social and scientific practice is most commonly used the term “physical culture”, only possible if using scientifically sound concepts [1]. In a previous post [2], the concept of “physical culture” was introduced as a result of the cognitive activity of many scientists, that is, it is consensual. Obviously, for the unbiased and unbiased perception of this definition, the cultural and historical origins of the scientific community need to be uncovered.

Goal

To highlight the conditions for the emergence of the concept of “physical culture” in the process of cultural and historical evolution of the sphere of activity of people related to the use of exercise.

Research methods

Consist in the analysis of special literature, which covers various aspects of the development of basic forms of social manifestation of physical culture, as well as the use of a systematic and historiographic approach to the analysis of this problem. The study used Google’s online search service (Google Books Ngram Viewer).

Research results

According to the historical materials of the phrase “physical culture” entered widespread social practice in the first half of the 19th century. Its appearance was made possible by the fact that from the eighteenth century the term “culture”[1] (Latin culture, from the verb colure, which translates to cultivation, cultivation, improvement) began to be used, among other things (monoculture, agriculture etc.), to define human activities aimed at their own development. This term was introduced as an independent abstract concept in the late XVII century. the German philosopher S. Pufendorf (1632 -1694), who understood the concept of “culture” as created by man. He noted that the creator of culture is not a specific person, but large groups of people united by common activities, in a sense, “aggregate person”. Thus, in the early 19th century the word “culture” was used to refer to people to characterize their activities and their results in the processing, improvement, development, education of the human essence in all its dimensions.

In the period of occurrence of the phrase “physical culture” its other component, namely the word “physical” was used quite widely in different spheres of human activity to define the natural origin of various phenomena and objects as well as in the family education system to characterize the process of physical (physical) development of children. For example [3], when discussing family upbringing, stated that “… the first major part of upbringing, that is, caring for the body… the first one is because body training is already needed when other training is needed. has no place yet. This part of education is called by scientists’ physical education. It was this understanding of the concept of “physical” in relation to man (corporeal) that was most widespread in the 19th century. For example, in the same sense, the term “physical” was used by T. Smith in the book “Philosophy of Health: or a statement of the physical and mental constitution of man” [4], as well as in the study “The [1] The word “cultura” is first found in the treatise on Mark Portius Cato the Elder (234-149 BC) by De Agri Cultura (c. 160 BC). Almost two centuries later, Mark Tulius Cicero (106-143 BC) used the word in the Tusculan Conversations to characterize the process of educating the human soul “culture animi auten philosophic esf” (cultivation of the soul is philosophy) [5].

Based on the above analysis of the substantive essence of the concepts of “culture” and “physical” we can conclude that the phrase “physical culture” can be interpreted ambiguously, both narrowly and broadly. In a narrow sense, it means the development, nurture, care, perfection of human physicality. In this case, the word “physical” is used in the translation as “bodily.” Under this condition, the concept of “physical culture” is equivalent to the concept of “bodily culture.” For example, in his article on Principles of Physical Education, Taylor published in the American Homeopathic Journal [6] noted that people under the term “physical culture” usually understand muscular culture (physical culture). The results of the analysis of the specialized literature indicate that such an interpretation of the concept of “physical culture” has survived to some extent even to this day. For example [7], noting that the phrase “bodily culture” was quite widespread in the nineteenth and early twentieth centuries, suggested returning to it, arguing that the activity of people in the field of physical culture transforms the physical origin of a person from naturally this phenomenon in the phenomenon of socio-cultural in the book “Physical Culture, Strength and Body” [8] noting that in the last decade there has been a surge in books about “body” in society, raising a number of questions, in particular, about the nature of the body, about the relationship between “ the natural “(physical) body and the” constructed “body, between the” natural “body and the” virtual “body. The problem of human physicality is also analyzed in many other contemporary studies, for example [9, 10] and many others].

On the other hand, the concept of “physical culture” can be interpreted not only as “bodily culture”, but also much broader than the development, nurturing, nurturing, perfection of the totality of features of a given person from nature. In this case, the word “physical” is interpreted as “natural”, that is, given to man from nature. These natural attributes include not only the body, but also sensory-motor reactions, feelings, emotions, intelligence, as well as various needs, for example, in health, in physical activity, in cognition of the outside world and several others. These signs, in their totality, form the basis of a person’s spiritual existence. Therefore, the concept of “physical culture” in the broadest sense should be interpreted as the activities of people using physical exercises to educate (develop, nurture, improve) the physical and spiritual essence of man, as well as individual and socially significant results of such activities.

    Conclusion

a) The analysis of cultural and historical origins of the concept of “physical culture” showed that it should be interpreted as the activity of people with the use of physical exercises to educate (develop, care, improve) the physical and spiritual essence of man in all its diversity, as well as individual and socially significant results. of such activity

b) The results of the comparative analysis indicate that the definition of the concept of “physical culture” made based on the results of the analysis of its cultural and historical origins coincides with the consensus definition of this concept [2], which testifies to its objectivity and correctness. Therefore, this concept can be used as a basis in the development of a theory that describes the field of activity of people associated with the use of exercise, the name most commonly used in the broad scientific and social practice, the term “physical culture”.

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Increased Physical Inactivity - A Public Health Challenge with Several Side Effects-Juniper Publishers

Introduction

Physical inactivity is a global public health problem. Physical inactivity is identified as the fourth leading risk factor for global mortality, and nearly 3.2 million deaths each year are caused due to physical inactivity [1]. Being regularly physically active throughout your life is the key to a healthy life. It is well documented in the literature that daily physical activity reduces the risk of several chronic diseases [2]. In 2010, the World Health Organization (WHO) developed the “Global Recommendations on Physical Activity for Health” [1]. The overall aim of the recommendations was to provide national and regional level policy makers with recommendations for the dose-response relationship between the frequency, duration, intensity, type, and total amount of physical activity needed for the prevention of diseases which should be adapted to national conditions worldwide.

The WHOs Global Recommendations on Physical Activity are differentiated in the following age-groups:

children and young people from 5-17 years old should be physically active at least 60 minutes every day [2]. Physical activity in more than 60 minutes provide additional health benefits. The activity should range from moderate activity, such as cycling and playground activities, to vigorous activity, such as running and different ball games. Some of the activities should involve exercises like various strength trainings three days a week adults and elderly from 18-64 years old should be physically active for at least 150 minutes of moderate aerobic activity and strength exercises on two or more days a week which includes work with all the major muscles [2]. There are several ways for fulfilling the daily recommendations, e.g. to do 30 minutes on five days every week. If that feels easy or when that feels easy it is important to increase the intensity and time to 75 minutes of vigorous aerobic activity every week and strength exercises on two or more days a week. It is also possible to mix moderate and vigorous aerobic activity every week and strength exercises on two or more days a week that work all the major muscles elderly from 65 years and above should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate and vigorous intensity activity [2]. For additional health benefits, adults aged 64 years and above should increase their moderate intensity aerobic physical activity to 300 minutes per week or engage in 150 minutes of vigorous intensity aerobic physical activity per week, or an equivalent combination of moderate and vigorous intensity activity.

The daily recommendations for physical activity are a good start for being physically active. Physical activity is an important requirement for a long healthy life. Maximum health effects are obtained through regular physical activity, but there is a long way to go to get more people to meet national recommendations for physical activity.

Benefits of being daily physically active

Effects of physical activity depends on the three main factors:

(ii) the duration of executing the activity, and

(iii) the intensity of the activity [3].

The longer the activity period last, the greater the effects. The higher the intensity of the activity, the greater the physiological effects [4]. Other factors which influence the effect of physical activity are: type of muscle groups in use, gender, age, and diet [3]. Effects of physical activity occur after one bout of exercise and, for long term regular physical activity, after 6-8 weeks.

Regular physical activity improves oxygen uptake, reduces blood pressure, lowers heart frequency, strengthens muscles, and strengthens the skeleton [3]. Maximal oxygen uptake is the maximum oxygen consumption the body can use during maximum work, and it is related directly to the maximum capacity of the heart to deliver blood to the muscles [3]. Light-tomoderate intensity activities; e.g. walking, gardening, shoveling, and dancing; are examples of aerobic activity which can be performed over a longer period [3] and is influenced by the level of oxygen uptake. Anaerobic activity is physical exercise intense enough to produce lactate. Muscle energy systems trained using anaerobic exercise develop differently compared to those trained using aerobic exercise. Anaerobic activity leads to better performance in short-duration, high-intensity activities, which last from a few seconds up to about two minutes, e.g. running the fastest you can after a bus or lifting a height weight. Activities lasting longer than about two minutes has a large aerobic metabolic component [5].

The knowledge about the impact of strength on health is increasing and a correlation between low muscle strength and increase of early deaths has been demonstrated [6]. Low or reduced muscle function decreases the ability to execute daily activities and increases the risk of accidents, e.g. falling. Loss of muscle mass and strength can be rebuilt after two months of strength training [3]. A couple of months of strength training often provides significantly increased muscle strength, ranging from 20-30 percent up to several hundred percent [7]. The ability to increase strength capacity and muscle mass does not seem to diminish over the years, and even people 80 and 90 years old can achieve significantly increased strength and muscle mass after a period of strength training [8]. Strength training is especially important for people who have been physically inactive or being affected by diseases and, due to that, have lost both strength and endurance, which makes it hard for them to execute physical everyday activities.

Why is it so difficult to be regular physically active?

Physical activity should be a natural part of what we are. Being physically active every day may for many be difficult because

(i) the daily life for most people does not require physical activity, the challenge is to integrate the activity naturally in our lives,

(ii) many people do not like to exercise or to be physically active and since it is not naturally integrated in our lives, it will not be prioritized,

(iii) we are surrounded by easy choices of not being physically active e.g. escalators, autowalks, electric bicycles and scooters to mention some, and it can in many cases be difficult to find places for walking or physical activity due to expansions of motor roads, cars etc. etc., and

(iv) the world is constantly changing e.g. climate changes, urbanization and automatization.

Is it possible to solve the increasing problem with increased physically inactivity?

Yes, it is possible, but resolving the code for physical inactivity cannot be taken care of only in the health sector. The aim of increased physical activity must be on the agenda in every sector. Every sector must feel responsible. This challenge must be solved jointly. Yes, but efforts for preventive public health work must increase even more, along with the status for preventive workers. Preventive health care is not something that can be addressed with medicine or a single treatment. Preventive public health work starts with children and adolescents and lasts throughout their lives. We must from early life learn to take the physically active choices. It is a continuous long- life work. In the long term, the work will pay off and produce results in terms of fewer diagnosed with diseases.

Yes, but we must address this challenge seriously. If we think that we can get away with this by “sweeping it under the rug”, it will ultimately lead to major consequences in the future. And last, national daily recommendations for physical activity should be reviewed whenever new knowledge becomes available through research. Constantly adjustments of frequency, duration, and intensity of daily activity are important for future development with the aim of increasing the level of physical activity globally.

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Does Identity and Integration Cause Muslims to Choose to Support Celtic Football Club?-Juniper Publishers

Introduction

A motivation for this article’s topic arose from the realization that very little research has been carried out about Muslim communities in Scotland, let alone how their feelings of identity and integration into wider society have influenced their decision-making how they choose which football team to support. I start with a brief look at what a literature review is and the reasons why it is written. Next, a summarized look at Muslim numbers in Britain, according to the National Census, is carried out. In the main body of this article, with the help of existing studies and empirical evidence, a review of the literature is performed on how Muslims in general have integrated into society and how Muslims in the UK have integrated into Britain’s cultural norms. This is followed by a review of the main existing literature regarding how Muslims primarily come to view themselves in the context of either being British, Scottish, and/or Muslim. Finally, a brief review is done on how supporters of Celtic FC (sometimes referred to as Glasgow Celtic FC), comprising mostly of third- or fourth-generation Irish immigrants, view their identities according to existing literature. In doing so, a better sense can be made of the research findings which will come later.

Literature Review

Before writing a literature review, it is important to understand what it is and why it is done. At this point it should be stated that for the purpose of this piece of work a traditional literature review style has been chosen.

A literature review is a logically structured written appraisal of existing knowledge on a subject, with emphasis on describing, building on, then bringing together said knowledge with the added dimension of the writer’s interpretation. It shows the reader that you are aware of what has already been written; the reasons why your review is different and therefore important; and it shows that you can interpret the literature to highlight contradictions and find gaps in the knowledge base that exists. Furthermore, it helps guard against accusations of plagiarism since previous authors’ ideas are being acknowledged and it also stops you repeating and making the same mistakes as past studies.

Muslims in Britain and Scotland

Figures from the UK national census, 2001, show that 5% of the population is comprised of Muslims making it the second largest religious group behind Christians [1]. If we compare that to the figure in Scotland’s 2011 census, where Muslims only accounted for 1.4% of the population, we can see that this group was an even smaller minority then. However, the figures in Glasgow are more like that of the whole of the UK with 5% of the population comprising of Muslims and more than 40% of Abstract Substantial literature has been written regarding whether UK Muslims identify as British or Muslim. However, there appears to be a lack of research surrounding how these sentiments, in conjunction with other key determinants, impact on the decision as to which football team they support. This research will attempt to examine how identity is formed, how integration is achieved, and determine whether Muslims feel an affiliation towards Irish-Scots backed Celtic FC due to both groups sharing a minority status in Scotland. The present article comprises a literature review only and further research findings will be released in due course. Keywords: Celtic Football Club; Football; Glasgow; Muslim identity; Muslim integration; Old Firm; Scotland; Soccer the Muslim population of Scotland residing there. Furthermore, 44.6% of the Scottish Muslim population is UK-born meaning that 54.4% were born outside of the UK. This statistic demonstrates that first-generation Muslims outnumber the second-generation.

The 2011 Census portrayed the situation of Muslims in Scotland rather more positively compared to UK Muslims. However, there were areas for concern. Muslims in Scotland were still more likely to be living in deprived areas. Unemployment was higher compared to in Scotland as a whole and Muslims had a higher number of households with dependent children. Health conditions were also generally worse, especially amongst women and the elderly. These factors can pose a threat regarding how Muslims relate themselves to the greater society. Therefore, it is necessary to study Muslim integration and how identity is formed since “identities may become sharpened by perceived inequalities in power and resources” [2].

Muslim Integration

Understandably, immigration is a stressful process in one’s life. The challenges and problems of trying to become settled do not exist solely with the first-generation but are similarly experienced by future generations. Whilst the first-generation tries to cope with adjusting to a new culture, the second must attempt to integrate into society and at the same time develop their ethnic, religious and national identities. Throughout the world, many procedures and policies exist to assist immigrants in settling into a new society. Scotland, which presents itself as a multicultural society (albeit this representation is scrutinized constantly by politicians and the media alike), is no different. By way of assessing integration of immigrants in Scotland, tests such as the UK citizenship test and the English language test are in place. However, it is sometimes perceived that the function of these tests is to control immigration rather than to integrate immigrants [3]. Muslim integration into Western society is a widely discussed subject, both on social and political levels. With the introduction of the term ‘Global Village’, in the 1950s, sociologists and psychologists postulated a series of conceptualizations about integration. [4] proposed integration as being one of the four primary modes of acculturation, along with assimilation, separation, and marginalization. He stated that integration is in operation when a person tries to maintain both their own culture and that of the host. With assimilation, an individual reject their original culture and adopts the culture of the host. In contrast, with separation, one maintains ties with the original culture and avoids contact of any sort with the host culture. Finally, marginalization is when an individual loses interest in maintaining his/her culture whilst also having little or no interest in mixing with the local culture. Through these four modes of acculturation, Berry declared that by using integration to acculturate, an individual experience less stress and becomes better adapted to life. Oppositely, in marginalization, one is most stressed and adapts poorly or even not at all to life in the host society. Berry also claimed that assimilation and separation fall somewhere in between integration and marginalization in terms of ability to adapt and experiences of stress.

Berry’s model of acculturation has been applied by many researchers to better understand Muslim acculturation in various Western countries. For example [5] when making comparisons between how Muslim and non-Muslim immigrants in Belgium developed multiple identities and acculturated, discovered that the integration mode corresponded positively to Belgian and European identity but negatively corresponded to both groups’ country of origin. Therefore, it can be said that through the integration mode of acculturation, Muslims related to their Belgian and European identity more than to their original identity. To give meaning to his conceptualization of the various eras of immigration to the US and the status Muslims hold there [6] drew on Berry’s ‘integration mode’. Accordingly, since a Muslim sees both his/her Islamic culture and the system in which they lead their lives as being more important than the host culture’s, it is impossible for a Muslim to be bi-cultural. This concept that Muslims are unable to be bi-cultural seems rather extreme and far-fetched, taking into consideration [5] findings on how Muslim immigrants integrated themselves into Belgian culture. Shaub [6] later came to reflect on this in the same paper when he noted that in an era of connectivity (where the world is connected digitally, most prominently through the internet), it is easier for a Muslim to harmonize his/her own Islamic culture. Thus, it is possible to state that the ‘integration mode’ that Berry proposed is effective and useful when it comes to explaining how Muslims enter a new culture.

There are two major distinctions between Muslims and Westerners: religion and culture. However, these do not have to represent barriers to acculturation. There are many cases where immigrants completely adapt to the host country’s culture and instances where the host culture is totally rejected. [7] posits that an individual’s peer group plays a more important role than one’s parents when it comes to forming the path of secondgeneration immigrants’ acculturation. Through his research, he derived three modes of acculturation: Acculturation; Partial Acculturation; and De-acculturation. ‘Acculturation’ involves completely adopting the host country’s culture and its way of life, to the extent of taking part in activities which Islam forbids. ‘Partial Acculturation’ comprises of those who, in order to conform to society and their parents’ wishes, adapt somewhat to both cultures. ‘De-acculturation’ was said to be total obedience to one’s religion, whilst rejecting the host culture [7]. applied this categorization along a spectrum of age, proposing that secondgeneration Muslims, who are in the mode of ‘Acculturation’ in their youth, latterly evolve to become ‘Partially Acculturated’ as a way of being more settled. Therefore, not only do they hold on to their ‘Westernized’ identity, but they also bring harmony to their lives by adhering to familial norms. Conversely, those Muslim youths who conform to ‘De-acculturation’ hold true to their beliefs and way of life as they get older.

Here we can see that Ali’s ‘Partial Acculturation’ and Berry’s mode of ‘Integration’ share many similarities. It can be construed from these findings that there is no one defining process in which Muslim immigrants are acculturated and that being Muslim does not completely, and sometimes not at all, hinder one in adapting to a Western culture. It is important to recognize that, as research has shown, the process of forming identity in this context is interchangeable and contextualized. Identities are shaped based on the environment and context in which an individual lives and according to social norms that exist. Furthermore, identities have other significances and roles such as resistance, rebellion, and protection of one’s ethnicity, and can often result in an individual taking on a hyphenated identity, as will be discussed later [8,9].

Research regarding Muslim integration in the UK has borne mixed findings. Whilst some results indicate that much resistance exists, other research shows that there is an active desire to become integrated. However, upon reviewing this research, these varying results may be caused by a differentiation in method and sample. The research which demonstrates that Muslims are actively seeking to integrate is based on first-hand accounts of Muslims themselves whereas the data from official sources and reports has been created by non-Muslims. Examples of both types of research will now be examined. Taking the initial form of research mentioned above, in the cases where Muslims are asked about their own integration, it is apparent that they do not reject the idea but the way in which they view it can be complicated. From the viewpoint of Muslim Arabs in the UK, Nagel and [10] studied the process involved in integration and segregation. They concluded that this group considers interaction with the host society as important but instead of viewing integration as ‘social cohesion’, they think of it more as a discourse between diversified but equal communities who inhabit the same geographical space [11]. This implies that Muslims interpret the concept of integration differently compared to other residents in the UK. Similarly, [11] found that Muslims in Britain identified with Britishness and what it means to be British just as much as other groups. Additionally, discrimination played a part in forming their identities above all other socio-economic factors also stated that despite Muslims mainly residing in segregated neighborhoods, they feel part of the British community overall due to the materialization of integrated networks.

Adversely, research using national statistics data or from non-Muslim subjects, produces different results. Research was carried out by [12] to uncover patterns regarding the integration of Muslim immigrants into British society. Their results showed that regardless of the amount of time spent in the UK, Muslim immigrants still firmly held on to their religious identity. They were also viewed as being more impervious to cultural integration due to their unwillingness to use the English language. It was concluded by [12] that the system within which Muslims integrate in the UK is in direct contrast to the general concept of the UK’s policy on immigration, i.e. economic attainment and geographical homogenization. Thus, by retaining their fervent religious identity, Muslim immigrants display more resistance to cultural integration. What’s more, this pattern of integration was found to be more common amongst the bettereducated and more affluent Muslim immigrants who lived in more close-knit and well-to-do areas [12] This ‘alienation’ of Muslim immigrants in the UK was put down to the weaknesses of the government’s integration policy [13]. [14] contradict this viewpoint by suggesting that failure to adapt well was due to perceived discrimination. However, through a mix of ethnic and national identity, Muslims were able to successfully adapt to the way of life in the host society. Research regarding the integration of Muslims into Western society, especially those living in the UK, has produced mixed results. There is an obvious need for more research to be done, specifically regarding how Muslims in Scotland integrate into society as the amount of research to draw upon in this area is limited. To further understand the mindset of Muslim immigrants, we will now look at the concept of identity and how it is formed, which is closely linked to integration.

Formulation of Muslim Identity

The configuration and reconfiguration of ethnic, religious and national identity is fundamental to the lives of immigrants. Much research has therefore been done regarding this topic in order to achieve a better understanding of how immigrants form their identities throughout the world. Researchers have concentrated on varying patterns and features of religious identity formation among young Muslim immigrants. For instance, a study by Chaudhury & Miller [15]. looked at how young American Muslims of Bangladeshi descent developed religious identity and put forward two categories for this. The first group was called ‘internal seekers. These are young Muslims who look within their faith to find answers. The second was called ‘external seekers. This group looked to other faiths outside of Islam to get answers. Other contributory factors to their formation of identity were also uncovered in this study. Things such as praying five times per day; effective communication with family and peers; active participation in Muslim associations; and concentrating on present moment religious practices to ensure future rewards in life were factors. Likewise, Peek [16] proposed a three-phase formation of religious identity among young Muslim immigrants. He stated that religion as an identity was ascribed, chosen, and declared. The first phase tells us that Muslim children are primarily ascribed their religious identity. Then, after religious exploration, the child intentionally chooses to follow that religion. Finally, declared religious identity is adjudged to an identity formed on the back of the 9/11 attacks in New York in order to protect and maintain Muslim identity in response to discrimination [16]. ‘religion as a chosen identity’ phase appears like Chaudhury and Miller’s [15] ‘internal’ and ‘external’ processes of seeking religion. Consideration must be given also to the contributory role that mosques play in influencing identity development and how, through teaching the Al-Qu’ran and through Islamic principles, social control is managed.

It can also be a very stressful process for first- and secondgeneration Muslim immigrants, in general, when it comes to developing identity. According to a study by Ostberg [17] young Norwegian Muslims of Pakistani backgrounds must engage in identity negotiation all through childhood and into adulthood. He goes on to explain that these negotiations involve questions such as: ‘Who am I? What significance does be a Muslim and being a Norwegian citizen have? Which boundaries are negotiable, and which are unimaginable to traverse?’ These negotiations are taking place amongst parents and children, between siblings, and inside peer groups [17]. Studies which look at Muslim women have been carried out. These women face challenges related to the re-creation of familiarity, ethnicity, and their work lives [18]. It was suggested by Marranci (2007) [19]. when looking at the case of identity amongst Muslim women in Northern Ireland, that emotion plays a key role in identity development. There was an overall feeling of insecurity among these women and, undeterred by their authoritarian male counterparts, a desire to form their own identity as Muslim women. By doing so, they were aided in conquering sentiments of isolation, seclusion, and displacement [19]. Further afield, [21]. looked at the identity of Muslim immigrant women in Australia and their perceptions of community. What they discovered was that religion played a key part and was at the core of developing a sense of community and in settling into life there. Other factors which affected how a sense of identity and community were formed and maintained were racism and ostracization; social support networks; and the role of gender. The study also indicated that the role of religion was a facilitator rather than a hindrance in integrating this group into society [21].

Research in the UK indicates that there is a mixed trend regarding identity development. There is no definitive evidence as to which identity is favored by Muslims who live here. For example, the feeling of national and religious identity amongst Muslims in Scotland was analyzed by Hopkins [22]. His study focused on two core themes: being Muslim and being Scottish [22]. posits that despite ties to ethnic culture existing, Muslims’ Scottish identity was preferred to their British or ethnic one [22]. claims that the main reasons for this were that they were born and bred in Scotland; they had been educated here; and they spoke with a Scottish accent. [22]. also states that their Scottishness has an association with sports football. From the mid-nineteenth century onwards, Scotland’s national sport has been ‘fitbaw’ (football) and this is where Scottish nationalism is heightened, especially in matches between Scotland and the ‘auld enemy’- England. These feelings of national identity correspond to the findings of the Labor Force Survey (2003- 04). The evidence shows that around 65% of Muslims in Britain described themselves as English, Welsh, Scottish, or British as opposed to their ethnic identity. Also, more than 90% of Britishborn Muslims described their national identity as British (Office of National Statistics, 2004) [20].

The effect of culture and community involvement on young Pakistanis was examined by Din [23]. It was found that secondgeneration Pakistanis preferred a British identity to a religious or ethnic one. Hyphenated identities such as British-Asian, Scottish-Asian, Pakistani-Scot were found to be more popular. Interestingly, young Muslims considered their parents to be ‘less British’ and ‘more Pakistani’. The young people in Din’s (2006) study felt more attached and better adjusted to the British way of life due to their language skills, length of stay, and their jobs. The results of this study do not stand alone. Previous research [23,24] has shown that very few young Muslims describe their identities primarily as ‘Asian’, with most considering themselves to be ‘British’. This is reflected in how they look, the way they socialize, and how they entertain themselves [25] Similarly, [26]. tells us that many young Muslims in Britain are searching for answers about whether they belong in an ‘Islamic’ community or in a British one. He goes on to note that they are redeveloping their understanding of belonging regarding nationality, ethnicity, and religion, and are negotiating new methods of being Muslim in Britain. On the other hand, Jacobson [27]. argues that young British-Pakistani-Muslims regard religious identity as being more important than an ethnic one due to the universalism of ethnicity and religion. Furthermore, he stated that Muslims consider nationalism to be taboo according to Islam so expressed their loyalty and sense of belonging to a Muslim Ummah (Global Muslim Community). The difference between what is right and what is wrong, according to Jacobson [27] is clearly stated within Islam. Muslims perceive this to be less defined if one identifies with ethnicity and thus, they choose to identify with their religion instead [27]. The concept of Muslim Ummah also displays a Muslim’s necessity to be part of a global brotherhood in response to their ‘alien’ status and from living in a country where they are a minority. This was demonstrated by [28]. who noted in their study regarding Scottish Muslims that when presented with the option they opted for hyphenated identities? However, when they were only allowed to choose one option, they chose their Muslim identity over all others. This coincides with what was discussed in the previous section regarding integration, i.e. that there is at present no conclusive results in the research which indicates which identity Muslims have adopted as their preferred one(s)

Irish Identity and Celtic FC in Scotland

Hoberman [29] notes that “sport has no intrinsic value structure, but [it] is a ready and flexible vehicle through which ideological associations can be reinforced” while, for his part, Hobsbawm [30] declares that “the identity of a nation of millions seems more real as a team of eleven named people”. We can take these observations to mean that sport can incorporate and convey identity and community – socially, politically, ethnically, culturally, religiously, nationally, and even economically in a form unlike almost any other social manifestation. Celtic FC, a professional football team from Glasgow, Scotland, is a demonstration of these assertions, encompassing community involvement and supporter associations affiliated with Scottish football. As Robert Kelly (ex-Chairman of Celtic FC) once said, “[t]his Celtic Football Club is much more than a football club, to a lot of people it’s a way of life.”

Founded by Irish-Catholic immigrants in [33]. the role that Celtic FC plays and has played in forming cultural and ethical identity of their supporters is important on many levels. As Devine (2000)[33] posits, until very recently, the Irish community in Scotland has not “been effectively integrated into the wider study of Scottish historical development”. However, that which has been neglected in research has received attention through the Scottish media. Sport can replicate and reflect ethnic and national uniqueness as well as mirror social tensions and divisions. While most of the discourse is about Scotland as ‘one people’, on a range of cultural and identity designators, “the case of Celtic demonstrates how that dominance is manufactured as a social reality and norm by discounting, marginalizing, demeaning, or corrupting minority distinctiveness and difference” [32].

For second- and third-generation Irish communities for whom being white, having a local accent, and supposed cultural affinities have customarily been taken to reflect a population easily assimilated to the ‘white’ Scottish majority, the unwavering Irish identity of the fans of Celtic FC and the club itself contests these assumptions Modood (1996) [35]. Through supporting and following Celtic, the reproduction, preservation, and expression of Irishness in Scottish society is realized, and, therefore, it is significant for comprehending the various diverse means by which identity is formed in the multi-ethnic Britain of today. This takes place within the context of continuing debates regarding multiculturalism in Britain, in general; and, within lively and occasionally rancorous debates about the controversial topic of sectarianism within Scottish society [31]. A great deal of the research conducted in this area came from the Irish 2 Project which was undertaken in the early-2000s. This sociological enquiry considered the problems of identity among those born in Britain but with at least one parent or grandparent born in Ireland. On top of this research, a web-based analysis over a period since 1990 of all the major newspapers in Scotland demonstrates that the discourses and narratives presented in this media problematize Irish pride and the Irish identity of Celtic FC and its fans. Hundreds of direct and indirect remarks about Celtic as well as many, many more in other media channels makes it evidently clear that a certain type of commentary is foremost, all-encompassing, and perpetual, weaving its way through editorials, newspaper columns, magazine articles, radio debates, and TV interviews [32].

To sum up, discourses that are profoundly disparaging of Celtic FC’s Irishness are embedded and ingrained within Scottish society. According to Conner [33] while the origins of socially constructed identity links are important to comprehend, “these identities are being performed, maintained, and renegotiated on an everyday basis, (and) provide a more complete understanding of collective identities in today’s globalized world.” He goes on to conclude that the reasons and motivations for people all over the world to support a football team from Scotland are not as simple as one might first imagine and are repeatedly reformed and realigned across the spectrum of space and time [35].

    Conclusion

From the review of the literature, identity is a complex subject and is formed differently according to age, sex, generation, feelings of togetherness or otherness, religion, amongst other things. Muslims in Britain are still not fully integrated into British society and probably never will be due to their strong cultural traditions and religious beliefs. Similarly, the Irish population of Scotland still does not feel Scottish enough to renounce its Irish identity, which may only be evident through its members’ grandparents’ or even great-grandparents’ birthplaces. Since both groups possess a concept of being outsiders and are minorities, they share a common bond. Research in the form of interviews and questionnaires would need to be performed in order to gain a better insight into whether these similarities are the defining factors as to why Scottish Muslims choose to support Celtic, or if there are other drivers such as peer-group pressure, geography (i.e. closeness to Celtic’s home stadium, Parkhead), search for glory, or even down to the simple explanation that one of our Pakistani-Scot friends told us when he said: “The Celtic flag is green and white. The Pakistan flag is also green and white. So, I support Celtic.”

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[journalofsportsmedicine]

Physical Development of 11-12-Year-Old Girls Involved in Swimming and Diving Physical-Physical Development of 11-12-Year-Old Girls Involved in Swimming and Diving Physical Introduction The study of morphological and functional indicators of athletes of various specializations has long been one of the important areas of sports science. Many well-known scientists studied the physique of athletes [1,2]. The study of morphological and functional indicators helps to solve the main problems of modern sports, namely: - selection and determination of sports suitability in various sports [2-5] determination of growth rates and short-term prospects for individual age periods [6] orientation of residents of various regions in the choice of sports specialization, etc. In recent years, a lot of material has been accumulated on the dynamics of the physical and biological development of athletes and the relationship with the growth rate of sports achievements has been shown [6,7]. However, a comparison of physique and physical development of girls involved in swimming and diving was not previously conducted. The goal was to determine the physique and physical development rate of girls, swimmers and jumpers in the water for 11-12 years. Research Objectives i. To study the features of the physical development of girls 11-12 years old, engaged in swimming and diving. ii. Compare the body mass composition of girls 11-12 years old, engaged in swimming and diving. iii. To identify the main differences in the physique of girls 11-12 years old, engaged in swimming and diving. Research methods and organization The study of the physical development and physique of girls aged 11-12 years was carried out by the method of anthropometry. The results are processed by methods of mathematical statistics. The average indices were calculated - X, standard deviations - σ, and the significance of differences in the average indices by Student t-test. The study was conducted based on the Moscow School of Education in 2016 - 17 years. The study involved girls of 11-12 years old, engaged in swimming and diving in the amount of 18 people in each age group. The Results of the study A comparative analysis of the main indicators of physical development (Table 1) showed that the swimmers are 11-12 years old in length over their peers in the water. At 11 years of age, the difference is 6.4 cm, and already at 12 years of age - 17.0 cm. A comparison of the annual increments in body length from 11- 12 years allowed to establish higher values for representatives of sports swimming (13.8cm), compared with divers in water (3.3cm) (Table 1). Comparison of body mass indicators of girls 11-12 years old, engaged in swimming and diving, shows that at 11 years of age, swimmers reliably surpass jumpers in water by 3.8kg, and at 12 years old the difference is more significant and equal to 13.9kg Accordingly, the annual increments also change, which are 11.6kg for swimmers and only 1.5kg for jumpers in the water. In terms of girth of the chest, swimmers also surpass jumpers in the water. So, at 11 years old the difference is 4.2cm, and at 12 years old 12.2cm. These differences are statistically significant and are due to the specifics of the sport. For swimmers, the size of the chest affects the vital capacity indicator (VC), which is closely related to the athletic performance in swimming. The annual growth from 11-12 years for young swimmers is 11.6cm, and for jumpers in the water only 1.5cm. According to Brock’s index, swimmers also outperform jumpers in the water. So, at 11 years old, this indicator for girls-swimmers is 10.3, while for jumpers in the water 7.8. By the age of 12, the Broca index increases in subjects of both specializations and is 12.6 for swimming and 9.5 for representatives of diving (Table 1). This reflects the specifics of swimming as a sport: the higher the Brock index, the better the hydrodynamic qualities of the swimmer. For divers in the water, this indicator is not significant. Higher annual growths of the studied indicators of physical development may indicate an earlier entry of swimmers into the puberty period of development. Assessment of body proportions was carried out by calculating the ratio of body weight, chest circumference, shoulder width, arm and leg length to body length in %. According to the proportions of the body of the girl, the swimmers noticeably differ from the jumpers into the water. So, the ratio of weight to body length in girls-swimmers increases from 11-12 years more significantly than in jumpers in the water. Also, high growths are observed in swimmers according to indicators characterizing the ratio of chest circumference to body length. The ratio of shoulder width to body length in 11-year-old swimmers is significantly higher than that of jumpers in the water. However, by age 12, the differences become statistically unreliable. A study of the body proportions of girls aged 11-12 years suggests that swimmers have longer limbs compared to divers in the water. The ratio of arm length to body length at the age of 11 years is 45.5% for them, and for jumpers in the water - 43.3%. At 12 years old, respectively, 45.1 & 43.8%. The same trend persists in relation to leg length to body length (Table 2). An analysis of the body mass components of the studied groups showed that water jumpers are superior to swimmers in muscle tissue already at the age of 12, although at 11 years old, these indicators were lower. However, the differences between them are not significant. A comparison of bone mass also indicates a heavier skeleton of jumpers in the water. At the same time, the differences in swimmers and jumpers in water in terms of bone mass are 3.1 at 11 years old, and at 3.3% at 12 years, and the significance of the differences reaches significant values. The same is confirmed by the data of active body weight, which is significantly higher among jumpers in the water in the studied groups (Table 3). As for the fat component, in swimmers it is more pronounced than among jumpers in the water. So, at 11 years old the difference is 12.1%, at 12 years old - 12.6%. This is due to the need for swimmers to stay in the water for a long-time during training, stimulates the body to form protection against hypothermia, and increases body buoyancy. Conclusion Thus, the study allowed us to identify differences in the physical development of girls-swimmers and jumpers in the water from 11 years of age. These differences, in our opinion, are associated both with sports selection and with the influence of sports specialization. And by the age of 12, the difference in most indicators becomes more pronounced. It was revealed that girls’ swimmers significantly surpass their peers in the water in terms of length and body weight, chest circumference, and Brock’s index. Characteristic for swimmers is a more pronounced increase in the annual growth of the studied indicators from 11-12 years, which is probably due to their earlier entry into puberty. This is confirmed by the established differences in the proportions of the body of swimmers and jumpers into the water. The body mass composition of the studied groups of athletes characterizes the divers in the water as athletically folded, as evidenced by higher rates of active body weight (bone + muscle component) compared to swimmers, and swimmers surpass them in fat mass. The revealed differences between girls specializing in swimming and diving indicate the presence of structural features of the body of athletes, which should be considered in the process of sports selection. For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com For more articles in Journal of Physical Fitness, Medicine & Treatment in Sports please click on: https://juniperpublishers.com/jpfmts/index.php For more Open Access Journals please click on: https://juniperpublishers.com

[journalofsportsmedicine]

Modern Innovative in The Pharmacy and Medicine for Patients in the Republic of Kazakhstan-Juniper Publishers

Introduction

The choice of priorities in the scientific and technical sphere has a value that goes beyond the perspectives of its own development [1]. The use of a systematic approach in forming the innovation policy in many developed countries of the world is of high priority. The relevance of the study is that by the end of the XX century it became obvious that the level of the development of the scientific and technical sphere science, education, high-tech industries, world technology markets - defines the boundaries between the rich and poor countries, creates the basis for dynamic economic growth and becomes the most important factor in the formation of power centers.

    Objective

i. -To analyze the possibilities of domestic pharmaceutical manufacturers in the production of medicines for treating patients with the socially significant diseases in the Republic of Kazakhstan

ii. -To analyze the update innovative inventions in the field of creating new medicines for significant diseases (mental diseases, tuberculosis, HIV infection and AIDS, diabetes mellitus and diabetes insipidus, oncological diseases, bronchial asthma, etc.)

iii. -To estimate the prospects in Kazakhstan’s own pharmaceutical industry for manufacturing the medicines for the treatment of this category of patients.

The level of innovative activity of update pharmaceutical enterprises in the Republic of Kazakhstan was estimated according to our specially developed questionnaire (consisting of 33 questions), which evaluated the ability of enterprises to manufacture medicines for the treatment of patients with the socially significant diseases, a content- analysis of documents regulating the innovative processes in the structure of the modern economy of Kazakhstan was conducted.

    Method

Content -analysis

    Results and discussion

Even an efficiently functioning market cannot compensate the inequalities in the amount of pharmaceutical care getting by different categories of patients. The concentration of the global economy makes companies to compete at ever higher levels of technology and at the same time stimulates the processes of specialization and localization of innovations. The efficacy of realizing the reforms of the pharmaceutical service is determined not only by the market laws, the regulatory and legislative base, but also by the scientific and methodological basis developed in accordance with the socially focused economic policy of the state. In Kazakhstan’s pharmaceutical practice, the new structures were formed rather spontaneously, being late and mainly in a chaotic way. They are poorly focused towards social interests; they do not have a stable legal base. The market mechanism is not able to meet the social requirements of accessibility, universality and social justice for medicinal assistance. The strategy of industrial-innovative development of Kazakhstan for 2015–2020, approved by the decree of the President of the Republic of Kazakhstan, and the Program for the Formation and Development of the National Innovation System until 2020, approved in April, 2015 by the Government of the Republic of Kazakhstan, were the main prerequisites on the implementation of timely diversification of the Kazakh economy.

Thus, the Republic of Kazakhstan took a course to create a competitive innovative economy. In the “Strategy of industrialinnovative development of Kazakhstan for 2015-2020yy.” it was noted that the state of health of the people determines the socio-economic, cultural and industrial development of any country. The public health sphere is one of the main and priority in the country in terms of sustainable and stable growth of the health state of population. The main task of public health in the framework of the Strategy is the creation and development of its own scientific and innovative potential, for which it is necessary to create conditions for the dynamic improvement of the health care system, considering the domestic and international experience. As noted, the state of health of the population of Kazakhstan, the sanitary-epidemiological situation and the development of the healthcare branch in the last decade were characterized by the both positive and negative indicators. In recent years, it has been possible to stabilize the main medical and demographic indicators as birth rate, mortality and average life expectancy; the incidence of infections caused by several pathogens has been reduced. Several reforms were undertaken in the healthcare sphere, some of which were successfully implemented, while others did not reach their logical conclusion. The latter include the creation of a regulatory legal base of the sphere, a significant increase in the financing of health care and medicinal supply [2,3]. A characteristic feature of the update period in the life of Kazakh society is the contradiction between the increase in the needs of patients with the socially significant diseases in medicines and the reduction in paying capacity to satisfy them.

Solving the problem of providing the population with medicines at the state level remains an important task, because the pharmaceutical care is one of the main components of the therapeutic process and preventive measures. The use of remedies is the most common and one of the most effective types of medical technology. Remedies are used for prophylaxis, treatment, reduction in the number of hospitalizations and length of staying in a hospital. Medicines are the unusual products. People do not choose the medicine themselves for taking, and it is not easy for them to decide how to replace one medicine with another. The level of expenditure on medicines to a greater or less extent remains outside the control of people, which is caused either by the nature of the disease or by the state of health. The cost of medicines might be high and often exceed the possibilities of people associated with payment, despite their undoubted and obviously significant role. Therefore, for all citizens it is important to have access to the necessary medicinal preparations. The market economy has put the pharmaceutical service of the Republic of Kazakhstan under the conditions of the need in reforming. The basis of the reforms in pharmacy was the search for a balance between the old, command and market economy with its needs in the field of providing the population with medicinal care. The model designed for operation under the conditions of a planned distribution system no longer works. Expectation of the omnipotence of the pharmaceutical market and the elimination of the state from the sphere of regulation of pharmaceutical care contradict the world experience of the postwar reforming in France, Germany, Japan and other countries and do not correspond to the real conditions of the economy.

Ways of transformation of the pharmaceutical service in the Republic of Kazakhstan cannot be considered in isolation from the changes occurring in the health systems of most countries at present. One of the main and responsible tasks of social policy throughout the world in the 1990s was the reduction of inequalities and injustices in social and health issues. Ensuring equity is one of the main issues of the European strategy of the world community, implemented by the World Health Organization (WHO) to achieve health for all people. In January 1998, at the 101st session of the WHO Executive Board, a decision was made concerning WHO’s activities in the field of medicines provision. It expresses concern about the current situation in the world, in which 1/3 of the world’s population does not have the guaranteed access to the most necessary medicines [4].

Four interconnected trends are observed in all parts of Europe: the changing role of the state and the pharmaceutical market; the decentralization of powers to the regional and / or municipal level of government; the engagement of the private sector; the change in the possibilities of citizens to exercise their rights to complete the reliable medicinal assistance. The main opportunity to ensure the equitable access to essential medicines for patients with the socially significant diseases is to increase the innovative activity of the domestic pharmaceutical enterprises. For forming the National Innovation System in the Republic of Kazakhstan, 4 main subsystems have been identified, where the state can effectively implement the innovation policy through the direct or indirect participation. As noted in the programs of the Government, in Kazakhstan a multi-level innovation infrastructure should be created, which is defined as a complex of interrelated manufacturing, consulting, educational and information structures. It should ensure the conditions for the implementation of innovation activities [2,5].

The experience of countries, including Finland, Singapore, South Korea, shows that government intervention in the innovation processes is necessary in order to create incentives for innovation that don’t generate sufficiently. Today, Kazakhstan has established the state development institutes, including the National Innovation Fund. Joint Stock Company “National Innovation Fund” was established by the decree of the Government of the Republic of Kazakhstan No. 502 of 30.05.03 “On the establishment of the joint stock company” National Innovation Fund “with 100% state participation in the authorized share capital. The authorized share capital of the fund is 150 million dollars. The purpose of the fund is to increase the overall innovative activity in the country, including the promotion to the development of high-tech and knowledgeintensive industries. At present, innovation is the key to survival; therefore, more and more pharmaceutical companies are considering them as components of success that can speed up the opening of the new commercial designs in the market. Application the external sources has become a powerful trend in the industry. As our analysis showed, despite there are few innovations in the pharmaceutical sector of the Republic of Kazakhstan, today we have the original domestic designs.

As noted by J.M. Arystanov and S.M. Adekenov, in case of successful use of innovations in Kazakhstana the second breakthrough in industry will happen. However, this time it happens not because of trade in minerals, but due to hightech industrial production [3]. According to Kazakh scientists’ opinions, today the scientific and industrial components of the pharmaceutical industry of the republic have reached such a level of development, when it is possible and necessary to talk about a systematic reduction of the country’s dependence on the import of medicines [2,3]. It is confirmed by the development and readiness for the industrial production of more than 20 original phytopreparations (arglabin, solkosollin, bialm, topolin, glycardine, etc.) by the Kazakhstan Institute of Phytochemistry.

Kazakhstan chemists and pharmacologists have got the great scientific potential, which allows them to create unique products that are competitive in quality and efficiency in both local and foreign markets [3, 5]. Thus, in Kazakhstan, the Government supported the production of the famous anti-tumor arglabin preparation, invented by Karaganda pharmacists of the Institute of Phytochemistry. Currently, this drug is included in the list of vitally essential medicinal preparations. Based on the Institute of Phytochemistry in Karaganda, the construction of a pharmaceutical plant with a production capacity of 2 million ampoules, 150 million tablets and 2 million packages of soft forms (ointment, suppositories) of arglabin per year [3] has started.

To date, the production of arglabin with a capacity of 2 million ampoules per year has already been launched. Studies by Russian scientists have confirmed that the treatment of all types of cancer using this drug increases the efficacy of treatment by up to 80%. At present, in addition to Kazakhstan, this product has been patented in 11 countries of the world, including the USA, Germany, Japan, France and China. Russian researchers have found that arglabin also provides antiviral effect, so the drug is also effective in the treatment of HIV infection patients. According to estimates of oncologists the need of Kazakhstan oncological clinics in this preparation accounts 3.7 million ampoules per year, and with the growth in the number of cancer patients in the country this figure increases [3]. In the Republic of Kazakhstan there are many opportunities for the industrial production of complex drugs for the treatment of patients with tuberculosis, viral hepatitis, oncological diseases, diabetes, circulatory system diseases [2,3]. The formation and development of an effective innovation system in the country is becoming an effective leverage for ensuring the diversification of the economy based on the application of knowledge and the introduction of innovations, and it has a huge impact on ensuring sustainable economic growth. On 24.07.11, the Government of the Republic of Kazakhstan approved the Republican Science and Technology program “Development and implementation in production of original Phyto preparations for the development of pharmaceutical industry in the Republic of Kazakhstan “ for 2015–2020.

Thus, in Kazakhstan, the development of medicinal preparations from herbal raw material was recognized as the most perspective scientific direction in the development of original medicines. In Republic of Kazakhstan the developers and manufacturers of original Phyto preparations with different pharmacological effects are the Institute of Phytochemistry of the Ministry of Education and Science of the Republic of Kazakhstan (Karaganda), Chimpharm JSC(Shymkent), The Production Cooperative “ Kyzylmay” (Almaty) and a number of other enterprises. All of them are the executors of this program. 40 phytopreparations which can be classified into three groups according to degree of reliability for manufacturing were planned by the executors of this governmental program for the period of 2015-2020 yy.

a) arglabin, salsokollin, bialmas, topolin, produced by the experienced pharmaceutical manufacturing by the Institute of Phytochemistry;

b) glycardine preparation, recommended for the treatment patients with chronic heart failure, was developed by the Institute of Chemical Sciences together with JSC “Chimpharm”.

c) asutigene ointment based on camel thorn was developed in the Al-Farabi Kazakh National Universityand its production was established at JSC “Chimpharm”.

d) The second group includes phytopreparations that have undergone separate stages of preclinical and clinical trials. For preparing the program it is necessary to complete all the necessary regulatory documents.

This group includes:

a) wound healing vitin preparation (recommended also in the treatment for psoriasis);

b) anti-inflammatory limonidin preparation;

c) anti-ulcer preparations as burdock oil and rhubarb oil;

d) immunostimulating, anti-TB ones based on bioslasticin, glyderin and its sodium salt.

As Prof. S.M. Adekenov noted, clinical trials of these drugs should be carried out considering all the requirements of the Ministry of Public Health of the Republic of Kazakhstan. The third group is composed of the new phytopreparations, the development of which has just begun. It is necessary to conduct a complex of preclinical and clinical trials of drugs and to complete all the necessary regulatory documentation.

Among the new phytopreparations being developed there are:

a) anti-diabetic ones based on capers of prickly, stachis, Jerusalem artichoke;

b) wound-healing products from sophora, poplar buds;

c) anti-inflammatory, adaptogenic, hepatoprotective ones from the bark and leaves of birch, etc.

Within the framework of the Republican scientific and technological targeted program “Use of methods of biotechnology and genetic engineering in medicine, agriculture and industry”, in Kazakhstan the biotechnological enterprises developed and organized the production of antibiotic rozeofungin, enzyme preparation imosimazy, probiotik bifidumbactinrin for dysbacteriosis treatment. In the South Kazakhstan State Medical Academy (Shymkent) a new combined preparation based on the root of licorice biaskin was developed. The proposed dosage form in the form of capsules has the following composition: bioslatin, ascorbic acid, starch. This composition includes two active substances - bioslatin and ascorbic acid, which determine hepatoprotective action, with intensive antioxidant activity. Kazakhstan researchers succeeded in obtaining immunoglobulins that are specific protein markers, typical for all tumor cells. On their basis, a preparation of normogen was created. It favorably differs from other oncological immunobiological preparations in that it has significantly fewer side effects, which were confirmed by the preclinical tests.

Rosezeostine preparation - ointment based on hydrophilic polyethylene oxide, containing anti-fungal polyene antibiotic roseophungin was created. The medicine is a highly active antifungal remedy. Based on the South Kazakhstan Pharmaceutical Academy, a preparation of glycyrrazide B6 was developed, which is positioned as a drug of the prolonged form of isoniazid on a dextran matrix, possessing the property of being selectively captured by macrophages, the ability to modulate the functional state of macrophages. This preparation gives a membrane-stabilizing effect, i.e, stabilizes the cell membranes with lysosomes, which contribute to decreasing the severity of the inflammatory process [2,3]. The advantage of this prescription is that it contains three active substances simultaneously, including bioslatilin - the final preparation of licorice root, the original hepatoprotection of plant origin containing Glycyrrhizinic acid.

Annually the scientific employees of the PC “Firm” Kyzylmai “develop and introduce into production 5-7 patented medical and prophylactic medicines on the basis of natural raw materials of herbs, berries and fruits, honey, wax and pollen, such as candles “Kyzylmai-lipofit”, “Kyzylmai with propolis”, “Kyzylmai with sea buckthorn oil”, “Kalefit”, “Metrophit” [2,3]. These preparations have been clinically tested in leading Kazakhstan and Russian medical centers. Their significant anti-inflammatory, antispasmodic, wound-healing and anti-septic action has been proved in the treatment for gynecological, proctological and urological diseases.

A new class of substances has been synthesized at the Institute of Chemical Sciences of the Republic of Kazakhstan - more than 10 compounds with anti-tuberculosis activity against resistant strains of tuberculosis, obtained in ‘in vitro’ studies on cell cultures, several compounds outperform rifampicin 20 times in the anti-tuberculosis activity of rifampicin. At the same time, they are less toxic than rifampicin. These results got positive results by the authoritative scientists of the Central Scientific Research Institute of Tuberculosis of the RAMS [2,3]. As noted in the Government’s programs, the economy of Kazakhstan should be developed through the introduction of domestic and foreign scientific and innovative designs, that implies a radical change in attitudes towards the development of science and innovation, education and training of professional stuff [3,5]. However, in the pharmaceutical industry of Kazakhstan there are also several problems associated with the introduction of new JICs [3,5].

The most important issue is to ensure the quality of domestic drugs, which is associated with the necessity for the development of an update system of standardization and certification. Firstly, it’s necessary to create a state bank of standard samples of biologically active substances that are active components of medicines. The problem of creating a bank of biologically active substances and data on them requires a solution at the governmental level. State certification and accreditation of land plots allocated for the cultivation of medicinal crops, especially endemic and acutely deficient species are required to ensure a stable raw material base of phytochemical production and stable quality of herbal raw materials, as well as rational and efficient organization of certification. Our analysis showed that at present time the Republic of Kazakhstan has its own innovative designs in the pharmaceutical industry. The Government of the Republic of Kazakhstan proclaimed that, as part of the development strategy, the state passes from passive investment to active policy and assumes the role of coordinator of investments for the development of new technologies in the Republic of Kazakhstan. For this purpose, a group of state financial development institutes is being created: the Kazakhstan Investment Fund, the Innovation Fund, the Export Credit and Investment Insurance Corporation. In addition, the Development Bank of Kazakhstan is being strengthened; centers for marketing and analytical research, engineering and technology transfer have been established [7].

In general, development institutes should form a unified system, the sustainable functioning of which will be based on the principles of decentralization, specialization, competition and transparency [2,5,6,8]. The Institute of Phytochemistry was offered to form a cross-cutting scientific and technical program for 2016-2018 on the development and organization of manufacturing the original export-focused Phyto preparations to develop the pharmaceutical cluster of the Republic of Kazakhstan.

    Conclusion

i. Under the new economic conditions, the government of the Republic of Kazakhstan pays much attention to the innovative development of the economy, including the pharmaceutical healthcare sector.

ii. At present, the Republic of Kazakhstan has its own promising innovative medicine designs, which can be widely used in the clinical practice for the treatment of patients with many socially significant diseases.

iii. Nowadays the main innovators, which are forming an innovative development in the pharmaceutical industry of Kazakhstan, are the representatives of the Karaganda Institute of Phytochemistry.

iv. Management of medicinal provision of patients with the socially significant diseases under the new socio-economic conditions should be based on the formular system and the “medicinal standards” that are the part of the economic models of medical services.

v. Planning of medicinal provision should be done “from the bottom to up”: from planning in the health care institution to planning at the level of the national department of health care.

vi. To learn the basics of an effective system of compensation for expenses on buying the medicines by patients with the socially significant diseases the studying and summarizing of the experience of medicinal provision systems for citizens in countries with the developed economies are of great interest.

[journalofsportsmedicine]

Juniper Publishers american independence day wishes

[journalofsportsmedicine]

Juniper Publishers american independence day wishes

[journalofsportsmedicine]

Juniper Publishers- JOJ Ophthalmology

Posterior Astigmatism: Improving Refractive Outcomes with Toric IOL Implantation- Juniper Publishers AbstractCataract surgery is not only a rehabilitative surgery, but also a refractive procedure, largely because of the intraocular lens (IOL) improves in latest years. However, recent studies showed a significant residual astigmatism after phacoemulsification with toric IOL implantation. There are several factors that can cause astigmatism refractive errors, such as IOL misalignment, factors related to the incision, incorrect calculation of toric IOL and corneal measurement errors. We believe that overlooking posterior corneal power is one of the most relevant reasons for refractive errors after cataract surgery with toric IOL.     Mini ReviewCataract is one of the leading causes of blindness worldwide, and its extraction is one of the most performed surgical procedures nowadays. The improvement of phacoemulsification techniques contributes for an increasingly less invasive procedure. Advances in IOL (intraocular lens) calculation, as well as the evolution of IOL technology increase patient's expectations for better results and postoperative spectacle independence [1}. Astigmatism is responsible for 13% of refractive errors [2]. Approximately 20 to 30% of patients submitted to cataract surgery had corneal astigmatism of 1.25 diopters (D) or higher, and around 10% of the patients have 2,00D or higher [3]. Recent studies demonstrate that residual astigmatism after toric IOL implantation is frequent [1,4]. Therefore, the correct astigmatism measurement is crucial for better post-operative results and, consequently, the patient's satisfaction. Furthermore, in present days, the 'gold standard’ in IOL power calculation is optical coherence biometry associated with keratometry. However, the capacity of this technique to determine the true corneal power is limited [5] because it assumes a fixed posterior-anterior curvature ratio, to estimate the posterior corneal curvature influence in the total corneal power [2]. Ignoring the posterior corneal power was recently highlighted as an important factor that leads to errors in toric IOL [5,6]. Posterior corneal refractive power is low when compared to the anterior surface, but when we take the astigmatic power into account, the posterior cornea surface can represent more than 20% of the total astigmatism power of the cornea [5].Devices for an accurate measurement of posterior corneal surface have a shorter story when compared to the methods to evaluate the anterior surface. Nevertheless, this data can currently be obtained by several methods such as Scheimplug imaging and optical coherence tomography. This way, total corneal power can be calculated by using ray tracing or Gaussian optics thick-lens formula [2]. Posterior astigmatism has its own clinical importance demonstrated since 1890 by Javal, and recent studies show that posterior astigmatism is usually against the rule and the mean power is around 0.3D (Table 1) [7-10]. When the anterior corneal surface shows with the rule astigmatism, the posterior astigmatism compensates the anterior surface, and consequently reduces the total astigmatism. However, if the anterior surface astigmatism is against the rule, the total astigmatism will increase [9]. Ho et al showed that neglecting posterior astigmatism can cause absolute errors of 0.2±0.16D in astigmatism magnitude and 7.4±10.3 degrees in astigmatism angle [11]. The surgical prognosis related to the reduction of postoperative residual refractive cylinder is influenced by the correct calculation of the total corneal astigmatism and its axis. In conclusion, the efficacy of toric IOL implantation can be enhanced with the measurement of both anterior and posterior astigmatism. For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.comFor more articles in  JOJ Ophthalmology (JOJO) please click on: https://juniperpublishers.com/jojo/index.phpFor more about juniper publishers  please click on: https://www.juniperpublishersgroup.com/

[journalofsportsmedicine]

Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Static and Dynamic Balancing and Gait Training in Shooters Leading to a Better Efficacy-A Prospective Study- Juniper Publishers The ability to walk upright is a defining characteristic of man. Gait is the way walking is performed and can be normal, antalgic, or unsteady [1]. Gait analysis can be assessed by various techniques but is most commonly performed by clinical evaluation incorporating the individual’s history, physical examination, and functional assessment. Gait abnormalities can be more precisely examined using gait laboratories. These laboratories utilize surface EMG activity of muscles, force plates, and kinematic evaluation of the lower limbs. They are highly specialized units that assess various gait abnormalities from individuals with neuromuscular disorders to high-level athletics. A proper clinical evaluation should always precede any gait lab assessment [2]. The determination of abnormal gait requires one to first understand the basic physiology and biomechanics of normal gait [3]. The gait cycle is a time interval or sequence of motion occurring from heel strike to heel strike of the same foot. The gait cycle has been broadly divided into two phases: stance phase and swing phase. These phases can then be further subdivided and discussed in terms of percentage of each within the gait cycle (Figure 1).The stance phase is 60 percent of the gait cycle and can be subdivided into double-leg and single-leg stance. In double-leg stance, both feet are in contact with the ground. At an average walking speed, it represents 10percent of the entire gait cycle, but decreases with increased walking speed and ultimately disappears as one begins to run. At slower walking velocities the double-leg support times are greater. Single-leg stance comprises up to 40 percent of the normal gait cycle [4]. The muscles that are active during the stance phase act to prevent buckling of the support limb. These include the tibialis anterior, the quadriceps, the hamstrings, the hip abductors, the gluteus maximus, and erector spinae. The swing phase is described when the limb is not weight bearing and represents 40 percent of a single gait cycle. It is subdivided into three phases: initial swing(acceleration), mid swing, and terminal swing (deceleration). Acceleration occurs as the foot is lifted from the floor and, during this time, the swing leg is rapidly accelerated forward by hip and knee flexion along with ankle dorsi flexion. Midswing occurs when the accelerating limb is aligned with the stance limb. Terminal swing then occurs as the decelerating leg prepares for contact with the floor and is controlled by the hamstring muscles.Determinants of Gait and Energy ConservationDuring gait, three main events occur in which energy is consumed. This includes controlling forward movement during deceleration toward the end of swing phase, shock absorption at heel strike, and propulsion during push off, when the center of gravity is propelled up and forward. A human’s center of mass (COM) is located just anterior to the second sacral vertebra, midway between both hip joints [5]. The least amount of energy is required when a body moves along a straight line, with the COM deviating neither up nor down, nor side to side. Such a straight line would be possible in normal gait if man’s lower limbs terminated in wheels instead of feet. This obviously is not the case, thus, our COM deviates from the straight line in vertical and lateral sinusoidal displacements. With respect to vertical displacement: the COM goes through rhythmic upward and downward motion as it moves forward. The highest point occurs at midstance, the lowest point occurs at time of double support. The average amount of vertical displacement in the adult male is approximately 5cm. With respect to lateral displacements: As weight is transferred from one leg to the other, there is shift of the pelvis to the weight-bearing side. The oscillation of the COM amounts to side-to-side displacement of approximately 5cm. The lateral limits are reached at midstance. Any pathology that increases the vertical distance between the high and low points, increases the energy cost of ambulation (Figures 2 & 3).     MethodologyA total of 32 shooters were examined clinically and gait analysis was performed on them thereafter with a proper consent for participation in the study at ABHINAV BINDRA TARGETING PERFORMANCE, INDIA from a period of January 2019 to May 2019 (Figure 4). Aims & ObjectivesGait analysis and pelvis muscles assessment for shooters prior to training and comparing the assessment post training, effect of stability and strengthening for improving the efficacy of the shooters.     DiscussionThe analysis of pre and post static balance as well as dynamic balance for both groups and the comparison of the post balance test of two groups were analyzed by using independent sample t-test. First, the GAIT assessment scoring of firm surface before the study among the control group was 5.14±1.069 and increased to 5.39±1.704, which did not show significant at 5% level of significance (ρ>0.05). while the scoring of foam surface before study was 7.79±0.851 and increased to 7.53±1.372, therefore it was not significant at 5% level of significance (ρ>0.05). On the other hand, the scoring of GAIT assessment for firm before the intervention among the experimental group was 5.34±1.269 and after the intervention training program, it reduced to 2.90±1.190 which showed significant improvement with ρ<0.05. The dynamic balance results were reported on left and right stance. The higher the score the better the dynamic balance of the individual.The shooters scores of mean and standard deviation of left stance before the study among the control group before test was 77.36±4.137 and after test score was 74.79±7.156, which the improvement did not show statically significant; whereas in right stance, before test was 76.37±6.785 and after test was 72.58±7.960 after four weeks of study and the improvement did not show statically significant. However, the score for experimental group in left stance was 75.31±5.334 before the intervention and improved to 82.14±5.661 after a month intervention training, and it was significant at 5% level of significance (ρ<0.05). Meanwhile, the scoring of in right stance increased from 77.12±7.015-86.29±5.795 before and after intervention respectively. Thus, this showed that the result of left stance and right stance in SEBT indicated significant improvement (ρ<0.05). Meanwhile, for standing on firm surface, the mean score for the experimental group was 3.20±1.191 and for the control group was 5.79±1.504. The result indicated there was significant difference between the pre training and post training after a month’s study.     ResultThe combination of the two exercises components in current study which were the balance exercises and jump landing training, gait training and static and dynamic balancing on firm and foam surface have drastically improved the ability of shooters to balance and aim accurately [6]. Thus, it is crucial that balance training should continue to be studied and promoted to ensure the improvement in static and dynamic balance and thus reducing the risks of injuries such as knee and ankle injuries and ensure the accuracy of shooters.

[journalofsportsmedicine]

Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Effects of Motor Imagery Techniques in Children with Spastic Cerebral Palsy- Juniper Publishers

Introduction

Cerebral palsy is not an ailment, its impairment. Cerebral palsy is somewhat a clinical explanation and do not identify the nature of illness as the term indicates nothing regarding etiology, pathology or expected recovery time. The brain insults are important for cerebral palsy and can happen at any moment in the beginning of 1st trimester of infancy; so, it is a broad term that covers a lot of etiologies and pathologies and its clinical details are manifold. So, cerebral palsy is a clinical syndrome that presents as a disorder in the development of postures, balance, coordination and movements due to lesion of immature brain occurring in the foetal period or infancy. The appearance of cerebral palsy can be comprehensive, psychological and physical disability or secluded instabilities in gait, perception, development or perception. The result is motor or sensory nerve disorders and the incapability to accomplish many tasks in everyday life and participation restriction. CP causes damage to motor or sensory nerves, functional limitation and impaired performance of daily life activities [1]. Cerebral palsy patients do lack in motor planning and execution of motor task. Motor dysfunction in cerebral palsy is usually associated with disabilities in sensory consolidation and stability, weak muscular contractions, weak or totally absence of motor planning which is the prerequisite of a motor task execution.

Moreover, simultaneous stimulation of prime movers and its associated opponent muscles, absence of particular regulation of movement in organisms, and reduced anaerobic muscle capacity and activity cause impaired functions and tasks restriction. Patients with this neurological disorder usually have worse dynamic and static balance. Overhaul services have commonly been ignored. Generally, exist inside the well-being sector. It is especially because of deficiency of complete guidelines. Cerebral palsy rehabilitation centers are very necessary to combat this deficiency. Even many clinical institutes give proper guidelines and treatments for cerebral palsy but still it is deficient and oldfashioned. Even patients can expire due to the devastating effect of bodily impairment, but it is in very exceptional and intensive cases. New treatments need to be established in response to impairments. So, this study is going to evaluate a unique and rare technique to treat and rehab gross motor manifestations especially of motor planning deficit and balance impairments in cerebral palsy. During the previous decade, the usage of databased interventions in cerebral palsy regimen has moderately increased and researchers have struggled to evolve further productive interventions to raise the standards of living of these individuals and their households.

A latest analysis has investigated that interventions established on motor learning improves functional levels in children with cerebral palsy [2]. Therefore, using Motor Imagery Techniques in CP might be a promising technique to ensure improvement in motor planning deficit. Motor imagery is the cognitive presentation of movement in the absence of any bodily movement. Profuse verification on the beneficial influence of motor imagery implementation on motor presentation and training in sportsperson, fit people, and individuals having neurological problems (e.g., stroke, spinal cord injury, Parkinson’s) has brought out. Imagery refers to the creation or re-creation of any practice in the mind like auditory, visual, olfactory, kinesthetic, organic. Specifically; motor imagery (MI) is the mental representation of movement without any body movement. It is a complex mental operation that is selfgenerated using sensory and perceptual processes, enabling the reactivation of specific motor actions within working memory. Therefore, sensory-perceptual, memory, and motor mechanisms are included in broader definitions of the term.

Motor imagery is the mental imagination of movement without any actual body movement. It is a mental activity by which an individual rehearses, or replicates a given action. It is mostly used in sport training as mental practice of action and also in neurological rehabilitation. Motor imagery is likely to develop more ‘cognitive’ aspects of motor behavior, and may, therefore, be helpful in promoting motor planning in patients with CP [3]. Several evidences show that motor imagery and actions are conveyed by the same brain circuits. For example, functional neuroimaging and transcranial Magnetic Stimulation studies demonstrate that the same brain structures are involved in action and imagining the same action. Functional brain imagines reviews have exhibited that many cortical as well as subcortical regions are triggered through definite motor performance, are equally triggered while imagination or cognitive execution of movements. Current verification shows that the primary motor cortex is associated with motor imagery procedure [4].

During motor imagery, many neural mechanisms are activated characterized by a marked elevation in tendinous reflexes of the limb part imagined moving, and by somatic variations which resembles with the level of mental work. At level of the cortex, precise planning of initiation narrowly looks like to the action executed, is noticed in areas concerned to motor control. This stimulation might oblige as the foundation for the special effects of mental training. A model that is called as, hierarchical model of the organization of action projected the temporary memory storage of a ‘copy’ of the many demonstrative stages. These retentions vanish when an action associated to the denoted goal takes place. By compare, if the act is partial or not performed, the entire system rest stimulated, and the content of the demonstration is experienced. This mechanism would be the foundation for conscious reach to this content during motor imagery and mental training [5].

By functional magnetic resonance imaging (FMRI) techniques, the intensity and latitudinal distribution of functional activation in the left pre and post central gyri, during actual motor performance (MP) and mental representation of selfpaced finger-to-thumb opposition movements of the dominant hand were investigated in fourteen right-handed volunteers [6]. For many patients, it is difficult or sometimes impossible to execute motor tasks, who have damaged central nervous system, even after initial involvement in an dynamic rehabilitation platform. It is lately offered by several investigators that these patients can use mental practice as a healing device to increase their motor functions, but very little experiential work reports this problem openly. This article deliberates the reason for inspecting mental practice for encouraging motor recovery in patients who have neurological syndromes. We first showed evidence that supports the presence of a resemblance between performed and imagined activities by using records from psychophysical, neurophysiologic, and brain imaging studies. Then this additionally describes the recurrence of movements through bodily and mental repetition of a mechanical skill. Lastly, a new model is suggested to focus the key role of motor imagery as a crucial method of mental rehearsal, and also to stimulate further research on this type of training in the restoration of patients with motor deficiencies having cerebral origin [7].

There is evidence to suggest that mental practice of movement can produce normal effects recognized as practicing the actual movements. Imagining hand movements could stimulate restoration and redistribution of brain activity, accompanied by recovery of hand function, thus resulting in a reduced motor impairment. Current evidence for mental practice with motor imagery (MI) in stroke is insufficient due to methodological limitations [8] (Figure 1). Mental practice is the intended preparation of mental tasks, whereas motor imagery practice results in motor improvement through motor imagery rehearsal. These both italicized terms are sometimes used interchangeably. So, we will treat them synonymously. MI is cheapest and easily available. It is necessary for physical therapist to be informed about the use of MI, because of increasing number of reports about its benefits of MI in improving motor performance [9]. Mental Rotation Task / Paradigm is a tool to assess the child’s ability of mental imagery. It is process of imagining an object rotating in three dimensional spaces. Person is asked to decide if these two figures are the same shape but rotated or they are two different shapes [10] (Figure 2).

Methodology

Randomized clinical trial was conducted in department of physical therapy of National Institute of Rehabilitation Medicine, Islamabad, for duration of 6 months. 30 patients with diagnosed with spastic Cerebral Palsy, then 22 participated in this study according to inclusion and exclusion criteria. After selection of patients who fulfilled inclusion criteria, they were arbitrarily divided into two groups by means of simple lottery method. i.e. Control group n=11 and Interventional Group n=11. Baseline assessment was done on 0 week; second Assessment on 4th week Post-intervention assessment was done after 8 weeks. Total duration of study treatment was 12weeks. The experimental group performed motor imagery training as specific intervention, that involves motor imagining of gross movements of lower limb 15 min. embedded in conventional therapy for 30 min. (45 min/day, 3 times/week). And, the control group was given conventional therapy only (30 min./day, 3 times/ week).

The interventional group received Motor Imagery training along with conventional therapy. In MI, a small animated Video clips were designed to display and guide the child through imagery process. Motor Imagery Training involves imagining task with external visual stimulus, given via short video clip i.e.

i. Football playing

ii. Running a race

iii. Balancing on one leg

iv. Keeping balance on a wobble board

v. Jumping from block to block

The control group received Conventional Physical Therapy only including,

a) Therapeutic Ball Exercises

b) Balance Board Training

c) Stretching Exercises

d) Recreational activities.

    Results

The Results of both tools TUF and MFR are significant indicates that Motor Imagery is an effective technique to improve balance and gross motor skills in Spastic Cerebral Palsy whereas tool GMFM results are non-significant indicating that this intervention techniques are not that much effective in case of cerebral palsy.

Overall, the Mean age of all patients was 9.36±3.170. and in control group mean and standard deviation values were 9.36±2.730 and in experimental group 9.36±3.695 were mean and standard deviation values. There were 77.3% male and 22.7% female in the study. In experimental group 72.7% were male and 27.3% female and in control group 81.8% were male and 18.2% female. In general, 31.8% patients were diagnosed with spastic hemiplegic CP (Rt), 22.7% patients with spastic hemiplegic CP (Lt), 27.3% patients with spastic diaplegia while 18.2% patients with Spastic quadriplegia. In experimental group, there were 27.3% of patients were diagnosed with spastic hemiplegia (Rt), 18.2% patients with spastic hemiplegic CP (Lt), 36.4% with spastic diaplegia while 18.2 % were with Spastic quadriplegia. In control group, there were 36.4% of patients were diagnosed with spastic hemiplegia (Rt), 27.3% patients with spastic hemiplegic CP (Lt), 18.2% with spastic diaplegia while 18.2% were with Spastic quadriplegia.

Then, by relating Q-Q PLOT normality of data was checked, to recognize normal distribution of the data Kolmogorov-Smirnov test indicated that data were not normally distributed for Time up and go test (TUG) test and Modified Functional Reach (MFR) at baseline. Nonparametric test that is Mann Whitney U- Test for between group analysis and wilcoxon test were applied on both TUG and MFR test, but for GMFM-IS66 Independent T test was applied for between group analysis and Repeated measure anova for analysis of time interval within each group was applied for. These tests were used to compare Pre and Post Treatment of between Group A and B. As, the data for TUG and MFR was nonnormally distributed at the baseline so Mann Whitney U Test was applied to compare the all three assessment values between control and experimental group (Tables 1-3).

Discussion

All patients with hemiplegia have difficulty with planning motor movements, Effect of motor imagery on hemiplegic cerebral palsy and on Developmental Congenital Disorder and concluded that anticipatory motor planning was improved by this intervention [11]. Results of this study were supported by the study, In 2013 by Bert Steen Bergen et al., on ‘Impaired motor planning and motor imagery in children with unilateral spastic cerebral palsy’ concluded that Motor imagery training may be a valid and useful tool to complement upper limb rehabilitation in young children with CP, supports researcher’s study as Motor imagery techniques were helpful in increasing balance and gross motor function of children with cerebral palsy and showed significant p value <0.005 [2]. According to another study in 2012 by Hwai-young Cho et al; on ‘Effects of motor imagery training on balance and gait abilities in post-stroke patients: a randomized controlled trial’ concluded that if gait training with motor imagery training is used it will recovers the balance and gait of chronic stroke patients more better then gait training alone, that supports researcher’s study as Motor imagery techniques were helpful in increasing balance and gross motor function of children with cerebral palsy and showed significant p value <0.005 [12].

According to another study in 2008 by Ayelet et al; ‘Home- Based Motor Imagery Training for Gait Rehabilitation of People With Chronic Post stroke Hemiparesis’ says that There were noteworthy rises in stride length, cadence, and single-support time of the pretentious lower limb, giving strength to my study as Motor imagery techniques were helpful in increasing balance and gross motor function of children with cerebral palsy and showed significant p value <0.005. According to another study in 2009 by Bert Steenbergen et al; on ‘Motor imagery training in hemiplegic cerebral palsy: a potentially useful therapeutic tool for rehabilitation’ gives that Motor imagery training may be a valuable additional tool for rehabilitation in children with hemiparetic CP giving strength to my study as Motor imagery techniques were helpful in increasing balance and gross motor function of children with cerebral palsy and showed significant p value <0.005 [11]. In 2012, a study by Hwai Young Cho et al., concluded that gait training along with motor imagery training increases the balance and gait capabilities of chronic stroke patients suggestively better than gait training alone thus, giving strength to my study as motor imagery techniques were helpful in growing balance and gross motor function of children up with cerebral palsy and revealed significant p value <0.005.

    Conclusion

The study results concluded that both treatment groups were improved by Physical Therapy. This study suggests that motor imagery techniques combine with conventional combination therapy has significant effects in improvement of gross motor functional skills of children with spastic cerebral palsy, age between 7 and 15 years. There was significant improvement in the balance level whereas, there was little increase in level of gross motor function. So, Motor imagery is an effective technique to improve motor planning and balance among cerebral palsy.

    Acknowledgement

First of all I would like to pay tribute to Almighty ALLAH who helps me in all the even and odd situations during the completion of my research work, without His will I would never be able to do the research project. I would like to express my great appreciation to my research supervisor Dr. Mirza Obaid baig who helped me throughout my research project with his priceless and productive ideas; it was my great pleasure to work with an individual of intellect like him. Then I would like to pay gratitude to my parents without their sincere prayers I would never be able to achieve what I have today. Sincere thanks to all my friends and family members who prayed for me.

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Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Static and Dynamic Balancing and Gait Training in Shooters Leading to a Better Efficacy-A Prospective Study- Juniper Publishers Introduction

The ability to walk upright is a defining characteristic of man. Gait is the way walking is performed and can be normal, antalgic, or unsteady [1]. Gait analysis can be assessed by various techniques but is most commonly performed by clinical evaluation incorporating the individual’s history, physical examination, and functional assessment. Gait abnormalities can be more precisely examined using gait laboratories. These laboratories utilize surface EMG activity of muscles, force plates, and kinematic evaluation of the lower limbs. They are highly specialized units that assess various gait abnormalities from individuals with neuromuscular disorders to high-level athletics. A proper clinical evaluation should always precede any gait lab assessment [2]. The determination of abnormal gait requires one to first understand the basic physiology and biomechanics of normal gait [3]. The gait cycle is a time interval or sequence of motion occurring from heel strike to heel strike of the same foot. The gait cycle has been broadly divided into two phases: stance phase and swing phase. These phases can then be further subdivided and discussed in terms of percentage of each within the gait cycle (Figure 1).

The stance phase is 60 percent of the gait cycle and can be subdivided into double-leg and single-leg stance. In double-leg stance, both feet are in contact with the ground. At an average walking speed, it represents 10percent of the entire gait cycle, but decreases with increased walking speed and ultimately disappears as one begins to run. At slower walking velocities the double-leg support times are greater. Single-leg stance comprises up to 40 percent of the normal gait cycle [4]. The muscles that are active during the stance phase act to prevent buckling of the support limb. These include the tibialis anterior, the quadriceps, the hamstrings, the hip abductors, the gluteus maximus, and erector spinae. The swing phase is described when the limb is not weight bearing and represents 40 percent of a single gait cycle. It is subdivided into three phases: initial swing(acceleration), mid swing, and terminal swing (deceleration). Acceleration occurs as the foot is lifted from the floor and, during this time, the swing leg is rapidly accelerated forward by hip and knee flexion along with ankle dorsi flexion. Midswing occurs when the accelerating limb is aligned with the stance limb. Terminal swing then occurs as the decelerating leg prepares for contact with the floor and is controlled by the hamstring muscles.

Determinants of Gait and Energy Conservation

During gait, three main events occur in which energy is consumed. This includes controlling forward movement during deceleration toward the end of swing phase, shock absorption at heel strike, and propulsion during push off, when the center of gravity is propelled up and forward. A human’s center of mass (COM) is located just anterior to the second sacral vertebra, midway between both hip joints [5]. The least amount of energy is required when a body moves along a straight line, with the COM deviating neither up nor down, nor side to side. Such a straight line would be possible in normal gait if man’s lower limbs terminated in wheels instead of feet. This obviously is not the case, thus, our COM deviates from the straight line in vertical and lateral sinusoidal displacements. With respect to vertical displacement: the COM goes through rhythmic upward and downward motion as it moves forward. The highest point occurs at midstance, the lowest point occurs at time of double support. The average amount of vertical displacement in the adult male is approximately 5cm. With respect to lateral displacements: As weight is transferred from one leg to the other, there is shift of the pelvis to the weight-bearing side. The oscillation of the COM amounts to side-to-side displacement of approximately 5cm. The lateral limits are reached at midstance. Any pathology that increases the vertical distance between the high and low points, increases the energy cost of ambulation (Figures 2 & 3).

    Methodology

A total of 32 shooters were examined clinically and gait analysis was performed on them thereafter with a proper consent for participation in the study at ABHINAV BINDRA TARGETING PERFORMANCE, INDIA from a period of January 2019 to May 2019 (Figure 4).

Aims & Objectives

Gait analysis and pelvis muscles assessment for shooters prior to training and comparing the assessment post training, effect of stability and strengthening for improving the efficacy of the shooters.

    Discussion

The analysis of pre and post static balance as well as dynamic balance for both groups and the comparison of the post balance test of two groups were analyzed by using independent sample t-test. First, the GAIT assessment scoring of firm surface before the study among the control group was 5.14±1.069 and increased to 5.39±1.704, which did not show significant at 5% level of significance (ρ>0.05). while the scoring of foam surface before study was 7.79±0.851 and increased to 7.53±1.372, therefore it was not significant at 5% level of significance (ρ>0.05). On the other hand, the scoring of GAIT assessment for firm before the intervention among the experimental group was 5.34±1.269 and after the intervention training program, it reduced to 2.90±1.190 which showed significant improvement with ρ<0.05. The dynamic balance results were reported on left and right stance. The higher the score the better the dynamic balance of the individual.

The shooters scores of mean and standard deviation of left stance before the study among the control group before test was 77.36±4.137 and after test score was 74.79±7.156, which the improvement did not show statically significant; whereas in right stance, before test was 76.37±6.785 and after test was 72.58±7.960 after four weeks of study and the improvement did not show statically significant. However, the score for experimental group in left stance was 75.31±5.334 before the intervention and improved to 82.14±5.661 after a month intervention training, and it was significant at 5% level of significance (ρ<0.05). Meanwhile, the scoring of in right stance increased from 77.12±7.015-86.29±5.795 before and after intervention respectively. Thus, this showed that the result of left stance and right stance in SEBT indicated significant improvement (ρ<0.05). Meanwhile, for standing on firm surface, the mean score for the experimental group was 3.20±1.191 and for the control group was 5.79±1.504. The result indicated there was significant difference between the pre training and post training after a month’s study.

    Result

The combination of the two exercises components in current study which were the balance exercises and jump landing training, gait training and static and dynamic balancing on firm and foam surface have drastically improved the ability of shooters to balance and aim accurately [6]. Thus, it is crucial that balance training should continue to be studied and promoted to ensure the improvement in static and dynamic balance and thus reducing the risks of injuries such as knee and ankle injuries and ensure the accuracy of shooters.

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Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports Efficacy of Positional Release Therapy versus Integrated Neuromuscular Ischemic Technique in the Treatment of Upper Trapezius Trigger Point-Juniper Publishers Abstract Background and Purpose: To evaluate the efficacy of positional release therapy versus integrated neuromuscular ischemic technique in the treatment of upper trapezius trigger points. Subject: 40students were selected for the study. Method: The 40 selected subjects with trapezius trigger points were randomly divided into 2 groups of 20 patients each. All participants who fulfilled inclusion criteria were selected from Isra Institute of Rehabilitation Sciences. Informed consent was taken from students. In both groups, trigger points were identified by the STAR palpation method, assessment Performa was filled up by the therapist and neck range of motion assessed by INCLINOMETER and neck pain was assessed by NUMERIC PAIN SCALE as base line measurement on the first day (pre-test scores) before starting the treatment. Results: PRT and INIT patients, results showed, among PRT patients NPR before treatment was 4.05±0.76 and after treatment it went down significantly to 2.25±0.79, similarly among INIT patients mean NPR was 4.4±1.1 and after treatment it was 1.4±0.76 and differences were statistically significant with p-value less than 0.05. Conclusion: The present study was done to find out the effectiveness of INIT versus PRT in the treatment of upper trapezius trigger points. This study endorses that trigger points in trapezius can cause neck pain with restriction in cervical range of motion. Both groups were found to be effective in reducing pain and improving cervical range of motion. However, when both groups were compared, there was a significant improvement in INIT group with greater mean than the PRT group. Keywords: Trigger Point; Trapezius; Integrated Neuromuscular Inhibition Technique; Positional Release Abbreviations: PRT: Positional Release technique; SCS: Strain Counter strain; PIR: post-isometric relaxation; INIT: integrated neuromuscular ischemic technique; MET: Muscle Energy Technique Introduction Trapezius fibers like occipital and nuchal passed down but insertion into the clavicle transverse mainly. Fibers from C7 to T1 vertebrae distributed diagonally and insert into the acromion process and spine of the scapula and thoracic fibers inserted into the deltoid tubercle of the scapula. Fibers from C7 to T1 vertebrae and the lower half of ligamentum nuchae were the largest. Drawing the scapula and clavicle backwards are action of these fibers rather or to rotate the clavicle and elevates the scapula around the sternoclavicular joint [1]. Myofascial pain syndrome correlated to activate sockets is a no inflammatory ailment of musculoskeletal origin, allied with native discomfort and muscle rigorousness, described by the existence of hyperirritable palpable nodules in the skeletal muscle fibers, which are termed activate points. Myofascial pain syndrome is incredibly usual with the local population. Chances of acquiring said ailment can be reaching up to 54% in the female locality and 45% in the male locality [2]. Active trigger points produce pain at resting tender on palpation and have referred pain pattern [3-5]. Latent Trps cause weakness and restrict the movement and pain is not spontaneous [5]. There are three portions of trapezius like upper middle and lower trapezius muscle and each portion have two trigger points plus one unusual due to autonomic phenomena. Trigger points of upper trapezius were found most frequently identified in body. Superior trapezius Trps referred ache in post lateral part of the neck, ear, and temple. Sudden trauma, downstairs, falling from height, poor posture, misfit furniture, muscular abuse and longtime immobility are factors due to which trigger points are formed in trapezius muscle [6]. Trigger points can be activated due to numerous factors which include prolonged muscle excess, by the initiation of further Trps like (primary/secondary), infection, emotional issues like (stress/anxiety), trauma, homeostatic imbalance, infections, and smoking [7]. Diagnosis of trigger points depends on examiner’s accuracy, experience, teaching and palpation abilities. There is no consent among clinicians concerning physical outcomes. Clinicians accept stiff, intense swelling identified as an active Myofascial trigger point. There is low sensitivity or specificity of digital examination which consider as Gold Standard [8]. Passive or active stretching of the concerned muscle consequents in a pain increase when trigger points are present. Limited muscle stretch. The pain increases when the affected muscle undergoes an isometric contraction and there is a reduced maximum contractile force. Deep sensitivity and dysaesthesia are commonly found in trigger point referral pain zones. Muscle palpation adjacent to active myofascial trigger points feels tense [9]. Positional Release technique (PRT) is a soft tissue application, correspondingly acknowledged as Strain Counter strain (SCS) is a moderate physical management for muscle pain and spasm which include readjusting muscle tone and increasing circulation [10]. Palpate connecting contradictory muscles to localize central and other Trps. Palpable Trps on a consistent measure (enormously sensitive, exact sensitive, temperately sensitive, no painfulness). Do not strain to disrupt the Trps with firm pressure—first dent the skin (1 kg of force). Grasp the position of comfort until fasciculation declines considerably or ends altogether [11]. In neuromuscular inhibition technique a trigger point is situated by palpation, nearly all frequently with the fingers. A trigger point is a confined area of deep hardening. The skilled practitioner will frequently observe a palpable change as a finger pass above the trigger point. Stress on a trigger point will frequently cause twitching in the muscle that within the trigger point. Finger strain is maintained on top of the trigger point, the trigger point will fabricate a pain which refers to an area exterior the muscle which within it. Area doesn’t have to be adjacent with the muscle contain the trigger point. There might very well be a number of diverse trigger points and their mention areas may well overlie [12]. A study was done to compare the effectiveness of postisometric relaxation (PIR) along with ultrasound and massage versus integrated neuromuscular ischemic technique (INIT) along with ultrasound and massage in the treatment of trigger point pain of the upper trapezius muscle. Results of this study reveal that subjects with trigger points in the upper trapezius muscle had significant reduction in pain, improvement in ROM and reduction in scores of NPNPQ. This study concluded that in the treatment of trigger point pain in the upper trapezius muscle both treatment techniques were highly effective [13]. In the year 2017 a study was done by Dr. Priyanka Devang Rana et al. to compare the effectiveness of Muscle Energy Technique (MET) versus Positional Release Technique (PRT) in terms of subjective improvement in Pain, Range of Motion and Function in computer workers suffering from trapezius muscle spasm and study concluded that. PRT was a lot of statistically and clinically superior for decreasing VAS pain score, NDI score and rising range of motion and MMT. PRT showed earlier pain relief as compared to MET. So, if patient needs prompt pain relief positional release technique is that the best treatment which may be offered by therapist [14]. Methodology The study was experimental (Pre and Post). Setting was Isra Institute of Rehabilitation Sciences Karachi Campus. Both male and female Presence of a taut band in the upper trapezius muscle with an active painful trigger point at its middle, pain is produced upon palpation. Patients complain from neck pain restriction of neck ROM 19 years to 25 years old. The data collection tool was Numeric pain scale Inclinometer was used. The 40 selected subjects with trapezius trigger points were randomly divided into 2 groups of 20 patients each. All participants who fulfilled inclusion criteria were selected from Isra Institute of Rehabilitation Sciences. Informed consent was taken from students. In both groups, trigger points were identified by the STAR palpation method, assessment Performa was filled up by the therapist and neck range of motion assessed by INCLINOMETER and neck pain was assessed by NUMERIC PAIN SCALE as base line measurement on the first day (pre-test scores) before starting the treatment. The patients in group A and group B received the following treatment a) Group A-Positional Release Therapy (PRT). b) Group B-Integrated Neuromuscular Ischemic Technique (INIT). c) Patients with upper trapezius trigger points received 4 weeks treatment of INIT. Protocol The study was divided into 3 phases. i. Phase (A) Pre-treatment assessment: Baseline outcome measure was NRS scale, ROM. ii. Phase (B) Intervention phase: INIT was given for 3 days in a week for 4 weeks. iii. Phase(C) Post- treatment assessment outcome measures were recorded at the end of 4 -weeks [15]. As the primary focus of the INIT approach is to deactivate specific TrPs, the practitioner first identified the TrPs to be treated within the upper trapezius muscle. The subjects were placed in supine to reduce tension in the upper trapezius muscle. Their arm was positioned in slight shoulder abduction with the elbow bent and their hand resting on their stomach. Using a pincer grasp, the practitioner moved throughout the fibers of the upper trapezius and made note of any active TrPs. Once the TrPs were identified treatment began. The therapist again utilized a pincer grasp, placing the thumb and index finger over the active TrP. Slow; increasing levels of pressure were applied until the tissue resistance barrier was identified. Pressure was maintained until a release of the tissue barrier was felt. At that time, pressure was again applied until a new barrier was felt. This process was repeated until tension/tenderness was unable to be identified or 90 s had elapsed, whichever came first. Treatment duration: 3 sessions per week for 4 weeks. All identified TrPs were treated (Figure 1) [16]. [Click here to view Large Figure 1] Application of PRT-Total 20 subjects was given Positional Release technique. The subject was in supine with therapist sitting on the affected side, trigger points were located along the upper fibers of the trapezius. The subject’s head was laterally flexed toward the side of trigger point, then therapist grasps the subject’s forearm and abducts shoulder to approximately 90° and adds slight flexion or extension to fine-tune. The ideal position of comfort achieved was held for a period of 90 seconds and followed by a passive return of the body part to an anatomically neutral position continued for 5minutes (Figure 2). Treatment duration: 3 sessions per week for 4 weeks [17]. Data were stored and analyzed using SPSS, version 16.0 , count and percentages were reported for gender, and number of patients enrolled in each technique, mean and standard deviation were reported for age , duration of pain, cervical range of motions at pre- post treatment, and NRS scores, paired sample t-test was used to compare the mean levels of pre and post treatment and independent sample t-test was used to compare the post mean scores of PRT and INIT patients, p-values less than 0.05 were considered as significant. Pie and Bar chart were also used to give the graphical presentation of mean scores (Figure 3). Table 1 gives the baseline characteristics of studied sample, in the following study total forty sample were enrolled, 80% were female samples, patients equally divided into two treatment groups of PRT and INIT, the mean age of samples was 20.92±3.82 years and the mean pain duration was 1.43±1.15 months. (Table 2) reports the mean and standard deviations of cervical moments among PRT treated patients at pre and post levels, results showed that, right rotation, left rotation, right lateral flexion and left lateral flexion were significantly improved after the treatment with p-values less than 0.01. (Table 3) reports the mean and standard deviations of cervical moments among INIT treated patients at pre and post levels, results showed that, right rotation before treatment was 65.6 degree and after treatment it was 73.4 degree, significantly improved, left rotation before treatment was 65 degree and after treatment it was 73.15 degree, similarly right and left flexion rotation were significantly improved after the INIT treatment with p-values less than 0.01. Figure 4 gives the mean comparison of NRS scores among PRT and INIT patients, results showed, among PRT patients NRS before treatment was 4.05±0.76 and after treatment it went down significantly to 2.25±0.79, similarly among INIT patients mean NRS was 4.4±1.1 and after treatment it was 1.4±0.76 and differences were statistically significant with p-value less than 0.05 Figure 5 gives the post mean comparisons of cervical moments and NRS scores between PRT and INIT techniques results showed that, right rotation significantly get improved among INIT patients, right lateral flexion and left lateral flexion were also significantly improved among INIT patients , however left rotation did not give any significant differences between PRT and INIT techniques, the mean NRS scores was significantly low among INIT patients as compared to PRT patients with p-value less than 0.05. 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Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports Run and Gait Analysis in Junior Badminton Players of South Asia-Juniper Publishers Introduction The intermittent nature of badminton makes it hard to determine exactly what is happening physiologically, because so much is dependent on standard of players, the type of game being played, the duration of the play, coordination, mental acuity and the environmental conditions encountered Mikkelsen [1]. Great athletes make difficult moves look effortless with a combination of skill, strength, and balance and accordingly, train for smooth and fluid movement to help prevent muscle imbalances, mobility restrictions, stability problems, and injuries Cook [2]. It has been previously established that the biomechanical rationale for achieving and maintaining optimal posture is to move efficiently, free of impairment and dysfunction Kritz & Cronin [3]. Human motion analysis is receiving increasing attention from researchers, including athletic performance analysts Aggarwal & Cai [4]. Gait analysis has now advanced to the point where it is used as a routine part of patient management in certain centres Whittle [5]. It is best thought of as a special investigation, which is used together with the history, physical examination and other special investigations to perform a detailed assessment of a patient with a walking disorder Whittle [5]. The first results of a complete marker free methodology for human gait analysis was recorded and after having reconstructed the 3D model of the human, gait parameters were extracted and analysed in order to detect pathologies or abnormalities Desseree-Calais & Legrand [6]. Gait analysis measures the effects of combined causes and compensatory activities of the body Rose [7]. It has been studied previously but is generally done to check gait abnormalities post injury/pain. It was studied in patients with anterior knee pain Callaghan & Baltzopoulos [8]. Plantar pressure distribution during gait in athletes with functional instability of the ankle joint has also been studied Nawata, Nishihara, Hayashi, & Teshima [9]. Gait patterns between ACL reconstructed athletes who pass return-to-sport criteria and those who fail were studied and found to be different Di Stasi, Logerstedt, Gardinier, & Snyder-Mackler [10]. For an athlete, an ideal gait or running pattern is very important. Bilaterally symmetrical joint range of motion is key to ensuring an athlete is moving correctly in his/her sport. One of the reasons for a difference in joint range of motion between the right and left sides of the body is muscle tightness and imbalances around that particular joint restricting and limiting its movement Ranawat [11]. Muscle imbalance occurs when muscles become constantly shortened or lengthened in relation to each other Norris [12]. Few studies have been done on muscle imbalance in sport. The relationship between hip muscle imbalance and occurrence of low back pain in athletes has been studied Nadler [13]. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes has been documented Page [14]. Muscle imbalances of the lower extremities in competitive sports like basketball and volleyball have been analysed Sommer [15]. A preliminary alternative approach in an attempt to assess muscle function in relation to both- performance & injury prevention and muscular recovery after injury has been documented as well Schlumberger [16]. Additionally, strength imbalances in professional soccer players has been discussed as well Croisier, Ganteaume, Binet, Genty, & Ferret [17]. Studies on the co-elation between posture and its importance in sport have also been conducted Hébert-Losier & Rahman [18], Watson & Mac Donncha [19], Padua & Hirth [20], Oddsson & De Luca [21]. A study on the epidemiology of injuries in elite badminton athletes showed that the most common region of pain in the body is the back Yung, Chan, Wong, Cheuk, & Fong [22], Goh, Mokhtar, & R. Mohamad Ali [23]. Studies have shown that most sports injuries are related to flexibility, posture, acceleration, clinical defects, and previous injury Watson [24]. A study was also conducted on the sports injuries in footballers related to defects of posture and body mechanics with the objective being to investigate possible relationships between the incidence of sports injury and the existence of body mechanics defect in players Watson [25]. Studies co-relating injuries to muscular imbalances have been documented such as a relationship between shoulder mobility, rotator muscles’ strength and scapular symmetry, and shoulder injuries and/or pain in elite volleyball athletes Wang & Cochrane [26]. A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities has been conducted Devan, Pescatello, Faghri, & Anderson [27]. The purpose of this study was to identify the modifiable and non-modifiable factors that contribute to abnormalities in the walking and running pattern in badminton players, resulting in an increased risk of injury. Non-modifiable factors include gender, height, age and years of experience. Modifiable factors include body mass index, level, current pains, clicks and catches in the body. Methodology One hundred junior badminton players under the aegis of Badminton Association of India (BAI) were recruited for the study. Informed consent from the players, legal guardians and coaches was taken prior to participation. Approval from the BAI was taken prior to initiation of the study. All players were screened using a combination of a questionnaire and machine analysis. The questionnaire consisted of a self-developed item set with focus on demographics, injury history, treatment history, playing career history and current injury state. The demographic data included age, sex, height, weight, and dominant hand. The injury history included questions regarding injuries in the past, their severity, whether they occurred during competition, training or daily activity, whether it prevented the player from taking part in a competition and/or training and/ or daily activity, and if the pain was more during a particular badminton stroke. The treatment history questioned the form of treatment taken for the injuries, whether it was oral medication, physiotherapy, surgery, or any other. Playing career history included information regarding the age at which the player began playing badminton, whether the player has a dedicated coach and/or trainer, age at which he/she began playing badminton tournaments, and current professional level. Current injury state involved questions regarding any current pain faced by the player, and whether the player has experienced any clicks, cracks or catches in the body in the last 12 months.Run: As seen in Table 3, there is a significant difference in Knee range of motion between those who have current pain and don’t and those who experienced clicks and catches in the past 1 year and those who didn’t. Gait: As seen in Table 3, there is a significant difference in Knee range of motion between those who have current pain and don’t and those who experienced clicks and catches in the past 1 year and those who didn’t. A total of 100 junior South Asian Badminton players underwent the assessment. Out of the 100 players, 59 were male players and 41 were female players. 90 of them were from India, 4 each from Nepal and Sri Lanka, while 2 players were from Maldives. The age group was between 8 and 15 years. Gender, height, age, BMI, experience in years, level at which they play, current pain, and clicks & catches in the past 1 year were the variables. The data is presented in Table 1-4. Table 1 shows difference in trunk range of motion between right and left sides of a body among various groups. Run- There is a significant difference (0.01) between those aged below and above 12 (Graph 1). Gait- There was no significant difference in across all variables. Table 2 highlights the difference in hip range of motion between right and left sides of the body. Run- We observed a significant difference between those who have current pain and don’t (0.03) (Graph 2) and those who experienced clicks and catches in the past 1 year and those who didn’t (0.02) (Graph 3). Gait- There was no significant difference in across all variables. Table 3 highlights the difference in knee range of motion between right and left sides of the body. Run- We observed a significant difference between those who have current pain and don’t (0.04) (Graph 4) and those who experienced clicks and catches in the past 1 year and those who didn’t (0.03) (Graph 5). Gait- There is a significant difference between those who have current pain and don’t (0.001) (Graph 6) and those who experienced clicks and catches in the past 1 year and those who didn’t (0.001) (Graph 7). Table 4 shows the difference in load symmetry between the right and left sides of the body. Run- There is a significant difference in those with a BMI less than and more than 18 (0.03) (Graph 8) and between those who have current pain and don’t (0.01) (Graph 9). Gait- There is a significant difference in between those who have current pain and don’t (0.01) (Graph 10) and those who experienced clicks and catches in the past 1 year and those who didn’t (0.01). [Click here to view Large Figure 8] .  Discussion Badminton requires specific physical conditioning in terms of action controls such as reaction time, foot stepping, and static or dynamic balances, which are essential motor demands in the sport Laffaye, Phomsoupha, & Dor [28]. In addition to moving back and forth on the court, players conduct various movement patterns during the game including twists, jumps, and swings to strike the shuttle-cock Phomsoupha & Laffaye [29]. Having an ideal gat and run pattern can be of utmost importance in a player’s performance. But due to the high physical demands of the game, it is not surprising that badminton players may have abnormalities in their walking or running patterns. The results of our study have highlighted certain factors resulting in walking and running pattern abnormalities, but it also sheds light upon the lack of importance given by players and coaches in including a training and conditioning program in an athlete’s regimen that focuses on improving their muscle tightness or imbalance, which could be the main reason for bilaterally asymmetrical joint range of motion and overall body load. We divided the variables into non-modifiable factors including gender, height, age and years of experience and modifiable factors including body mass index, level, current pains, clicks and catches in the body. Non-Modifiable Factors The factors in question here were gender, height, age and years of experience. There was a significant difference in the trunk range of motion between the right and left side in players below and above the age of 12 while running. The players above the age of 12 scored better and had lesser trunk range of motion asymmetry. This shows that younger players had greater trunk range of motion asymmetry which could be either due to muscle tightness or imbalances which later got corrected (either itself or by training) or as players get older, they develop better neuromuscular control over their trunk flexion and extension while run. Scapular and lumbar load asymmetry has been discussed by the current authors and it could play a role in decreased trunk range of motion Ranawat [11]. There was no significant difference found in hip range of motion while walking or running, however when the same authors tested hip stability and hip musculature in the sitting position, certain differences were found Manan, Digpal, Apoorva, & Manit [30]. There was no significant difference observed between any of the other groups in both, run and gait analysis. Modifiable Factors The factors being considered here were body mass index, level of play, current pains, and presence of any clicks and catches in the body in the past 1 year. In run analysis, there was a significant difference in the hip and knee range of motion between those who have current pain and don’t and those who experienced clicks and catches in the past 1 year and those who didn’t. There was also a significant difference in load symmetry while running between those who have current pain and don’t. In gait analysis, there was a significant difference in knee range of motion and load symmetry between those who have current pain and don’t and those who experienced clicks and catches in the past 1 year and those who didn’t. In all the above groups, athletes not having any current pain or not having experienced any clicks and catches in the past 1 year scored better than the injured or in-pain athletes. This shows that so many athletes go about their game while still injured or suffering from muscle tightness or imbalances causing restricted joint range of motion and asymmetrical body load distribution which could further increase their risk of injury. A study conducted on football players showed that knee injuries were found to be associated with lumbar lordosis and sway back Watson [25]. It also stated that back injuries were associated with poor shoulder symmetry, scapulae abduction, back asymmetry, kyphosis, lordosis and scoliosis. In general, it was found that the incidence of ankle, back, knee and muscle injuries was influenced by the presence of defects of body mechanics and the results suggest that intervention to improve body mechanics would be likely to reduce the incidence of sports injuries in football Watson [25]. The importance of good posture in sport and prevention of muscle imbalance needs to be highlighted to players and their coaches to help prevent injuries and maximise performance. There was no significant difference observed between any of the other groups in both, run and gait analysis. There are various studies that have suggested methods to assess muscle function and help prevent muscle imbalance Kritz & Cronin [3]. The authors suggested that the additional information provided by a posture assessment may assist the strength and conditioning professional in developing a strength programme that is more specific to the athlete’s needs in order to enhance performance and possibly reduce the incidence of injury. To optimize function, an athlete should be suggested an integrated functional exercise program for stretching of potentially overactive and tight muscles, and for strengthening of underactive and weak musculature Padua & Hirth [20]. The advantages of balance and stability training too have been highlighted. The authors indicate balance and stability training to be effective for gain in muscular strength and equalization of muscular imbalances Heitkamp, Horstmann, Mayer, Weller, & Dickhuth [31], Manan [30]. Another study showed the concept of hip muscle imbalance being associated with low back pain occurrence in female athletes Nadler [13]. Their research further supported the need for the assessment and treatment of hip muscle imbalance in individuals with low back pain. In a previous study, we assessed hip stability, helping us pin-point the exact region of muscle imbalance and treat it accordingly Manan [30]. Importance should also be given to injury prevention. Stretching before playing and cool down exercises after playing are necessary. It is also suggested that injury prevention programmes should concentrate on improving posture and the rehabilitation from previous injury, rather than flexibility Watson [24]. There were some limitations we faced in our study. Firstly, the participants included players between the ages of 8 and 15 years only. Secondly, the study could have included a wider geographical area including players from more Asian countries. Thirdly, an assessment after correction of muscle tightness and imbalance could have been done. This study opens up new grounds for further research. Further studies can address other variables not included in the present study. Additionally, targeted interventions are needed to correct the abnormalities and prevent muscle tightness and imbalance in athletes and the effect of such improvements on performance needs to be determined. Conclusion This study shows that there are various factors that affect an athlete’s gait and run pattern. The key lies in early detection and correction of these abnormalities at a young age. In competitive sport, it’s the small details that can end up making a large difference and identifying them is the first step. Consequently, understanding the need of injury prevention programmers, strength & conditioning, and sports rehabilitation and its importance in overall improvement in badminton performance is vital and may help take a badminton player’s fitness and game performance to a whole new level. For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com For more articles in Journal of Physical Fitness, Medicine & Treatment in Sports please click on: https://juniperpublishers.com/jpfmts/index.php For more about juniper publishers  please click on: https://www.juniperpublishersgroup.com/