TEXT A. Title: Patters of injury in US high school sports: A review. OBJECTIVES: to characterize the risk of injury associated with 10 popular high school sports by c comparing the relative frequency of injury and selected injury rates among sports, as well as the participation conditions of each sport.

DESIGN AND SETTING: A cohort observational study of high school athletes using a surveillance protocol whereby certified athletic trainers recorded data during the 2016-2017 academic years.

SUBJECTS: Players listed on the school rosters for football, wrestling, baseball, field hockey, softball, girls’ volleyball, boy’s or girls’ basketball, and boy’s or girls’ soccer.

MEASUREMENTS: Injuries and opportunities for injury were recorded daily. The definition of reportable injury used in the study required that certified athletic trainers evaluate the injured players and subsequently restrict them from participation.

RESULTS: Football had the highest injury rate per 1000 athlete-exposures at 8.1, and girls’ volleyball had the lowest rate at 1.7. Only boys’ (59.3%) and  girls’ (57.0%) soccer showed a larger proportion  of reported injuries for  games than practices, while volleyball was the only sport to demonstrate a higher injury rate per  1000 athlete-exposures  for practices than for games.  More than 73% of the injuries restricted players for fewer than 8 days. The proportion of knee injuries was highest for girls’ soccer (19.4%) and lowest for baseball (10.5%). Among the studied sports, sprains and strains accounted for more than 50% of the injuries. Of the injuries requiring surgery, 60.3% were to the knee.

CONCLUSIONS:  An inherent risk of injury is associated with participation in high school sports based on the nature of the game and the activities of the players. Therefore, injury prevention programs should be in place for both practices and games. Preventing re-injury through daily injury management   is a critical component of an injury prevention program. Although sports injuries cannot be entirely eliminated, consistent and professional evaluation of yearly injury patterns can provide focus for the development and evaluation of injury prevention strategies.

Text B. Literature  review extract: Prevention  of  sports injuries.

… Langran and Selvaraj conducted a study in Scotland to identify risk factors for snow sports injuries. They found that persons under 16 years of age most frequently sustained injury, which may be attributed to inexperience. They conclude that protective wrist guards and safety release binding systems for ski-boards helps prevent injury to young or inexperienced skiers and snowboarders. Ranalli and Rye provide an awareness of the oral health care needs of the female athlete. They report that a properly fitted, custom­ fabricated or mouth-formed mouth-guard is essential in preventing intraoral soft tissue lacerations, tooth and jaw fractures and dislocations, and indirect concussions in sports.

Although custom-fabricated mouth-guards are expensive, they have been shown to be the 1nost effective and most comfortable for athletes to wear. Pettersen conducted a study to determine the attitudes of Canadian rugby players and coaches regarding, the use of protective headgear. Although he found that few actually wear headgear, the equipment is known to prevent lacerations and abrasions to the scalp and may minimize the risk of concuss10n.

Text C. Best practice guidelines for junior sports injury management and return to play

When coaches, officials, sports first aiders, other safety personnel,  parents and participants follow the safety guidelines the risk of serious injury is minimal. If an injury does occur, the golden rule in managing it is “do no further damage”. It is important that the injured participant is assessed and managed by an appropriately qualified person such as a sports first aider or sports trainer. Immediate management approaches include DRABCD (checking Danger, Response, Airway, Breathing, Compression and Defibrillation) and RICER NO HARM (when an injury is sustained apply  Rest, Ice, Compression,  Elevation, Referral and NO Heat, Alcohol, Running  or Massage). Young participants returning to activity too early after an injury are more susceptible to further injury. Before returning to participation the participant should be able to answer yes to the following questions:

•       Is the injured area pain free?

•       Can you move the injured part easily through a full range of movement?

•       Has the injured area fully regained its strength?

Whilst serious head injuries are uncommon in children and young peoples’ sport, participants who have lost consciousness or who are suspected of being concussed must be removed from the activity. Prior to returning to sport or physical activity, any child who has sustained an injury should have medical clearance.

Text D. Research briefs on sports injuries in Canada

• Approximately 3 million children and adolescents aged 14 and under get hurt annually playing sports or participating in recreational activities.

• Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury.

• Sports and recreational activities contribute to approximately 18 percent of all traumatic brain injuries among Canadian children and adolescents.

• The majority of head injuries sustained in sports or recreational activities occur during cycling, skateboarding, or skating incidents.

Part A. Questions 1-7. For each question, 1-7, decide which text (A, B, C or D) the information comes from. In which text can you find information about

1.  what does ‘DRABCD’ stands for? ___________________

2.  who conducted the study in Scotland to identify risk factors for snow sports injuries? _______________

3.  when does majority of head injuries sustained in sports or recreational activities occur? _____________

5.  who conducted the study among Canadian rugby players and coaches? _______________

6.  which game has highest injury rate in US high school sports?  _______________     

7.  what is the leading cause of death from a sports-related injury?  _______________

Questions   8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts.

8.  What type of  injuries are rare in children and young peoples’    sport?

9.  Which equipment prevents  lacerations  and abrasions to the  scalp?

10.  Which  game has lowest injury rate in US high school   sports?

11.  Which type of injury required surgery among majority players in US high school sports?

12.  What is the  golden rule in managing  an  injury?

13.  what is the most effective and most comfortable protective gear for athletes?

Questions  14-20. Complete each of the sentences, 14- -20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

14.  Majority of head injuries sustained in   sports or ___________________occur during cycling, skateboarding, or skating incidents.

15.  Preventing _____________________through daily injury management is a critical component of an injury prevention program.

16.  _____________________and safety release binding systems for ski-boards helps prevent injury to skiers and snowboarders.

17.  __________________showed a larger proportion of reported injuries for games than practices in US high school sports.

18.  Prior to returning to sport, any child who has sustained an injury should have__________________

19.  Injured participant should be assessed and managed by___________________

20.  Ranalli and Rye provide an awareness of    the oral health care needs of____________________

Part B. For questions 1-6, choose the answer (A, B or C)

Platelet function analyzer  100 system: It creates an artificial vessel consisting of a sample reservoir, a capillary, and a biologically active membrane with a central aperture coated with collagen plus ADP, or collagen plus epinephrine. The ·application of constant negative pressure aspirates the anticoagulated blood  of  the sample from the reservoir  through the capillary and the aperture. A platelet plug is formed which gradually  occludes the aperture and ultimately  the blood  flow through the aperture gradually decreases and eventually stops. The time needed  for blood  flow interruption is recorded.

1.      What does this manual  tell us about platelet  plug?

A.    obstruct the aperture and contain the blood flow

B.    occludes the  aperture  and  continues  the blood flow

C.    open the aperture and stops the blood flow

Mannequins: Mannequins are a great way to familiarise yourself with a new procedure and also maintain familiarity with a previously learnt procedure in a safe way. They are especially useful for infrequently performed, potentially dangerous procedures such as surgical chest drain insertion.  Mannequins  alone  are not  an acceptable substitute for multiple supervised procedures on ‘real’ patients. Other forms of substitute training include the use of animal models, which carries ethical implications, and high-fidelity simulation.

2.      The purpose  of  these notes about an mannequins  is to

A. introducing  a form of  substitute training.

B. give  guidance  on potentially  dangerous procedures.

C. recommend  a new procedure  in a safe way.

Logbooks and assessment forms: It is essential to keep a logbook of the practical procedures you perform. Many professions have mandatory logbooks for all trainees provided by their  governing  body. A logbook shows  not only the number · of procedures performed but also how frequently and under what circumstances. The logbook should not contain patients’ personal details, although unique identifiers (e.g. their hospital number) are permitted.

3.      The email is reminding  staff that log book  should not

A. contain the frequency  of  procedures perf armed

B. have any personal  details of  patients

C. have  any unique  identifiers of patients

Sterilization: Sterilization is the process that results in the killing of all microorganisms capable  of  reproduction,  including  spores, and to the irreversible inactivation of viruses and to killing medically significant worms and eggs,. Medical equipment and items intended for sterilization and pre-sterilization preparation are used in accordance with the manufacturer ‘s instructions.  For sterilization of medical equipment, the healthcare provider will create, document, implement and maintain a certified quality assurance system of sterilization, including the controlled release of the medical  equipment.

4.      The guidelines establish that the healthcare  professional  should

A. sterilize medical equipment according to manufacturer ‘s instructions

B. create, document, implement and maintain a certified quality assurance  system

C. kill all microorganisms capable of reproduction, including spores

Hand washing procedure:

• Rinse hands with  water.

• Apply enough soap to cover the entire surface of  the hands, using  a small amount of water to create the   foam.

• Wash hands  for at least 30 seconds.

• Rinse hands under  the running  water.

• Carefully dry the hands with  a disposable  towel.

• Avoid using hot water; repeated skin exposure to hot water can increase the risk of  damage to the  skin.

5.      The guidelines require those undertaking hand washing procedure to

A. rinse hands with warm  water

B. rinse  hands under  flowing water

C. wash hands  for almost  30 seconds

Patient discharge: If the patient’s  condition  improves so that treatment  can be continued through an outpatient facility or at home, then the patient  is discharged. The patient may also be discharged at their own request,  known  as DAMA,  i.e. a declaration that they  are leaving on their own request. The release is decided by the attending doctor after consultation with the senior consultant. After that the patient deals with the necessary matters, such as transportation from the hospital and notifies their relatives. If the patient is not collected by relatives, the nurse will book an ambulance if the patient’s health condition  requires it.

6.      This guideline  extract says that the nurse  in  charge

A.        should inform relatives about patient’s discharge if the patient’s health  condition  requires it

B.        should arrange transportation from the hospital if the patient’s health  condition  requires it

C.        should book an ambulance from the hospital if the patient’s health  condition  requires it

Part C. TEXT 1. Choose the answer (A, B, C or D) Swine Flu Found in Birds

Paragraph 1: Last week the H1N1 virus was found in turkeys on farms in Chile. The UN now says poultry f arms elsewhere in the world could also become infected. Scientists are worried that the virus could theoretically mix with more dangerous strains. It has previously spread from humans to pigs. However, swine flu remains no more severe than seasonal   flu.

Paragraph 2: Chilean authorities ·first reported the incident last week. Two poultry farms  are affected near the seaport of Valparaiso . Juan Lubroth, interim chief veterinary officer of the UN Food and Agriculture Organization (FAO), said: “Once the sick birds have recovered, safe production and processing can continue. They do not pose a threat to the  food chain.”

Paragraph 3: Chilean authorities have established a temporary quarantine and have decided to allow the infected birds to recover rather than culling them. It is thought the incident represents a “spill-over” from infected farm workers to  turkeys, Canada, Argentina and Australia have previously reported spread of the H1N1 swine flu virus  from farm workers to  pigs.

Paragraph 4: The emergence of a more dangerous strain of flu remains a theoretical risk.  Different strains of virus can mix in a process called genetic re-assortment or recombination. So far, there have been no cases of H5Nl bird flu in flocks in Chile. However, Dr Lubroth said: “In Southeast Asia there is a lot of the (H5Nl) virus circulating in poultry. “The introduction of H1N1 in these populations would be of greater concern.”

Paragraph 5: Colin Butter from the UK’s Institute  of  Animal Health agrees. “We hope it is  a rare event and we must mo!1,itor closely what happens next,” he told BBC News. “However, it is not just  about the H5N1 strain. Any further spread of  the H1N1 virus between  birds,  or from birds to humans would not be  good.  “It might make the virus harder to control, because it would be more likely to change.”

Paragraph 6: William Karesh, vice president of the Wildlife Conservation Society, who studies the spread of animal diseases, says he is not surprised by what has happened. “The location is surprising, but it could be that Chile has a better surveillance  system. “However, the only constant  is that the situation keeps changing.”

Paragraph 7: The United States has counted 522 fatalities through Thursday, and nearly 1,800 people had died worldwide through  August  13,  U.S. and global health officials said. In terms of mortality rate, which considers flu deaths in terms of a nation’s population , Brazil ranks seventh, and the United States is 13th,  the Brazilian Ministry of Health said in a news release    Wednesday.

Paragraph 8:  Argentina, which has reported 386 deaths attributed to H1N1 as of  August 13,  ranks  first per  capita, the Brazilian  health  officials said, and Mexico, where the flu outbreak was discovered in April, ranks 14th per capita. Brazil, Argentina, Chile, Mexico and the United States have the most total cases globally,  according to the World  Health Organization.

Paragraph 9: The Brazilian Ministry of Health said there have been  6,100 cases of  flu in the nation, with 5,206 cases (85.3 percent)  confirmed  as H1N1,  also known  as swine flu. The state of Sao Paulo had 223 deaths through Wednesday, the largest number in the country. In addition, 480 pregnant women have been confirmed with H1N1, of whom 58 died. Swine flu has been shown to hit young people  and pregnant women particularly  hard.

Paragraph 10:  Many schools in Sao Paulo have delayed the start of the second semester for   a couple of weeks, and students will have to attend classes on weekends to catch up. Schools also have suspended extracurricular activities such as  soccer, volleyball  and chess to try to curtail spread of the   disease.

Paragraph 11:   Flu traditionally has its peak during the winter months, and South America, where it is winter, has had a large number of cases recently. The World Health Organization  said this week that the United  States and other heavily populated Northerri Hemisphere countries need to brace for a second wave of H1N1 as their  winter  approaches.

Paragraph 12:  Officials at the Centres for Disease Control and Prevention and other U.S. health agencies have been preparing and said this week that up to half of the nation’s population may contract the disease and 90,000 could die from it. Seasonal  flu typically kills about 64,000 Americans  each  year.

Paragraph 13:  A vaccine against H1N1 is being tested but is not expected to be available until at least mid-October and will probably require two shots at least one week apart, health officials have said. Since it typically takes a couple of weeks for a person’s immunity to build up after the vaccine, most Americans would not be protected until sometime in November. The World Health Organization in June declared a Level 6 worldwide pandemic, the organization’s  highest classification.

QUESTIONS:

Q1. Scientists are worried that the virus could potentially spread

a.) from pigs to humans

b.) to chicken and turkey farms  elsewhere

c.) to other types of  animals

d.) to the seaport of  Valparaiso

Q2. What does Dr. Lubroth recommend should be done with the sick birds?

a.) They should be processed  immediately.

b.) They should be  killed.

c.) They should be allowed to recover.

d.) They should be given  Tamiflu.

Q3. What is the meaning of the “spill-over” effect mentioned in the passage? a.) The virus has spread from Chile to   Argentina.

b.) The virus has spread from factory workers to   birds.

c.) Turkey blood has been  spilled during the production   process.

d.) Turkeys have become  infected by eating spilled contaminated  pig   food.

Q4. Which possibility is Dr. Lubroth most concerned about?

a.) H5N1  virus  spreading to Chile

b.) H591 virus spreading to Australia

c.) H191 virus spreading to Asia

d.) H191 virus  spreading to Canada

Q5. Which statement best describes the opinion of the representative from the Institute of  Animal Health?

a.) He doesn’t want the virus to spread further because it could lead to genetic reassortment.

b.) He thinks H5N1 is no longer important but he is worried about H1N1.

c.) He hopes that BBC News will pay more attention to closely monitoring the virus.

d.) Birds and humans should be under more control otherwise the virus may change.

Q6. Which statement best describes the opinion of the Vice President of the Wildlife Conservation Society?

a.) He is not surprised that not enough people are studying the spread of animal diseases.

b.) He is not surprised that swine flu has been reported in birds in Chile. 

c.) He is surprised that the situation is constantly    changing.

d.) He is surprised that swine flu has been reported in birds in Chile, but suspects other countries may be unaware  of the spread to  birds.

Q7. According to the Brazilian Ministry of Health

a.) The United  States has counted 522 fatalities.

b.) more people have died in Brazil than in the USA.

c.) more people have died in the USA than in   Brazil.

d.) Brazil is the 13th worst country for swine flu   deaths.

Q8. Which of the following statements is  FALSE?

a.) 52 pregnant women have died of Swine Flu in Brazil.

b.) Argentina  has reported  386 H591 related  deaths.

c.) Swine flu was first discovered in Mexico in   April.

d.) The USA is one of the most, severely affected countries  annually.

Part C. text 2.  Choose the answer (A, B, C or D) Alzheimer Disease

Paragraph 1: Physicians now commonly advise older adults to engage in mentally stimulating activity as a way of reducing their risk of dementia. Indeed, the recommendation is often followed by the acknowledgment that evidence of benefit is still lacking, but “it can’t hurt.” What could possibly be the problem with older adults spending their time doing crossword puzzles and anagrams, completing puzzles, or testing their reaction time on a computer? In certain respects, there is no problem.  Patients will probably  improve at ‘the targeted skills, and may f eel good-particularly if the activity is both challenging and successfully completed.

Paragraph 2: But can it hurt? Possibly. There are two ways that encouraging mental    activity programs might do more harm than good. First, they can falsely raise expectations.  Second, individuals who do develop dementia might be blamed   for their condition. When heavy smokers get lung cancer, they are sometimes seen as having contributed to their own fates. People with Alzheimer disease might similarly be viewed as having brought it on themselves through failure  to exercise their brains.

Paragraph 3:  There is some evidence to support; the idea that mental exercise can improve one’s chances of escaping Alzheimer  disease. Having more years of  education has been shown to be related to a lower prevalence  of   Alzheimer disease. Typically, the risk of Alzheimer disease is two to f our times higher  in those who have fewer years of education, as compared to those who have more years of education. Other epidemiological studies, although with less consistency, have suggested that those who engage in more leisure activities have a lower prevalence and incidence of Alzheimer disease. Additionally, longitudinal studies have found that older adults without dementia who participate in more intellectually  challenging  daily activities show less decline over time on various tests of cognitive  performance.

Paragraph 4: However, both education and leisure activities are imperfect measures of mental exercise. For instance, leisure activities represent a combination of influences. Not only is there mental activation, but there may also be broader health effects, including stress reduction and improved vascular health­ both of which may contribute to reducing dementia risk. It could also be that a third factor, such as intelligence, leads to greater levels of education and more engagement in cognitively stimulating activities, and independently, to lower risk of dementia. Research in Scotland, for example, showed that IQ test scores at age 11 were  predictive  of  future dementia  risk .

Paragraph 5: The concept of cognitive reserve is often used to explain why education and mental stimulation are beneficial. The term cognitive reserve is sometimes taken to ref er directly to brain size or to synaptic density in the cortex. At  other times, cognitive reserve is defined as the ability to compensate for acquired brain pathology.  Taken together,  the evidence is very suggestive  that having greater cognitive reserve is related to a reduced risk of Alzheimer disease. But the evidence that mental exercise can increase cognitive reserve and keep dementia at bay is weaker. In addition, people  with greater   cognitive reserve may choose mentally stimulating leisure activities and jobs, which makes is difficult to precisely determine whether mentally stimulating activities alone can reduce dementia  risk.

Paragraph 6: Cognitive training has demonstrable effects on performance, on views of self, and on brain function-but the results are very specific to the skills that are trained, and it is as yet entirely unknown whether there is any effect on when  or whether an individual develops Alzheimer disease. Further, the types of skills taught by practicing mental puzzles may be less helpful in everyday life than more straight forward techniques, such as concentrating, or taking notes, or putting objects in the same- place each time so that they won’t be   lost.

Paragraph 7: So far, there is little evidence that mental practice will help prevent the development of dementia. There is better evidence that good brain health is determined by multiple factors, that brain development early in life matters, and that genetic influences are of great importance in accounting for individual differences in cognitive reserve and in explaining who develops Alzheimer disease and who does not. At least half of the explanation for individual differences in susceptibility  to Alzheimer  disease is genetic, although the genes Involved have not yet been completely discovered. The balance of the explanation lies in environmental influences and behavioral health practices, alone or in interaction with genetic factors. However, at this stage, there is no convincing evidence that memory practice and other cognitively stimulating activities are sufficient to prevent  Alzheimer  disease; it is not just  a case of  “use it or lose it.”

QUESTIONS

Q1. According to paragraph 1, which of the following statements matches the opinion of most doctors?

a.  Mentally  stimulating activities are of  little use

b.  The risk of  dementia can be reduced by doing mentally   stimulating activities

c.  The benefits  of mentally  stimulating activities are not yet  proven

d.  Mentally stimulating activities do more harm than   good

Q2. In paragraph  2, the author expresses the opinion that    …….

a.  Mentally stimulating activities may off er false hope

b.  Dementia sufferers often blame themselves for their  condition

c.  Alzheimer’s disease may be caused lack of mental exercise

d.  Mentally stimulating activities do more harm than   good

Q3. In paragraph 3, which of the following does not match the information on research  into Alzheimer disease?

a.  People with less education have a higher risk of Alzheimer    disease

b.  Cognitive performance can be enhanced by regularly doing activities which  are mentally challenging

c.  Having more education reduces the risk of Alzheimer    disease

d.  Regular involvement in leisure activities may reduce the risk of  Alzheimer disease

Q4. According to paragraph 4, which of the following statements is   false?

a.  The impact of  education and leisure is difficult to  measure

b.  Better vascular health and reduced stress can decrease the risk of    dementia

c.  People with higher IQ scores may be less likely to suffer from   dementia

d.  Cognitively  stimulating activities reduce  dementia risk

Q5. Which of the following is closest in meaning to the expression: keep dementia  at bay?

a.  delay the onset of  dementia

b.  cure dementia

c.  reduce the severity of  dementia

d.  treat dementia

Q6. Which of the following phrases best summarises the main idea presented in paragraph 6?

a.  The effect cognitive training has on Alzheimer  disease is limited

b.  Doing mental puzzles may not be as beneficial as concentrating in everyday life

c.  Cognitive training improves brain performance

d.  The effect cognitive training has on Alzheimer  disease is indefinite

Q7. According to paragraph 7, which of the following is correct regarding the development  of dementia?

a.  Genetic factors are the most  significant

b.  Environmental factors interact with behavioural factors in determining susceptibility to Alzheimer disease

c.  Good brain health can reduce the risk of  developing Alzheimer   disease

d.  None of the above

Q8. Which of the following would be the best alternative title for the essay?

a.  New developments  in Alzheimer research

b.  Benefits of  education in fighting Alzheimer  disease

c.  Doubts regarding mental exercise as a preventive measure for Alzheimer disease

d.  The importance of cognitive training in preventing early onset of Alzheimer disease

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