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The association of high level climbing performance with small stature and low body fat percentage, and the possibility of improving strength/mass ratio through body mass reduction, has raised concern about the potential long term health effects on climbers. Some authors have expressed concern over the effects of extreme body fat reduction, potential for eating disorders, and associated health and performance risks for climbers. Diamant Damen Latein Tanzschuhe 025087091 Women’s Ballroom Dance Shoes Black Schwarz browse cheap online manchester great sale for sale uHdUJJg
7 Despite anecdotal references to eating disorders and unrealistic weight reduction practices in climbers, no supportive published data in this area are available and no data exist to link the pursuit of excellence in climbing with associated long term health risks.

Despite this lack of data, there has been at least one action to discourage manipulation of body mass through imposition of a minimum body mass index (BMI) standard on young competitive climbers. 8 Whether the selected levels of limitation are justifiable or reasonable for this specialised group of athletes is not known because no published anthropometry data for young competitive sport climbers exist.

This study attempted to fill a portion of this information void relative to young climbers who perform at high levels. Specifically, its purpose was to evaluate anthropometry data for experienced junior competitive sport climbers between the ages of 9 and 18 years and to compare data for this group with an age matched group of physically active youth who do not climb.

METHODS

Ninety experienced competitive climbers (52 boys, 38 girls) volunteered and gave informed consent to participate in the study. These subjects were competitors at the United States National Championship of the Junior Competition Climbers Association (JCCA). All data for the climber group (climbers) were collected before competition at the site of the JCCA National Championship in September, 2000.

At the time of data collection, climbers completed a questionnaire to document training volume and self reported climbing ability for best top rope (with the rope anchored above the climber at all times) and red point (where the climber clips the rope into intermediate anchors along the climbing route) ascents. Climbing ability was defined as the most difficult ascent by top rope or red point style, whichever was higher, rated on a modified Yosemite decimal system (YDS) scale. The modified YDS scale for technical “free” climbing difficulty, where no artificial means are used to aid progress, currently extends from 0 to 15 with letter grades of a, b, c, and d subdividing the numerical categories. Letter subdivisions were assigned values of a = 0.00, b = 0.25, c = 0.50, and d = 0.75. Thus, a YDS rating of 13b became 13.25 for the calculation of means. A similar rating conversion has been previously used by Watts . Creative Recreation Mens Turino SlipOn Sneaker White Gum sale geniue stockist buy online best prices online Ysy5YAVb

A comparison group of 45 age matched volunteers (controls; 30 boys, 15 girls) gave informed consent and underwent the same testing procedures as the climbers. Controls consisted of youths who were physically active in one or more organised sports but did not participate in climbing. They came from a variety of sports and activities including basketball, cross country running, cross country skiing, soccer, and swimming. All control testing was carried out in the Exercise Science Laboratory of Northern Michigan University. Data were expressed in the same way as for climbers to enable comparisons between the two groups.

All anthropometry measurements were made in a resting state according to established procedures. Sneakers Diadora Heritage Men Suede UOMO20117061001 UK Red comfortable online Manchester iH2ho2
A Lafayette anthropometer was used, by a single investigator, to obtain all skeletal dimensions, with measurements made to the nearest millimetre. Standing height was recorded to the nearest half centimetre with the subject barefoot and with the back against a vertical wall. Mass was measured using a Tanita calibrated electronic scale. BMI was calculated as mass/height lowest price Living Kitzbühel Unisex Adults Pantoffel Karo Mit Weißem Filzrand LowTop Slippers Black Schwarz Anthra 600 clearance marketable sale online with paypal cheap online IcLfmjhng0
where mass was expressed in kilograms and height in metres. Height, mass, and BMI were expressed as absolutes and as normative centile scores according to tables published by the US Department of Health and Human Services Centers for Disease Control and Prevention (CDC).

Arm span was measured in the standing position with the arms abducted horizontally. The greatest tip to tip distance between the extended fingers was recorded in centimetres. The ratio of arm span to height, known to climbers as the ape index, was calculated as arm span divided by height.

Biiliocristal breadth was measured as the distance between the most lateral points on the iliac tubercles. Biacromial breadth was measured as the distance between the most lateral points on the acromion processes. Biiliocristal/biacromial ratio was calculated as the biiliocristal breadth divided by the biacromial breadth. A lower score for this ratio indicates a more triangular torso.

Skinfold thickness was measured to the nearest 0.5 mm with a calibrated Lange caliper at nine anatomical sites by the same trained technician. The nine sites measured were chest, subscapula, midaxilla, suprailiac, iliac crest, abdomen, triceps, thigh, and calf. All measurements were taken on the subject’s right side. Percentage body fat (%fat) values were estimated by two different methods. The procedures of Jackson and Pollock use seven skinfold site measurements to estimate body density, with %fat subsequently calculated by the Brozek equation. Fendi Womens 8P6702A166F112O Black Polyamide Espadrilles the cheapest for sale 1GhOR
The sum of the seven skinfolds (S7) used in the Jackson-Pollock equations and the sum of all nine skinfolds (S9) were calculated as variables. %fat was also estimated directly from two skinfold measurements (triceps and calf) by the youth specific equations of Slaughter . cheap discount authentic cheap sale lowest price DC Shoes Trase Tx Boys LowTop Trainers Dark Red buy cheap latest cheap sale cheapest price HV7lcKD

Forearm and hand volumes were measured to the nearest millilitre by water displacement with the arm in a vertical anatomical position. Hand volume was measured by immersion to the level of a horizontal line between the styloid processes of the radius and ulna. Hand-forearm volume was measured by immersion to the level of the distal edge of the medial epicondyle of the humerus. Forearm volume was calculated as the difference between hand volume and hand-forearm volume.

An adjustable Jaymar hydraulic hand dynamometer was used to record handgrip force, with the subject seated and the elbow flexed to 90°. Maximum handgrip forces for each hand were recorded in kilograms as the highest of two trials. Right and left maximum handgrip forces were averaged to provide an average handgrip score. Handgrip/mass ratio was calculated as handgrip divided by total body mass.

Jandel Sigma Stat software was used for all statistical analyses. Means (SD) were calculated for measured and calculated variables. Analysis of variance with Tukey post hoc tests were used to test for differences between groups. A p level of 0.05 or less was considered significant for all analyses.

Mean ages were 13.5 (3.0) and 13.7 (2.7) years for climbers and controls respectively. Climbers had participated in the activity for 3.2 (1.9) years and had competed in 10 (5) organised competitions within a 12 month period.

To overcome the above problems, ESC Guidelines on pacing 294 —in patients with LVEF >35%—recommend a strategy of EPS followed by ILR if the EPS findings are unremarkable. With this strategy, a pacemaker was implanted in approximately half of the patients and these patients had syncope recurrence after pacemaker implantation in 0–7% of cases 188 , 217 . This strategy was safe; however, this Task Force recognizes that in the ‘real world’, an empirical pacemaker may be acceptable in selected patients at high risk of traumatic recurrence (e.g. elderly patients with unpredictable syncopes) and that an individual risk–benefit evaluation is warranted ( Figure 14 ).

Figure 14
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Therapeutic algorithm for patients presenting with unexplained syncope and bundle branch block. BBB = bundle branch block; CRT-D = cardiac resynchronization therapy defibrillator; EPS = electrophysiological study; ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; PM = pacemaker.

Figure 14
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Therapeutic algorithm for patients presenting with unexplained syncope and bundle branch block. BBB = bundle branch block; CRT-D = cardiac resynchronization therapy defibrillator; EPS = electrophysiological study; ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; PM = pacemaker.

Even if the quality of evidence is moderate, there is strong consensus that in patients with bifascicular BBB with a positive EPS or documentation of paroxysmal AV block during prolonged ECG monitoring, cardiac pacing is highly effective in preventing syncope recurrence. The evidence of efficacy of empirical pacing strategy is weak and the estimate of benefit is uncertain.

Although syncope is not associated with an increased incidence of sudden death in patients with preserved cardiac function, a high incidence of total deaths (about one-third sudden) was observed in patients with BBB and heart failure, previous myocardial infarction, or low ejection fraction. 345–347 Indeed, the high total and sudden mortality seems to be mainly related to underlying structural heart disease and ventricular tachyarrhythmias. In this latter situation, syncope is a risk factor, rather than the cause, of death. 218 Unfortunately, ventricular programmed stimulation does not seem to identify these patients correctly, and the finding of inducible ventricular arrhythmia (VA) should therefore be interpreted with caution. 345 , 346 Therefore, an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy defibrillator is indicated in patients with BBB, congestive heart failure, or previous myocardial infarction and depressed systolic function for the prevention of SCD, but may be unable to prevent the recurrence of syncope, which is often due to non-arrhythmic causes such as OH or vasodepressor reflex. The strategy for the management of patients with unexplained syncope and BBB is summarized in Figure 14 .

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Whenever possible, pre-operative coronary angiography is recommended. Achieving complete revascularization in addition to correcting the mechanical defect improves the clinical outcome.

The use of an IABP is recommended only in the presence of haemodynamic impairment [ 96 , 97 ]. The IABP should be inserted before angiography in patients with haemodynamic instability (particularly those in cardiogenic shock and with mechanical complications) [ 92 ]. The benefits of an IABP should be balanced against device-related complications, mostly vascular and more frequently observed in small stature patients and/or females, patients with peripheral arterial disease (PAD), and diabetics. An IABP should not be used in patients with aortic insufficiency or aortic dissection.

Mechanical circulatory assistance other than an IABP can be offered at tertiary centres with an institutional programme for mechanical assist therapy if the patient continues to deteriorate and cardiac function cannot maintain adequate circulation to prevent end-organ failure ( Figure 2 ). Extracorporeal membrane oxygenator (ECMO) implantation should be considered for temporary support in patients with AHF with potential for functional recovery following revascularization [ 98 ]. If the heart does not recover, the patient should undergo a thorough neurological assessment (especially in the setting of a pre-admittance out-of-hospital resuscitation or prolonged periods with low cardiac output). The patient may be considered for a surgical left ventricular assist device (LVAD) or biventricular assist device (BiVAD) therapy in the absence of permanent neurological deficits. In young patients with no contraindication for transplant, LVAD/BiVAD therapy as a bridge to transplant may be indicated [ 99 ]. In some patients, total implantable assist devices may be applied as a destination (or permanent) therapy.

Fig. 2
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Download slide

Treatment algorithms for acute heart failure and cardiogenic shock. After failure of initial therapy including reperfusion and revascularization to stabilize haemodynamics, temporary mechanical support using an extracorporeal membrane oxygenator should be considered. If weaning from the extracorporeal membrane oxygenator fails or heart failure persists, left ventricular assist device/biventricular assist device therapy may be considered if neurological function is not permanently impaired.

Fig. 2
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Treatment algorithms for acute heart failure and cardiogenic shock. After failure of initial therapy including reperfusion and revascularization to stabilize haemodynamics, temporary mechanical support using an extracorporeal membrane oxygenator should be considered. If weaning from the extracorporeal membrane oxygenator fails or heart failure persists, left ventricular assist device/biventricular assist device therapy may be considered if neurological function is not permanently impaired.

Several mechanical assist devices that can be implanted percutaneously have been tested with disappointing results. The use of percutaneous centrifugal pumps (Tandem Heart) has not resulted in improved outcome after STEMI [ 97 ]. Despite early haemodynamic recovery, secondary complications have resulted in similar 30-day mortality rates. The use of a microaxial propeller pump (Impella) resulted in better haemodynamics but similar mortality after 30 days [ 100 ]. A meta-analysis summarizing the data from three RCTs (100 patients) showed no difference in 30-day mortality and a trend for more adverse events, such as bleeding and vascular complications in the group receiving percutaneous assist devices [ 101 ].

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