Yes / Objective To identify the injury history features reported by patients with ACL injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services. Multi-site cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated (LIMP) were ‘Leg giving way at the time of injury’, ‘Inability to continue activity immediately following injury’, ‘Marked effusion’ and ‘Pop (heard or felt) at the time of injury’. 194 patients with ACL injury were identified of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any 2 of the 4 LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged. Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of 2 or more of the 4 LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications.

A produção de energia elétrica em usinas de açúcar e álcool em sistema de co-geração tendo como combustível o bagaço da cana-de-açúcar é uma prática tradicional. No Brasil, desde os anos 1980, as usinas evoluíram para uma posição de quase auto-suficiência na produção de eletricidade, indicando um forte potencial de produção de eletricidade excedente que pode ser incorporado à matriz energética nacional como complemento. O interesse pela geração de energia por fontes renováveis ganhou destaque devido ao risco de desabastecimento e à necessidade de adequações tecnológicas por parte das usinas. Entretanto, embora o potencial exista, há fatores que influenciam e colocam em risco a decisão de uma usina investir na geração de excedentes que devem ser analisados, dentre eles a volatilidade dos preços da energia. O objetivo deste trabalho é analisar o processo de formação de preço da energia elétrica gerada a partir de biomassa negociada no Ambiente de Contratação Livre (ACL). Neste ambiente, a energia gerada por biomassa pode ser negociada bilateralmente por agentes privados (geradores e consumidores livres). Mais precisamente, pretende-se mostrar como o risco hidrológico incorporado no processo de formação de preço e no despacho físico da geração do sistema hidrotérmico brasileiro afeta o preço da energia elétrica gerada a partir de biomassa negociada no ACL, dadas suas atuais características institucionais. Para isso, desenvolve-se um mercado artificial de energia elétrica gerada por biomassa que busca captar as principais características institucionais do ACL. Várias simulações são geradas pelo modelo computacional, as quais mostram o impacto negativo da volatilidade do preço de curto prazo sobre os preços da energia elétrica gerada por biomassa negociada no ACL. / Electricity generation in ethanol and sugar mills using bagasse as a fuel in cogeneration process is a traditional practice. In Brazil, since the 1980s mills have evolved to a position of almost self-sufficiency in electricity production, which indicates a strong potential of electricity surplus that can be used as a complement in the electricity national matrix. Such interest for electricity generation from renewable sources got outstanding due to the lack of supply risk and also the mills necessity of technological adaptations. However, even though the potential exists, there are some factors that influence and put in risk a mills decision to invest in electricity surplus generation which must be evaluated, such as energy prices volatility. The objective of this work is to analyze the electricity price setting process generated by sugarcane biomass and negotiated in the Free Agreement Environment (ACL). In this environment, biomass generated electricity can be negotiated among private agents (free consumers and generators). More precisely, the aim is to show how the hydrological risk that is part of the price setting process and of the system physical dispatch affects the price of the biomass electricity in the ACL, given its actual institutional features. To enable that, an electricity biomass artificial market is developed with the aim to capture the main institutional features of ACL. Several simulations are generated by this computational model, which show the negative impact of spot price volatility over the biomass electricity prices in ACL.

Non-contact anterior cruciate ligament (ACL) injuries is a serius and traumatic injury to the knee that is common in female soccer players and often force the player to quit or lower the level of activity because of lost stability in the knee or from fear to suffer  a new injury. Female soccerplayers have a higher risk than their male counterparts to get an ACL rupture and especially adolescent females have a high risk. The most common causes to a non-contact ACL rupture is side-cutting manuvers and landing after jumping. Every other player with an ACL rupture develops osteoarthritis within 10-15 years from the time of injury Results: The higher risk for females to incur a ACL rupture is due to smaller intercondylar notch, they’re in the follicular or ovulatory phase of their menstrual cycle, increased knee laxity, dominance in the quadriceps muscles, flexion in hip and valgus movement in the knee. An effective preventionprogram is based on the risk factors individual players exhibit. Preventionprograms including plyometrics and at least one other component (strength, neuromuscular training, awarness or proprioceptiv training) at a regular basis have been most succesfull in reducing the risk for ACL injury for female soccer players. Discussion: Female soccer players may have neuromuscular, hormonal and anatomical differences that increase the risk of them achieving an ACL injury in a non-contact situation. Theese differences should be taken into account when designing a preventionprogram in order to succesfully reduce the risk for female soccer players to achieve an ACL injury. A preventionprogram should include plyometric training, proprioception, balance training and resistance training for hamstrings.

Både biomekaniska och neuromuskulära faktorer hos kvinnliga fotbollsspelare har visat sig påverka risken att drabbas av främre korsbandsskador. Obalanserad muskelaktivering kring knäleden har visat sig påverka ledstabiliteten. Syftet med studien var därför att undersöka sambandet mellan muskelaktiveringen i vastus medialis och vastus lateralis i relation till valgusvinkel hos fotbollsspelande kvinnor vid ett drop-landingtest. Studien gjordes i samarbete med det finska företaget Fibrux OY, som har utvecklat en bärbar sEMG-apparatur. I studien deltog 15 kvinnliga fotbollsspelare som under en drop-landing bar sEMG-elektroder på vastus medialis och vastus lateralis samtidigt som rörelsen filmades framifrån för att möjliggöra 2D analys av valgusvinkel. Resultaten visar en tendens till samband mellan muskelaktiveringsgrad och valgusvinkel (r=0,51) (p&gt;0,05) samt ett svagt samband mellan muskelaktiveringsordning och valgusvinkel (r=0,32) (p&gt;0,05). Det svaga sambandet gör att det inte går att utesluta att det är andra muskler kring knäleden som har större inverkan på ledstabiliteten. Framtida forskning bör utföras på en större population och rikta sig på prospektiv epidemiologisk forskning eftersom det är den enda studiedesignen som avslöjar vilka variabler som kan associeras med risken att drabbas av en knäskada. / Both biomechanical and neuromuscular factors affect the risk of suffering an ACL rupture among female soccer players. Unbalanced muscle activation around the knee has been found to affect the joint stability. The aim of this study was therefor to investigate the muscle activation in vastus medialis and vastus lateralis in relation to dynamic valgus among female soccer players. The study was conducted in cooperation with the Finnish company Fibrux OY, who has developed a portable sEMG testing equipment. The participants consisted of 15 female soccer players who were tested with sEMG electrodes on vastus medialis and vastus lateralis during a drop-landingtest that was filmed to enable 2D analysis of valgus angle. The results show a tendency to correlation between the activation ratio and valgus(r=0,51) (p&gt;0,05), and between activation delay in vastus medialis and valgus (r=0,32) (p&gt;0,05). But both correlations lack significance. The results could be explained by that there might be other muscles around the knee at that affects the joint stability even more than vastus lateralis and medialis do. Future studies should be conducted with larger sample size and focus on prospective epidemiological research because that is the only study design that reveals what variables can be associated with the risk of suffering a knee injury.

A produção de energia elétrica em usinas de açúcar e álcool em sistema de co-geração tendo como combustível o bagaço da cana-de-açúcar é uma prática tradicional. No Brasil, desde os anos 1980, as usinas evoluíram para uma posição de quase auto-suficiência na produção de eletricidade, indicando um forte potencial de produção de eletricidade excedente que pode ser incorporado à matriz energética nacional como complemento. O interesse pela geração de energia por fontes renováveis ganhou destaque devido ao risco de desabastecimento e à necessidade de adequações tecnológicas por parte das usinas. Entretanto, embora o potencial exista, há fatores que influenciam e colocam em risco a decisão de uma usina investir na geração de excedentes que devem ser analisados, dentre eles a volatilidade dos preços da energia. O objetivo deste trabalho é analisar o processo de formação de preço da energia elétrica gerada a partir de biomassa negociada no Ambiente de Contratação Livre (ACL). Neste ambiente, a energia gerada por biomassa pode ser negociada bilateralmente por agentes privados (geradores e consumidores livres). Mais precisamente, pretende-se mostrar como o risco hidrológico incorporado no processo de formação de preço e no despacho físico da geração do sistema hidrotérmico brasileiro afeta o preço da energia elétrica gerada a partir de biomassa negociada no ACL, dadas suas atuais características institucionais. Para isso, desenvolve-se um mercado artificial de energia elétrica gerada por biomassa que busca captar as principais características institucionais do ACL. Várias simulações são geradas pelo modelo computacional, as quais mostram o impacto negativo da volatilidade do preço de curto prazo sobre os preços da energia elétrica gerada por biomassa negociada no ACL. / Electricity generation in ethanol and sugar mills using bagasse as a fuel in cogeneration process is a traditional practice. In Brazil, since the 1980s mills have evolved to a position of almost self-sufficiency in electricity production, which indicates a strong potential of electricity surplus that can be used as a complement in the electricity national matrix. Such interest for electricity generation from renewable sources got outstanding due to the lack of supply risk and also the mills necessity of technological adaptations. However, even though the potential exists, there are some factors that influence and put in risk a mills decision to invest in electricity surplus generation which must be evaluated, such as energy prices volatility. The objective of this work is to analyze the electricity price setting process generated by sugarcane biomass and negotiated in the Free Agreement Environment (ACL). In this environment, biomass generated electricity can be negotiated among private agents (free consumers and generators). More precisely, the aim is to show how the hydrological risk that is part of the price setting process and of the system physical dispatch affects the price of the biomass electricity in the ACL, given its actual institutional features. To enable that, an electricity biomass artificial market is developed with the aim to capture the main institutional features of ACL. Several simulations are generated by this computational model, which show the negative impact of spot price volatility over the biomass electricity prices in ACL.

Introduction: A successful return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R) demands optimal physical and psychological rehabilitation. Aim: Study the change in psychological readiness to RTS between three- and six-months post ACL-R, to associate psychological readiness to patient-reported knee function and identify factors associated to greater psychological readiness to RTS. The secondary aim was to examine how the Covid-19 pandemic has affected the patients’ rehabilitation. Methods: Prospective cohort study including patients with primary ACL-R recruited from the Swedish Knee Ligament register, age 16-40 and physically active on Tegner&gt;3. Demographics including pre-injury sport participation, psychological readiness reported with the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, knee function reported with the subjective International Knee Documentation Committee (IKDC) and the impact on rehabilitation by Covid-19 were analyzed at three- and six-months post-surgery. ACL-RSI scores were compared, correlated to IKDC and univariate analysis was used to determine the association between factors and the psychological readiness to RTS. Results: 141 patients were analyzed (56 men, 85 women; median age 24 years), all were recreational or competitive athletes (median Tegner level 8). The psychological readiness progressed through rehabilitation, was correlated to subjective IKDC. No differences could be detected between ACL-RSI scores and included factors at six months post ACL-R. Covid-19 had an impact on 36% (40/112) of the patients’ rehabilitation. Conclusions: Psychological readiness improved after ACL-R and was significantly associated to self-reported knee function at six months post ACL-R. Covid-19 restrictions affected rehabilitation for one in every three participants.

Bakgrund: Skador på det främre korsbandet (anterior cruciate ligament, ACL) är vanligt och sker framför allt under idrottsutövning. Ungefär hälften av de som drabbas genomgår korsbandsrekonstruktion (ACLR). När det gäller rehabilitering efter ACLR finns en kunskapslucka i litteraturen  gällande hur denna skall struktureras, vad den ska innehålla, samt hur rehabiliteringen skall utvärderas innan återgång till idrott (return to sport, RTS) tillåts. Syfte: Syftet med litteraturöversikten var att studera rehabilitering av individer som genomgått ACLR, de tester som görs, samt hur vanligt det är att den studerade populationen kan återgå till idrott. Metod: Litteratursökning genomfördes i tre databaser (PubMed, MEDLINE, Sage Journals) i november 2023 enligt flexibel sökstrategi. 22 studier kvalitetsgranskades enligt SBUs granskningsmall och 17 inkluderades sedermera i litteraturöversikten. Resultat: Inför återgång till idrott förekom ett testbatteri, där bland annat enbenshopp ingick, i 11 av de granskade artiklarna. När det gäller att utvärdera muskelstyrka förekom olika isometriska och isokinetiska tester av quadriceps och hamstrings i 10 av de granskade artiklarna. Gällande enkäter användes International Knee Documentation Committe (IKDC) och ACL-return to sport after injury scale (ACL-RSI) respektive i 11 av de granskade artiklarna. Idrottare med goda hopptestresultat, limb symmetry index LSI ≥85%, samt LSI ≥85% för isokinetiskt styrketest, återvänder till idrott oftare än idrottare med sämre resultat (LSI &lt;85%). Få testdeltagare klarar RTS-tester 6 månader postoperativt, men desto fler klarar samma tester 12-24 månader postoperativt. Konklusion: Ytterligare studier behövs för att konkretisera ett vetenskapligt belagt rehabiliteringsprotokoll gällande såväl utformandet av träning som metodval när det gäller RTS-tester. / Background: Injuries to the anterior cruciate ligament (ACL) are common and occur most often during sports participation. Approximately half of those affected undergo anterior cruciate ligament reconstruction (ACLR). When it comes to rehabilitation there is a knowledge-gap in the literature regarding how it should be best structured, what it should contain, and how it should be evaluated before allowing the athlete to return to sport. Purpose: The purpose of this study was to study the rehabilitation of athletes who have undergone ACLR, the RTS tests that have been performed, and to what extent the athletes have returned to sport. Method: A scoping review of current literature (from 2019 and forward) was conducted. In November 2023 a literature search with a flexible search strategy was made, across three databases (PubMed, MEDLINE, Sage Journals). Twenty-two studies were checked for quality and subsequently 17 studies were included in the review. Result: Prior to the RTS phase the athletes undergo a series of tests. Single leg jumps performance was assessed in 11 of the included articles. Muscle strength tests of the hamstrings and the quadriceps, including isometric and isokinetic tests of the hamstrings and the quadriceps were conducted in 10 of the included articles. Surveys, most commonly International Knee Documentation Committee (IKDC) and ACL-return to sport after injury scale (ACL-RSI) were employed in 11 of the included articles. Athletes with good results (limb symmetry index, LSI ≥85%) in the jump tests, and LSI ≥85% in the isokinetic strength test, returned to sport more often than those athletes with poorer results (LSI &lt;85%). Few athletes passed all the RTS tests six months post-surgery, however a higher number achieved a passing grade on the tests 12-24 months post-surgery. Conclusion: Further studies are needed to verify the best scientifically based rehab-protocol following ACLR. Additionally, there is a need to identify a well-structured test-battery that can safely determine athlete’s readiness to return to sport post-ACLR.

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