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Ukscityzen.plthe Exercise Physiology and Nutrition Steering Groups of the British Olympic Associationand Staff from Northwick Park Hospital ‘The Travelling Athlete’ for national governing bodies. A substantial amount since and it is now timely to update the booklet for athletes intending to train climates more extreme than our own. They also give advice on preparation for travel and on general health precautions. Individuals can ‘dip’ into the booklet and make use of the sections that are The staff at the British Olympic Medical further advice or explanations. Their address and fax and telephone numbers Department of Health booklet “Health Advice for Travellers” available by Travelling for competition requires a lot of preparation. If you are travelling as a group make sure that you know which parts of the trip your manager or coach is dealing with and which you should organise. For example, you will be responsible for obtaining a passport if you require one, whereas someone else may be organising the tickets. Ensure that your passport is up to date. Buy travellers’ cheques and some local Apply for a new one in good time. You can no longer travel on a visitor’s passport. You will need to obtain a full EU Passport.
A good back-up is an international debit Check whether you need a visa. Apply for card, which can be used in international one in good time. Ask your travel agent for cash-point machines in most countries. Ask Make a separate note of the numbers of your passport, travellers’ cheques and credit/debit Get insurance for both luggage and medical cards, as well as the telephone numbers that cover. Costs of medical treatment, especially you should contact in case of loss. Leave another copy of these at home with someone that you can contact whilst you are away.
interfere with training, eating and getting A cheap and convenient way to call home is sleep; all of which will affect performance. by using a telephone charge card. The card Getting treatment will waste time and can be is free. Calls made from abroad using one will be charged to your next home phone bill. or have other special dietary requirements remember to tell the airline in advance so that they can provide you with appropriate food. Telling them at the check-in desk at the Check travel arrangements, meeting points Travelling in uniform can be a great help. Officials are often more willing to help you and smooth the way if there are problems.
Take something comfortable to change into Try to keep together. Looking for people on a long flight and something warm in case Equipment and clothing that you compete in.
Official clothing for opening ceremonies etc. Driving licence (if you are going to have use of a car or hire one). Some countries require an International Driving Licence with your Prescribed medications with a note from your photograph and your UK driving licence with Food, drinks and any nutritional supplements Money, travellers’ cheques, credit/debit cards you normally use. Check customs if you are unsure as to what you can take through.
Contact numbers for lost cards and cheques.
Sunscreen, sunglasses (goggles) and a hat.
the place where you are staying or of the The correct clothing for the climate and the Make sure that the airline or train company Allow enough time between connections to knows that you are bringing large equipment Make sure that you have sufficient baggage allowance on all of the aeroplanes you are travelling on to cover your equipment.
Check what the customs regulations are. You equipment even if it is refunded on your When travelling carry extra food and drinks with you. If you are travelling by road or rail, food may not be available or may be costly. Aeroplane meals may not be sufficient. Also, a long period in an aeroplane causes you to become dehydrated if you do not drink enough fluid. Allow plenty of time for travel to the airport Eat regularly. Carry some snacks to eat on Telephone before to check that the departure average passenger! Try to stick as closely as possible to your normal diet on the plane.
hanging around at airports waiting for flights.
Have all essential items of medication with If a problem arises e.g. flight delay, be prepared to entertain yourself. Take books or competition kit (especially shoes) with you in your hand-luggage in case your bags are lost games and cards can relieve boredom. Hand held computer games are surprisingly time- Do not drink alcohol at the airport or during Ear plugs (available at most high street the flight. This will increase the risk of chemists) can be a great help if you plan on becoming dehydrated during the flight and Eat and drink sensibly, taking into account take your lens case/solutions on board in Avoid drinking too much tea, coffee and cola; all of these may increase dehydration as they contain caffeine which is a diuretic.
Take at least one litre bottle of fluid for drinking during the flight. Ask the cabin staff Get up and stretch occasionally to avoid stiffness and swelling of your legs and feet.
Wear shoes that will be comfortable if your Travelling in itself can be very tiring and often sleep is lost. Even if you have not travelled across a large number of time zones, you may be tired the next day. Be prepared to have a few days of low training intensity. Use this time to find your way around the accommodation and the training or competition venues.
Jet lag, which occurs when you have crossed a large number of time zones, is a result of your body’s natural rhythms having to adapt to a new cycle of day and night. It may last for some days, depending on the number of time zones crossed. Most people find that it is more severe when travelling towards the east as opposed to westwards. As well as a general feeling of tiredness, the symptoms may include; loss of concentration, loss of appetite, headache, dizziness, nausea and If possible arrive in the new time zone well before competition. To adjust fully, most people should allow up to 1 day for each time zone shift. Readjustment is slightly quicker after westward travel.
The British Olympic Association Medical Committee advises great caution in the use of drugs such as hypnotics (sleeping pills) or melatonin to help overcome jet lag. Melatonin is not licensed or available in the United Kingdom and sleeping pills are only available on prescription. These drugs have unpredictable effects, including prolonged drowsiness in some individuals and they may even slow Only consider using sleeping pills or melatonin if you have used them before and know the effect on you. It is essential that your team doctor and other sports science and medicine support staff, such as team psychologist, are closely involved with your strategy to overcome jet lag as quickly as possible. Adapt to the local time as soon as possible. evening after a westward flight. This will help Alter your watch to the local time on the plane and try not to keep converting it back evening after an eastward flight: This will hour) in the new location should be avoided help your body clock to adjust in the right for a few days, as this may act to keep you Take meals at an appropriate time for your Adopt local sleep/wake patterns as soon as Avoid large meals and caffeine containing beverages late at night as this may disturb When crossing a small number of time zones (3-5 hours) train at mid-day or early in the Stay in daylight or bright artificial light during the day.
Your performance may be reduced if you are not used to exercising in the heat. It will be further reduced if you become dehydrated. Exposure to hot conditions will help your body to adapt or acclimatise. Undertake light training for 60 to 100 minutes for the first few days that you are in the heat (or heat chamber). It is important to remember that as you adapt you will sweat more, which will mean that you need to monitor your fluid intake carefully. Humidity levels in indoor sports halls can lead to dehydration even when air conditioned. Your heart rates for equivalent exercise will be increased until you acclimatise to the heat. You may need to adapt your training to together with good advice on its use.
Consult a doctor if you have an illness that During competition and training be aware of could be dehydrating such as a fever, upper respiratory tract infection or diarrhoea and dizziness and lack of co-ordination. These sickness. It may be necessary to reduce or may be an indication of dehydration or heat low as frequent changes from high to low that you do not overheat. Warm-up in an air- temperatures may cause upper respiratory conditioned environment if possible.
Keep cool at night time so that you sleep Reduce your body temperature after exercise well. Do not turn off the air-conditioning. by finding shade or an air-conditioned room.
Doing so will not help you to acclimatise.
Remember that you can burn even when it is cloudy. Also be aware that when it is sunny, but also windy, you will feel cooler and not notice that you are burning. Shade provided by hats, trees and awnings provides only partial protection from sunburn so make sure that you continue to use a high protection suncream even in these situations. Wearing a sunscreen with a Sun Protection Factor (SPF) of 10 allows you to stay out in before exposure to the sun. This will allow the sun ten times longer without burning.
A sunscreen with a high SPF should be used. Sunscreen should be reapplied regularly.
Use SPF 15 - 20 if you are fair-skinned, SPF exposed skin with light clothes and wear a Choose a sunscreen which is not oily, so that sweat does not run into your eyes or make Black and dark skin can burn so care should your hands slip if you hold equipment.
burning is increased. Use a SPF of 20 and wearing eye protection with a UV filter.
burning can occur 3 times faster than in other hot, sunny areas of the world.
Sun reflects off water and will increase your When you are beside water, wear sunscreen chances of burning. Take care while in, on or and sunglasses to counteract the reflection of Reapply sunscreen after a swim, even if the manufacturers claim that their product is Have a T-shirt ready at the side to put on as Even a mild reddening of the skin can be uncomfortable and reduce acclimatisation and may impair temperature The likelihood of dehydration increases when heat is combined with high humidity. The major way that the body cools itself is by the evaporation of sweat. When the humidity is high, less sweat will evaporate so the body temperature rises. In an effort to cool, the body will sweat more which can quickly lead to dehydration. Dehydration may reduce your performance. If you are thirsty you are As water is lost from your body you lose weight This should be replaced with about 1½ times the quantity of fluid lost (to allow for kidney function).
Look at your urine colour compared to at home. If you are dehydrated it will be darker and you will pass less urine. If this is the case increase your volume of fluid and/or drink more often.
Check that you are not progressively losing weight. This could be dehydration. If it is due Check during training and competition how much A decrease in weight indicates how much water water you are losing as sweat. Weigh yourself immediately before and after exercise. Do this Replace this loss with about 1½ litres of fluid without clothes both times, or change into dry kit. Do not weigh yourself wearing sweat- Drink this amount after competition.
drenched clothes. This will not show your water Begin all training and competition hydrated. Before going to bed place at least one drinks Drink throughout, if your activity allows.
bottle beside your bed to drink from at night. In conditions of high heat and humidity make However, it is best to drink regularly through an effort to drink enough fluid. This may the day. Drinking too much before bed may mean drinking more than double your normal Using drinks designed to replace fluids and Replace any weight loss that you note in the electrolytes can help you to remain hydrated, morning or after exercise by drinking more.
Assess how much weight you generally lose during exercise and drink this amount of fluid Before competition in the heat, determine during training how much you need to drink Make sure you drink half to one litre of fluid before, during and after exercise in order to 30-60 minutes before you exercise to help meal. Regardless of whether you feel thirsty calories in your drink. It may need to be or not, it is a good idea to drink at least half diluted when you are using it for rehydration a litre of water, diluted fruit juice or squash that you do not take in excessive calories.
WHICH DRINKS OR STRENGTH OF DRINKS TO USE The oxygen composition of the air is the same all over the world, but at altitude the pressure is lowered. This reduction in pressure has little effect on someone who is resting, but greatly affects people when they start to exercise. This applies especially above altitudes of 2000 metres (about 6000 feet), although you may notice a difference above 1800 metres and your performance and/or ability to train can even be affected at 1500 metres.
The reduction in performance at altitude is greater in endurance sports which require more oxygen, than in events that require power e.g. weight-lifting. The maximum rate at which the body can use oxygen (the VO2 max) decreases with altitude and endurance is impaired. Both will improve with acclimatisation over a period of 2 to 3 weeks. At first you may suffer from tiredness as you exercise, headaches and occasionally a feeling of nausea and difficulty in sleeping. These will pass as you acclimatise to the higher altitude.
On subsequent visits to altitude you may acclimatise faster. However, adaptation varies between individuals and whilst some athletes will adapt quickly others may not. You will easily become tired if you attempt your normal You should be fit and healthy prior to visiting Protect yourself from the sun which will be more intense than at sea level. (See section Training intensity should be reduced.
on ‘Protecting yourself from the sun’ for Have longer rests and recovery periods.
Too great a volume or intensity of training will result in symptoms of overtraining; such altitude so ensure an adequate fluid intake. as headache, loss of appetite, inability to (See section on ‘Dehydration’ for advice).
sleep, general fatigue, and aching muscles Eat more iron-rich foods before going to constipation, so do not take iron tablets unless advised by your GP, sports dietitian or glycogen than the same activity at sea level. before the trip to check iron stores. If these are low, your doctor may advise taking iron supplements, and a further sample is then recommended 2 weeks before departure. If iron stores are still low, it would be best not Exercise performance is reduced when the body is cold. The maximum rate at which the body can use oxygen (VO2max) is reduced. Also lactic acid will appear in the blood at lower levels of activity. Both of these will reduce performance.
Several layers of thin clothing are better than Try to select the correct clothing to avoid one thick one. This will insulate you better sweating. Damp clothing will increase the from the cold and layers can be removed as rate at which heat is lost from the body.
Avoid alcohol as this dilates the blood vessels Choose your clothing relative to the intensity which will increase the rate of heat loss.
of exercise. It is better at the beginning to You will use more energy exercising in the feel slightly cold as you will quickly overheat cold than normal. Plan a snack every 2 hours when training or competing in the cold.
The hands and feet should be well protected to prevent chilblains or in extreme cases, Sun at altitude and sun reflected off snow Hypothermia is an extreme condition, but signs of vagueness and lethargy should be watched for in fellow athletes if they are very ‘Protecting Yourself from the Sun’.
Protect eyes from the wind. Cold wind can freeze the surface cells of the eye.
Appropriate eye protection should be worn to safeguard the eyes against light reflected When travelling abroad always check with a Have vaccinations as long as possible before travel clinic if you need specific vaccinations.
competing, as some vaccinations can have All athletes travelling abroad should have a Hepatitis A vaccine. You can now have one Find out if you need anti-malarial tablets. vaccination of Havrix monodose which will Check well in advance as the course has to booster 6 months later. Check with a travel continue to take them for 4 weeks after you get back home. You may develop malaria after your return if you do not.
Athletes with a fever, higher than normal heart rate at rest, severe muscle aches and dehydrated if you have diarrhoea or have Athlete’s foot should be dealt with quickly. It If you have an illness which is chronic (e.g. can lead to severe infections if left untreated.
asthma) or prolonged (e.g. glandular fever) To help prevent catching infectious diseases make sure that your training is appropriate, you are clear about the treatment and follow To reduce the risk of catching HIV or other Some vaccines require a course of injections over a number of weeks. Anti-malarial tablets have to be taken in advance of entering the country where they are needed and continued for 4 weeks on leaving it.
Some countries do not have very good sanitation or clean water supplies. If you suspect this is the case then follow the guidelines below.
Do not eat food from stalls on the street or in markets. The hygiene may not be good. Also showering, washing your face and shaving.
Be wary of salads and raw vegetables they Eat in places well-known or recommended by Where possible choose food that has been Do not have ice in drinks. This may be made Avoid spicy foods unless you are used to Do not eat ice-cream in hot countries where Do not drink the tap water. Stick to bottled water. Check that the seal on the cap is intact, as some places refill the bottles with Remember to use bottled water to clean your Remember that your health and recovery are vital to the success of your team, so it is just as important for you to follow the advice in The Travelling Athlete on travel and speeding adjustment to new time zones as it is for competing athletes. You should consider travelling out before the main team departs in order to adjust and recover before the arrival of your athletes. Get fit and as near to your ideal weight as possible. If in doubt how to do this, refer to the BOMC or to the position statement of the American College of Sports Medicine* for advice. If you have any medical condition that could be dangerous or might interfere with your performance, such as heart or lung disease or are on any regular medication, you must discuss this with your team doctor or the BOA’s Chief Medical Officer. The physiological challenge of travel, including adjustment to heat, altitude and general travel fatigue as well as jet lag and crossing time zones, is greater Read and use the Well-Being in the Air programme on British Airways. This gives sensible advice on light eating, rehydration, relaxation, stretching and gentle exercise. Heed the advice in The Travelling Athlete on sleeping pills, There may be an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus after long haul flights. If you are on hormonal treatment, such as the oral contraceptive pill or HRT, there is an increased risk of DVT. Regular stretching and exercise will reduce this risk. Follow the advice in the Well-Being in the Air, particularly exercising your calves by moving your feet up and down. A paediatric aspirin (75mg) may also reduce the risk but should not be taken if you have a history of stomach ulcers and medical advice should be sought if you have a history of asthma. * Position statement of the American College of Sports Medicine in Med Sci Sports Exerc 1998 30:975-991 “The recommended quantity and quality of exercise for developing and maintaining cardio-respiratory and muscular fitness and flexibility in healthy adults”.
We acknowledge the substantial contribution made by the following individuals:- Dr Richard Budgett, Richard Godfrey, Paul Davies, Rachel Ramsay and Steve Professor Geoffrey Pasvol, Department of Infection and Tropical Diseases.
Members of the BOA Acclimatisation Working Party Dr Richard Budgett, BOMC; Lynn Booth, Chairman of the BOA Physiotherapy Committee; Professor Ron Maughan, University of Aberdeen; Professor Tom Reilly, Liverpool John Moores University; Mr Brian Miller, BOA Consultant Psychologist, Mr Nick Fellows, BOMC; Mr Richard Godfrey, BOMC; Mr Malcolm Arnold, British Athletics Coach; Mr Kevin Hickey, BOA; Mr Richard Simmons, BOA; Mr David Flower, British Airways.
Members of the BOA Exercise Physiology Steering Group Professor Tom Reilly, Liverpool John Moores University; Greg Whyte, University of Wolverhampton; Professor Neil Spurway, University of Glasgow; Professor Tudor Hale, University of West Sussex; Professor Colin Boreham, University of Ulster; Dr Richard Budgett, BOMC; Mr Nick Fellows, BOMC; Mr Richard Godfrey, BOMC; Members of the BOA Nutrition Steering Group Professor Ron Maughan, University of Aberdeen; Dr Paul Greenhaff, University of Nottingham; Dr Richard Budgett, BOMC; Jane Griffin, BOA Consultant Nutritionist; Peggy Wellington, Consultant Nutritionist; Gill Regan, Consultant Nutritionist; Mr Nick Fellows, BOMC; Mr Kevin Hickey, BOA. E-mail: <firstname.surname>@boa.org.uk
Antiinfliximab antibody status and its relation to clinical response in psoriatic patients: a pilot study
Journal of Dermatology 2010; 37: 708–713Anti-infliximab antibody status and its relation toclinical response in psoriatic patients: A pilot studyEsra ADIS¸EN,1 Arzu ARAL,2 Cemalettin AYBAY,2 Mehmet Ali GUDepartments of 1Dermatology and 2Immunology, Gazi University, Faculty of Medicine, Ankara, TurkeyAlthough the mechanisms underlying the loss of response to infliximab are not completely und