Injury Risk - Health Dissertations - Free Essay Example

Injury risk in elite basketball players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and interven tion that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his g ymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst tra ining, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it enc ompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see sub stantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This wi ll be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather th an a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes w ho participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompan ied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improvin g the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up thei r sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in spo rtsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict oursel ves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review th e desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the fiel d and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their con clusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports gener ally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functio ns of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that t hey work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two cons iderations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be more severely dealt with and that these rules should be supported with more diligent refereeing. In view of the number of dental injuries recorded in the game ofbasketball, Kuala et al. also recommend the mandatory wearing ofdental shields or mouthguards It should be noted that taping and bracing are commonly employed techniques for protection in many sports, but their efficacy has onlybeen demonstrated in sportsmen with a history of previous injury (5,6).These techniques are most frequently applied to the ankle and kneejoints as these joints are both the most commonly affected and alsothey move in a primarily sagittal plane, therefore they are technicallythe easiest to mechanically brace. Other joints can be braced. The elbow can be successfully supported. It’s a common sight in players of racket sports to see a brace in place. Clearly this is of use if there is joint instability, but it is often mistakenly used in cased of â€Å"tennis elbow† where its value is often little more than a placebo. There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. The introduction of â€Å"high-top† basketball boots has not produced any definitive evidence that sprains and st rains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing seems to be more acceptable in terms of comfort for long-term use. Taping is clearly cheaper but will probably have tube re-applied at every sporting occasion. We do not propose to discuss taping in detail as there are a great many different techniques invented by a great many different clinicians, all of whom will, no doubt, claim that there particular method is the best. We do not presume to make a judgement on this issue and when referring to â€Å"taping† this should be taken as a generic process rather than a specific one. In most cases the object of the exercise is to reduce the range of abnormal movement at a joint and also (on occasions) to reduce the possible movement in a normal direction, in an attempt to help to reduce the inflammatory processes that may be present. In most cases, the taping can be applied by the patient themselves after basic in struction by the doctor or physiotherapist. There is the commonly held belief that strapping or braces should not be worn because they impair performance. In a study by Thacker teal., (1999) (27) a careful study of the literature was made and they were able to conclude that â€Å"appropriately applied braces, tape, or orthoses do not adversely affect performance.† They were also able to recommend that, after an ankle injury, athletes should complete supervised rehabilitation before returning to practice or competition and those athletes who suffered moderate or severe sprain should wear an appropriate orthotic for at least six months. In a theme that we shall return to in this piece, Thacker concludes by observing that it is not only doctors and physiotherapists that must assume the burden of responsibility for prevention of injuries in sports, but it is also the coaches, trainers and, indeed, the athletes themselves, who must also share in that responsibility. Pr e-match training is a major area where athletes and their professional advisors can influence both the incidence and severity of injuries. Appropriate strength, agility and flexibility training will all help to reduce the likelihood of problems arising during and after play. Stretching is an area of considerable controversy at present. Most authorities would agree that a pre-match warm-up and stretch is a good sensible prophylactic measure. Hard evidence for this (in terms of randomised, placebo controlled trials) is hard to find. The second edition of Mate and Char land’s book (28) Facilitated stretching, is useful compendium of opinion on the subject. It has been well reviewed by a physiotherapist, Ian Horsley, (29) who makes some very pertinent observations on the text. Controversially, the book expounds the virtues of post-match stretching rather than pre-match stretching. Its particularly useful for an erudite explanation of the current thinking on the anatomy and physiology of the stretch reflex and the impact of this on the various modalities of stretching techniques. In terms of research specifically into the role of stretching in the prophylaxis of injury, an interesting review of the available literature is provided by Young (30) who examined the available literature and came to the conclusion that â€Å"Stretching is perhaps the most common routine advocated by sports coaches and sports medicine professionals. In this study, no evidence for its effectiveness in the prevention of sport related injury was found. â€Å" It is fair to observe, however, that the implication that stretching does not reduce subsequent injury is not justified. Young qualifies his statement by asserting that the reason that â€Å"no evidence could be found† was due tithe fact that the trials studied were not sufficiently scientifically rigorous to provide unequivocal evidence of the benefits of stretching. He cites studies (31,32,33) as examples o f this. Ian Shirer (2000) produces a very thought provoking article (34) in which he specifically looks for the evidence to support the perceived role of stretching in reducing injuries. He points to the fact that many of the trials that came out in support of stretching used stretching as a co-intervention and therefore the effects of stretching could not be isolated. In one, often quoted study, Strand et al.(1983) (35) reported a 75% reduction in injury rates after using stretching as a warm-up routine. Careful reading shows that while thesis true, Strand’s study also used leg guards, special shoes, taping ankles, controlled rehabilitation, education, and close supervision during play, so it was hardly surprising that there was a significant reduction in injury rates. In his pursuit of an answer, Shirer produces some carefully constructed arguments regarding stretching. Most injuries occur during eccentric muscle contractions (36) which has the ability to cause dam age inside of the normal envelope of motion because of the differing length of the muscle sarcomeres (37). Why then, if injuries occur within the normal range of movement, would an increased range of movement prevent injuries? It is a physiological fact that even mild stretching can cause a degree of damage at the cellular level (38). It also appears that stretching has an ability to produce a tolerance to pain or an analgesic effect (39,40,41). Why, he argues, should it be considered prudent to increase the tolerance to pain, produce some damage at the cellular level and then exercise this damaged, partially anaesthetised muscle? Against this he cites the counter argument that there is scientific data to support the warm up as a prophylactic for injuries during a match (42) Other risk factors can be identified that can predispose to injury. Overzealous or misguided training schedules can also lead to overuse syndromes in their own right. In addition to strength training, elit e basketball players will often run considerable distances on a weekly basis in order to improve or maintain their levels of cardiovascular fitness. This can have associated problems and the supervising physiotherapist should be aware of the potential hazards. liotibial band syndrome, tibia stress syndrome, patella-femoral pain syndrome, Achilles tendinitis, and plantar fasciitis have all been associated with overtraining (30). Prophylaxis can be achieved by modifying the training schedule, adequate warm-up and stretching and possibly modifying the footwear. There is evidence to suggest that athletes who train one to three days per week are less likely to be injured than those who train five days per week (30). Similarly, with intense training, athletes who train for15-30 mines. per day have significantly lower injury incidence than those who train for 45 mines a day ( The reference here is to running training not any other form). Interestingly, the results of this study show ed that there was no significance in the prevention of injuries (from the running section of training) when a graduated programme was used. A specific and large study on the subject of ankle injuries in basketball (20) also makes interesting reading. Significant findings included the fact that the ankle injury rate was 3.85 per 1000participations in a match, with almost half missing at least one week of competition as a result of the injury. In terms of prophylaxis, the study finds that factors that increased the risk were: a) A history of previous ankle injury made it five times more likely to sustain a further injury. b) b) Air cells in the heels of shoes made it 4.3 times more likely and c) c) players who did not stretch before the game were 2.6 times more likely to injure an ankle than those who did. The authors noted that taping a previously injured ankle reduced the likelihood of further injury, although they could not quantify the rate of reduction due to other con current factors Male vs. Female considerations Basketball is a sport that is enjoyed by both male and female participants. It does not follow, however, that the injury patterns are the same for both sexes. One can argue that men may tend to be physically heavier, more aggressive and move faster, all of which are indisputable anatomical and physiological facts. These reasons can be cited as reasons why male and female injury patterns are different. Unfortunately that is nowhere near sufficient to explain some of the observed facts. Some of the most studied differences come in relation to injuries to the knee. Women damage their ACL over three times more frequently than men. (20a)If the explanations of body weight, speed or aggression were employed, then one would confidently predict that men were more likely to suffer than women. Arendt (14) studied the problem and postulated that there were possibly a great many factors that could influence the aetiology of the injury. His team thought that it was likely that non-conta ct mechanisms were the main factor in the genesis of these injuries. They cited several different mechanisms of injury including such extrinsic factors such as relative muscular strength, shoe-surface interface and specific body geometry (women have a wider stance than men due to the anatomical shape of the pelvis. They also cited certain intrinsic factors such as cyclical joint laxity (under the influence of the menstrual hormones), the actual dimensions of theatre-condylar notch in the knee (where the ACL runs) and also the actual size of the ACL itself. As a matter of completeness we would also cite the paper by Gael teal. (2005) (43) which also looks specifically at the issue of ACL injury, in the broader context over a prolonged period (1990-2002).This paper provides a very detailed analysis of the injuries sustained while playing basketball. It enhances the arguments for an extrinsic causation of the excess of female injuries by quoting the fact that there was found to b e no significant difference between the injury rates of men and women after direct contact incidents. Women, however, sustained a higher rate of non-contact injuries than men did. Further evidence for non-contact, intrinsic causes for the ACL sex difference is found by comparing the rates of ACL injury in basketball with those rates in football. A similar preponderance in female injury is found (43) implying that the difference is not likely to be sport specific. One completely unexplained finding was the fact that, over the 13 years that the study ran, the ACL injury rate for men progressively fell whereas the rate for women remained constant. The authors did not offer any explanation for this fact other than they postulated that the message to increase proprioception enhancing training may be being absorbed by the male population more effectively that the female population. Gael concludes the article with a comment that bears repeating. Despite focusing in this section on the injury of the ACL, it should be remembered that such injuries are still comparatively rare events when taken in the context of the totality of the sport. The possibility oracle injury should not be allowed to put off participation in the sport. Discussion The whole issue of injury in the area of basketball is the consideration of those issues that are relevant to sport in general and those that are specific to basketball. In this piece we have considered both areas. The incidence and types of injury have been discussed in detail together with the appropriate measures that a physiotherapist can take to minimise the incidence and severity of a specific injury occurring. The knee and ankle are areas at particular risk of injury and we have discussed these as separate cases both in terms of the mechanism of injury and the prophylaxis of the injury. It is clear from reviewing the literature on the subject, that the whole area of stretching before and after exercise is confused, with reputable authorities presenting arguments both for and against the issue. It would appear that, on balance, there is a general ground-swell of feeling that pre-exercise stretching is useful and evaluable prophylactic against injury however, there appea rs to belittle peer-reviewed literature which can be cited as unequivocal support for this view. Most of the studies that have been done in this area have not looked at stretching as a single entity but have included it as part of a pre-exercise routine. As a result, there is little firm evidence that stretching – by itself – is of unequivocal value. It is clear, from consideration of all of the evidence, that there is a great deal that a physiotherapist can do both in terms, not only of treatment, but also in terms of knowledgeable advice and guidance, to help the participants in the field of basketball compete safely. References 1. Ruhr M Kuala, Simon Tameka, Ilka Antti-Poika, Sakari Orava, Risto Tuominen, and Pertti Myllynen (1995) Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data BMJ, Dec 1995; 311: 1465 1468. 2. W. H. Meeuwisse, R. Sellmer, and B. E. Hagel (2003) Rates and Risks of Injury during Intercollegiate Basketball Am. J. Sports Med., May 1, 2003; 31(3): 379 385. 3. Roald Bahr (2001) Recent advances: Sports medicine BMJ, Aug 2001; 323: 328 331. 4. Surve I, Schwellnus MP, Noakes T, Lombard C. (1994) A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthotic. Am J Sports Med 1994; 22: 601-606 5. Tropp H, Askling C, Gillquist J. (1985) Prevention of ankle sprains. Am J Sports Med 1985; 13: 259-262. 6. Sitler M, Ryan J, Wheeler B, McBride J, Arciero R, Anderson J, et al. (1994) The efficacy of a semi rigid ankle stabilizer to reduce acute ankle injurie s in basketball. A randomized clinical study at West Point. Am J Sports Med 1994; 22: 454-461. 7. Verhagen EA, van Mechelen W, de Vente W. (2000) The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med 2000; 10: 291-296. 8. Thacker SB, Stroup DF, Branche CM, Gilchrist J, Goodman RA, Weitman EA. (1999) The prevention of ankle sprains in sports. A systematic review of the literature. Am J Sports Med 1999; 27: 753-760. 9. Boden BP, Griffin LY, Garrett Jr WE. (2000) Etiology and prevention of noncontact ACL injury. Physician Sportsmed 2000 ; 28: 53-60. 10. Carafe A, Cerulli G, Projetti M, Aisa G, Rizzo (1996) Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc 1996; 4: 19-21 11. Heidt Jr RS, Sweeterman LM, Carlonas RL, Traub LA, Tejkulve FX. (2000) Avoidance of soccer injuries with preseason conditioning. Am J Sports Med 2000; 28 : 659-662 12. Sharon L. Home, Jennifer M. LaFemina, David R. McAllister, Geoffrey W. Schaadt, and Frederick J. Dorey (204) Fractures in the Collegiate Athlete Am. J. Sports Med., Mar 2004; 32: 446 451 13. U M Kuala, J Kaprio, and S Sarno (1994) Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes BMJ, Jan 1994; 308: 231 234. 14. Arendt E, Dick R. (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 1995; 23: 694-701 15. Natri A, Beynnon BD, Ettlinger CF, Johnson RJ, Shealy JE. (1999) Alpine ski bindings and injuries. Current findings. Sports Med 1999; 28: 35-48 16. Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. (1999) Prevention of injuries in young female players in European team handball. A prospective intervention study. Scand J Med Sci Sports 1999; 9: 41-47 17. British Journal of Sports Medicine 1997;31:332-6 Quoted in Minerva BMJ, Jan 1998; 316: 320. 18. Adams WB (2004) Treatment options in overuse injuries of the knee Current Sports Medicine Reports 2004, 3:256-260 (1 October 2004) 18a LS Weil, JW Moore, CD Kratzer, and DL Turner A biomechanical study of lateral ankle sprains in basketball J Am Podiatr Med Assoc 1979 69: 687-690. 19. G.M.M.J. Kerkhoffs, L. Blankevoort and C.N. van Dijk (2005) A measurement device for anterior laxity of the ankle joint complex Clinical Biomechanics, Volume 20, Issue 2, February 2005, Pages 218-222 20. G D McKay, P A Goldie, W R Payne, and B W Oakes (2001) Ankle injuries in basketball: injury rate and risk factors Br. J. Sports Med., Apr 2001; 35: 103 108. 20a. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. (1999) The effect of neuromuscular training on the incidence of knee injury in female elite athletes. A prospective study. Am J Sports Med 1999; 27: 699-709 20b. Jon Nicholl and Patricia Coleman (1996) Acute sports injuries BM J, Mar 1996; 312: 844. 21. Randall DN (2005) Dental Injuries in Sports Current Sports Medicine Reports 2005, 4:12-17 (1 February 2005) 22. Dietzel DP, Hedlund EC (2005) Injections and Return to Play Current Pain and Headache Reports 2005, 9:11-16 (1 February 2005) 23. Sanchez II AR, Sugalski MT, LaPrade RF (2005) Field-side and Prehospital Management of the Spine-injured Athlete Current Sports Medicine Reports 2005, 4:50-55 (1 February 2005) 24. McKean DB (2005) The Disposition of the concussed athlete: A common conundrum and an all too common injury Current Sports Medicine Reports 2005, 4:9-11 (1 February 2005) 25. Johnston KM, Bloom GA, Ramsay J, Kissick J, Montgomery D, Foley D, Chen JK, Ptito A (2004) Current Concepts in Concussion Rehabilitation Current Sports Medicine Reports 2004, 3:316-323 (1 December 2004) 26. J C Chula (1994) ABC of Sports Medicine: Sport for people with disability BMJ, Jun 1994; 308: 1500 1504. 27. Stephen B. Thacker, Don na F. Stroup, Christine M. Branche, Julie Gilchrist, Richard A. Goodman, and Elyse A. Weitman (1999) The Prevention of Ankle Sprains in Sports: A Systematic Review of the Literature Am. J. Sports Med., Nov 1999; 27: 753 760. 28. Robert E Mate, Jeff Charland. (1999) Facilitated stretching.: 2nd ed. (Pp 143) Leeds: Human Kinetics Europe Ltd, 1999. ISBN 0-7360-0066-6. 29. Horsley : Book review of ref (28). Br. J. Sports Med., Aug 2000; 34: 315 316. 30. E W Young and S S Young (2001) A systematic review of interventions to prevent lower limb soft tissue running injuries Br. J. Sports Med., Dec 2001; 35: 383 389. 31. Pope R, Herbert R, Kirwan J. (1998) Effects of ankle dorsiflexion range and pre-exercise calf muscle on injury risk in Army recruits. Australian Journal of Physiotherapy 1998;44:165–72. 32. Pope RP, Herbert RK, Kirwan JD, et al. (2000) A randomized trial of preexercise stretching for prevention of lower limb injury. Med Sci Sports Exerc 200 0;32:271–7. 33. van Mechelen W, Hlobil H, Kemper HCG, et al. (1993) Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993;21:711–19 34. Ian Shirer (2000) Stretching before exercise: an evidence based approach Br. J. Sports Med., Oct 2000; 34: 324 325. 35. Strand J, Gillquist J, Liljedahl S-O. (1983) Prevention of soccer injuries. Am J Sports Med 1983;11:116–20 36. Garrett WE Jr. (1996) Muscle strain injuries. Am J Sports Med 1996;24:S2–8 37. Horowits R, Podolsky RJ. (1987) The positional stability of thick filaments in activated skeletal muscle depends on sarcomere length: evidence for the role of titin filaments. J Cell Biol 1987;105:2217–23 38. Edman KAP, Reggiani C. (1984) Redistribution of sarcomere length during isometric contraction of frog muscle fibres and its relation to tension creep. J Physiol (Lond) 1984;351:169–98. 39. Magnusson SP, Simonsen EB, Aag aard P, et al. (1996) Mechanical and physiological responses to stretching with and without preisometric contraction in human skeletal muscle. Arch Phys Med Rehabil 1996;77:373–8 40. Moore MA, Hutton RS. (1980) Electromyographic investigation of muscle stretching techniques. Med Sci Sports Exerc 1980;12:322–9. 41. Halbertsma JPK, Goeken LNH. (1994) Stretching exercises: effect on passive extensibility and stiffness in short hamstrings of healthy subjects. Arch Phys Med Rehabil 1994;75:976–81 42. Safran MR, Garrett WE, Seaber AV, et al. (1998) The role of warmup in muscular injury prevention. Am J Sports Med 1988;16:123–9 43. Julie Gael, Elizabeth A. Arendt, and Boris Bershadsky (2005) Anterior Cruciate Ligament Injury in National Collegiate Athletic Association Basketball and Soccer Am. J. Sports Med., first published on Feb 8, 2005

Printable Metric Conversion Quiz

Do you feel confident about your ability to make metric to metric unit conversions? Heres a quick little quiz you can take to test your knowledge. You can take the quiz online or print it out. You may wish to review metric conversions before taking this quiz. An online version of this quiz is available if you prefer to be scored as you take the quiz. TIP:To view this exercise without ads, click on print this page. There are ___ in 2000 mm?(a) 200 m(b) 2 m(c) 0.002 m(d) 0.02 mThere are ____ in 0.05 ml?(a) 0.00005 liters(b) 5 liters(c) 50 liters(d) 0.0005 liters30 mg is the same mass as:(a) 300 decigrams(b) 0.3 grams(c) 0.0003 kg(d) 0.03 gThere are ____ in 0.101 mm?(a) 1.01 cm(b) 0.0101 cm(c) 0.00101 cm(d) 10.10 cm20 m/s is the same as:(a) 0.02 km/s(b) 2000 mm/s(c) 200 cm/s(d) 0.002 mm/s30 microliters is the same as:(a) 30000000 liters(b) 30000 deciliters(c) 0.000003 liters(d) 0.03 milliliters20 grams is the same as:(a) 2000 mg(b) 20000 mg(c) 200000 mg(d) 200 mg15 km is:(a) 0.015 m(b) 1.5 m(c) 150 m(d) 15000 m30.4 cm is:(a) 0.304 mm(b) 3.04 mm(c) 304 mm(d) 3040 mmThere are ____ in 12.0 ml?(a) 0.12 l(b) 0.012 1(c) 120 l(d) 12000 l Answers:1 b, 2 a, 3 d, 4 b, 5 a, 6 d, 7 b, 8 d, 9 c, 10 b

VoIP Security Service - Free Essay Example

Sample details Pages: 20 Words: 5948 Downloads: 4 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Chapter 4 VoIP Security Issues Don’t waste time! Our writers will create an original "VoIP Security Service" essay for you Create order 4.1 Denial-of-Service (DoS) in VoIP Purpose: The purpose of VoIP DoS attack is to exhaust network resources and interrupt VoIP operations through a flood of messages or by corrupting or degrading the quality of messages, thus preventing subscribers from effectively using the service. Situation: We must consider different scenario when studying DoS attacks: In a typical situation of establishing a VoIP connection for voice conversation where end systems or/and gateway are targets. At first place subscribers try to establish a voice call conversation over a VoIP channel. VoIP services should be available to subscribers when requested. In order to manage the Media gateways deployed across the communications, some VoIP systems use control protocols (e.g. MGCP and Megaco/H.248) and security mechanism. VoIP secure gateways (VoIP-SGW) are developed in advance to make IP telephony protocols friendly for common firewall configuration. In order to meet the unflawed communication level, a VoIP system must be having enough capability (i.e. routing, bandwidth, and QoS) that provide the VoIP system a high level proficiency of communication across the infrastructure. A secure VoIP system implements an intrusion detection system (IDS), firewall on the phone itself to check the media packet flow, or perform authentication. But at least a minimum set of defenses that filter unwelcome packets, for example a firewall, must be deployed. Problem: IP telephony subscribers need to be blocked from using VoIP services. The attack can be carried out taking advantage of the following vulnerabilities: VoIP security is in an initial phase at the moment, there is lack of expertise and security standards. Users might unintentionally expose the system. While there exist some basic countermeasures such as IDS and firewalls, administrator may not configure them appropriately Older firewalls cannot work interactively with VoIP and may leave open many more ports than VoIP actually uses for a transmission, leaving your machine vulnerable to hackers. Unit now VoIP has been developed and deployed focusing on functionality with less thought for security [SAV01]. That means that not vary advanced defenses are in place. For example, strong authentication is not common in VoIP. VoIP is vulnerable to DoS attacks which have not previously been a security issue with the circuit-switched telephony systems because of its analog nature. With the rush to implement new VoIP systems, features and standards, implementation flaws are common. IP PBXs include many layers of software that may contain vulnerabilities. Programming mistakes, such as not properly checking the size of the parameters of protocol request, when exploited, can result in the following issues. [VVS01] Remote access: An attacker obtaining remote (often administrator level) access. Malformed request DoS: A carefully crafted protocol request (a packet) exploiting a vulnerability which results in a partial or complete loss of function. Load-based DoS: A flood of legitimate requests overwhelming a system. As with any network-base service, enterprise VoIP must communicate with other components on a LAN and possibly over an untrusted network such as the internet, where packets are easy to intercept. Because RTP carries media, which must be delivered in real-time to be usable for an acceptable conversation, VoIP is vulnerable to DoS attacks that impact the quality delivery of audio such as those that affect jitter and delay. VoIP tools can offer very good cover traffic for DoS attacks because VoIP runs continuous media over IP packets [CRN01] Solution: Two basic standards are used for VoIP systems: H.323 and SIP. We consider here an attack in an H.232 environment. The SIP attack can be considered a variant of this pattern or a separate pattern. Likewise, specific Dos attacks against gateways will be analyzed from the supporting Megaco/H.248 protocol viewpoint. Figure 5.1 shows the class diagram of the structure of an H.323 system. The Layer 2 Switch provides connectivity between H.323 components. The Gateway takes a voice call from a circuit-switched Public Switched Telephone Network (PSTN) and places it on the IP network. The PSTN uses PBX switches and Analog Phones. The internet (IP network) contains Routers and Firewalls to filter traffic to the Terminal Devices. The gateway also queries the Gatekeeper via the Internet with caller/callee numbers and the gatekeeper translates them into routing numbers based upon service logic. The IP-PBX server acts like a call-processing manager providing call setup and routing the calls throughout the network to other voice devices. Softphones are applications installed in Terminal Devices (e.g. PCs or wireless devices). One method to launch a DoS attack is to flood a server with repeated requests for legal service in an attempt to overload it. This may cause severe degradation or complete unavailability of the voice service. A flooding attack can also be launched against IP phones and Gateways (e.g. a flood of register or invite events). With this form of DoS attacks, the target system is so busy processing packets from the attack that it will be unable to process legitimate packets, which will either be ignored or processed so slowly that the VoIP service is unusable. Attackers can also use the TCP SYN Flood attack (also known as resource starvation attack) to obtain similar results. This attack floods the port with synchronization packets, normally used to start a connection. In a Distributed DoS, multiple systems are used to generate a massive flood of packets. To launch a massive DDoS attack the hacker previously installs malicious software on compromised terminal devices (infected with a Trojan horse) that can be triggered at a later time (a.k.a. zombies) to send fake traffic to targeted VoIP components. Targeted DoS attacks are also possible where the attacker disrupts specific connections. The class diagram of Figure 5.2 shows the structure for a DDoS attack in an H.323 architecture where any VoIP component can be a target for Dos. Classes Attack Control Mechanism and Zombie describe the software introduced by the attacker. Note that the Zombie is just a terminal device in a different role. The sequence diagram of Figure 5.3 shows the sequence of steps necessary to perform an instance of a DoS attack of the first type mentioned above. An attacker (internal or remote), with knowledge of a valid user name on a VoIP system, could generate enough call requests to over-whelm the IP-PBX server. An attacker may disrupt a subscribers call attempt by sending specially crafted messages to his/her ISP server or IP PBX component, causing it to over allocate resources such that the caller receives a service not available (busy tone) message. This is an example of a targeted attack. Similarly, out-of-sequence voice packets (such as receiving media packets before a session is accepted) or a very large phone number could open the way to Application Layer attacks (a.k.a. Attacks against Network Services). Buffer Overflow attacks might paralyze a VoIP number using repeated calling. For example, an attacker intermittently sends garbage (I.e. both the header and the payload are filled with random bytes corrupting the Callees jitter buffer voice packets) to the callees phone in between those of the callers voice packets. Therefore the Callees phone is so busy trying to process the increased packet flow that the jitter (delay variation) causes any conversation to be incomprehensible [MDPV01] Figure 5.4 shows the class diagram of the structure of a Megaco/H.248 environment. Megaco/H.248 is the media gateway control protocol, this is a master-slave, transaction oriented protocol in which Media Gateway Controllers (MGC) control the operation of Media Gateways (MG) [VVDN02] VoIP media gateways are vulnerable to DoS because they accept signaling messages. In this setting a Dos attack would occur at MGC when the attacker sends large amount of UDP packets to the protocols default port 2944 or 2945, which keeps the MGC busy handling illegal messages, and finally blocks the normal service. An attacker can keep sending Service change or Audit capabilities command to a MG and thereby bring down the MG [SVID01]. Therefore, VoIP Gateways will not be able to initiate calls or maintain a voice call during a DoS attack. The audio quality will be affected as well. An alternative to launch DoS attacks is when an attacker redirects media sessions to a media gateway. The attack will overwhelm the voice component and prevent it from processing legitimate requests. Signaling DoS attacks on media gateways con consume all available Time Division Multiplexing (TDM) bandwidth, preventing other outbound and inbound calls and affecting other sites that use TDM, On the other hand, due to the fact that VoIP media session are very sensitive to latency and jitter, DoS on media is a serious problem. VoIP media, which is normally carried with RTP, is vulnerable to any attack that congests the network or slows the ability of an end device (phone or gateway) to process the packets in real time. An attacker with access to the portion of the network where media is present simply needs to inject large numbers of either RTP packets or high QoS packets, which will contend with the legitimate RTP packets [VVS01]. Consequences: The success of this attack implies: DoS can be especially damaging if key voice resources are targeted (e.g; media gateways). Flooding of the firewall can prevent it from properly managing parts for legitimate calls VoIP QoS can be degraded by jitter and delay and may become totally unusable. The Zombies in the targeted network can also be used as DoS launching points from which to attack anther network Possible sources of failure include: Threats and attacks can be defined but are difficult to carry out in practice, mainly due to lack of knowledge and testing opportunities for attackers. 4.2 Call Interception in VoIP: Purpose: The VoIP call interception pattern provides a way of monitoring voive packets of RTCP transmissions. This kind of attack is the equivalent of wiretapping in circuit switch telephone system. Context: Two or more subscribers are participating in a voice call conversation over VoIP channel, In public IP network such as the Internet, anyone can capture the packets meant for another user. In order to achieve confidentiality, enterprises may use encryption and decryption techniques when making or receiving VoIP calls. Since cryptographic algorithms are typically implemented in hardware, they are difficult to implement in VoIP, which is software-base. In VoIP network, transport-protocol based threats rely on a non-encrypted RTP stream [VIS03]. On the other hand, enterprises may route voice traffic over a private network using either point-to-point connections or a carrier-based IP VPN service. Two basic standards are used for VoIP systems: H323 and SIP. We consider here an attack in an H323 environment. The SIP attack can be considered a variant of this pattern or a separate pattern. Problem: A call that traverses in converged network needs to be intercepted. The attack can be carried out talking advantage of the following vulnerabilities. The Real Time Protocol (RTP) is not a complete protocol but rather a framework where vendors are provided implementation freedom according to their specific application profiles [VIS03]. This means that specific implementations may have diverse degrees of security. In RTP, information on the used codec is available in the header of every RTP packet, via the PT header field [VIS03] PC-based IP phones (a.k.a. Softphones) are applications installed on user systems (e.g. desktops) with speakers and microphones that reside in the data segment. It is possible for worms, viruses and other malicious software common on PCs to infect the voice segment in VoIP. In wireless VoIP (i.e. VoIPoW), publicly available software can be used to crack Wired Equivalent Privacy (WEP) products. As VoIP in a wireless environment operates on a converged (voice, data, and video) network, voice and video packets are subject to the same threats than those associated with data networks. Likewise, all the vulnerabilities that exist in a VoIP wired network apply to VoIPoW technologies plus the new risks introduced by weaknesses in wireless protocols. The tools used for call interception purpose can be downloaded freely on the internet, greatly increasing the potential of this type of attack. VoIP security is in an incipient phase at the moment, there is lack of expertise and security standards. Users might inadvertently expose the system. While there exist some basic countermeasures such as IDS and firewalls, administrators may not configure them appropriately. Unit now VoIP has been developed and deployed focusing on functionality with less thought for security [SAV01]. That means that not very advanced defenses are in place. For example, strong authentication is not common in VoIP. Because of the many nodes in packet network, call interception can be applied in many places. The transfer of voice data over public networks (i.e. the internet), facilitates the possibility of attacks on this technology. It is much easier to hack VoIP network hubs than traditional phone switches. Although hackers cannot intercept voice calls, they can have access to packets traversing the converged network. Anyone can record, duplicate and distribute to unintended parties voice calls over IP. IP Phones have become available for software developers. The increase in features and complexity comes however with a security cost: more application equal more avenues of attack [VST04]. VoIP is vulnerable to call interception attacks which have not previously been a security issue with circuit-switched networks where tapping requires physical access to the system. Therefore tapping is a serious concern in IP telephony when compared with the traditional telephony environment. Solution: VoIP Call interception gives attackers the ability to listen and record private phone conversation by interception both the signaling and the media stream. The attacker is also able to modify the content of the packets being intercepted acting as a man in the middle. In principle this threat affects both the signaling and the data depending on the ability of attacker of intercepting both [VST04]. Due to the fact that voice travels in packets over the data network, hackers can use data-sniffing and other hacking tools to identify, modify, store and play back unprotected voice communications traversing the network, thus violating confidentiality. A packet sniffer is a software application that users a network adapter card in promiscuous mode (a mode in which the network adapter card sends all packets received in the physical network wire to an application for processing) to capture all network packets that are sent across a particular collision domain. This packet sniffer application can reside in a general-purpose computer attached, for example, in a local area network [Fer05]. For example, the tool voice over misconfigured Internet telephones (a.k.a. vomit), takes an IP phone conversation trace captured by the UNIX tool tepdump, and reassembles it into a wave file which makes listening easy [DSCN01, SATT03] using MP3 or alternative audio files. The reassembled files can be co llected later, emailed or otherwise sent on the eavesdropper. Figure 5.5 shows the sequence of the steps necessary to monitor a VoIP conversation. Figure 5.5 Sequence diagram for a call interception With tepdump, hackers can identify the IP and MAC address of the phone to be attacked. By using an Address Resolution Protocol (ARP) spoofing tool, the attacker could impersonate the local gateway and the IP phone on the network, creating a default gateway [DSCN01]. This allows RTP streams to and from the target IP phone to be monitored by the attacker. The communication between the Gateway and Gatekeeper is equally vulnerable to call interception using the same techniques described for terminal devices. The RTP streams can be intercepted between the IP end-stations or between the Gateways and Gatekeeper (IP Trunk) [SATT03]. Likewise, the FragRouter tool would have to be enabled on the attacking machine so the data packets would reach their ultimate destination. If the hacker has access to the local switched segment, he may be able to intercept a call by inserting a phone into the voice segment with a spoofed Media Access Control (MAC) address, and assuming the target phones identity. Consequences The success of this attack implies: It is possible to listen in on a conversation by intercepting the unencrypted media stream between the two terminal devices. Attackers may use telephone systems for divulging crucial information such as Social Security numbers, Credit Card numbers or other confidential information. Inside a company, eavesdropping could allow access to confidential business information. Hackers could capture the packets and decode their voice packet payload between two or more VoIP terminal devices. Due to the fact that voice travels in packets over the data network, hackers can use data-sniffing and other hacking tools to identify, modify, store and play back unprotected voice communications traversing the network, thus violating confidentiality and integrity. A hacker breaking into a VoIP trunk has access to many more calls than he would with traditional telephone tapping. Consequently, he has a much greater opportunity of obtaining useful information from tapping a VoIP data stream than from monitoring traditional phone systems. Call interception attacks result in the attacker being able to use the intercepted data for other malicious intents, such as: call pattern tracking, number harvesting, and conversation reconstruction [VST04]. The interception and modification threat results in the attacker being able to modify the packets for malicious actions, examples are: Call blackholing the attacker intentionally drops essential packets (e.g. INVITE) of the VoIP protocol resulting the call initiation to fail; Call rerouting the attacker redirects the packets on a different path in order to include unauthorized nodes in the path or to exclude authorized ones from it; Conversation alteration the attacker alters the packets in order to modify the conversation between two users; Conversation degrading the attacker intentionally drops a selection of packets or modify the content of them with the objective of degrading the overall quality of the conversation [VST04]. Possible sources of failure include: Call Interception is somewhat limited because it would require physical access to the local network or remote access to a compromised host on the local network. Intercepting voice traffic as it crosses the Internet is more difficult because once the packetized voice hits the carrier; it becomes much harder to single out among other traffic. It is more difficult to intercept calls on VoIP networks than capturing and reading text messages on public networks. 4.3 Theft of Service in VoIP Intent The Theft of Service pattern provides an opportunity for attackers to gain access to the VoIP network by imitating subscribers and/or seizing control of terminal devices and performing free calls. Situation: The VoIP system should have adequate capability (i.e. routing, bandwidth, and QoS) to meet the peak communication load. The system may have a minimum set of perimeter defenses, e.g. a firewall. Some VoIP systems use control protocols (e.g. MGCP and Megaco/H.248) and security mechanisms, in order to manage the Media gateways deployed across the infrastructure as well as to make it difficult for an attacker to overcome system resources. In a converged network both the signaling and media traffic must be monitored. Similarly, secure VoIP implementations use cryptographic algorithms to protect the media packets. Theft of service attack (a.k.a. IP telephony fraud) is intended against service providers. Problem An unauthorized user wants to make expensive phone calls without paying for them. The attack can be carried out taking advantage of the following vulnerabilities: Theft of service attacks may be caused by inadequate security mechanisms in VoIP, the insertion of malicious software that modifies the normal behavior of terminal devices, and the unauthorized connection of devices to the network. It is possible to charge calls to another users account by using stolen user identification details. Phone usage and billing systems can be manipulated by fraudulent telephone users in order to make profit. The benefits of portability and accessibility introduced by IP Telephony have a downside of an increased risk of service theft [SATT03]. When using Hoteling, the primary protection against theft of service in the traditional telephony environment, the physical security of the handset, is no longer enough [SATT03]. Unattended IP telephone. Rogue telephones can be installed. MAC addresses are easy to spoof. Solution: This attack could be accomplished using several techniques. An attacker may just simply want to place calls using an unattended IP phone or assuming the identity of the legitimate user of a terminal device. The attacker uses the identity of the owner (i.e. identity theft) without the owners consent. She then charges the call to the owners account. A more complex method is when the attacker places a rogue IP phone on the network or uses a breached VoIP gateway to make fraudulent calls. In a service volume fraud, the attacker injects in the network more traffic than what declared in the session request in order to avoid paying for the used resources [VST04].Theft of service can also be perpetrated using falsified authentication credentials. A number of IP Telephony vendors authenticate their end points via Ethernet media access control addresses (MACs). MAC addresses are notoriously easy to spoof [SATT03]. An attacker might impersonate as an IP Telephony signaling server and request an end-device to perform authentication before dealing with its call request. Using the endpoints IP Telephony network credentials the malicious party will be able to authenticate to any IP Telephony based server as well as to place free of charge phone calls. Figure 7 shows the sequence of the steps necessary to commit theft of service in VoIP (Figure 1 shows the units involved). First, the attacker uses a brute force attack to find the special prefixes that Internet phone companies use to identify authorized calls to be routed over their networks. The attacker then looks for vulnerable ports and routers in private companies and gets their IP addresses. On finding vulnerable ports, she hacks into the network to get administrator names and passwords. The attacker then reprograms the routers to allow them to handle VoIP calls, and to masquerade the true source of the traffic. The attacker then routes her calls to the targeted network via the routers she has hacked, and then sends the calls from the targeted network to Internet phone service providers. She may also attach the access codes to the calls, so that the Internet phone providers believe they are legitimate calls. Finally, unauthorized calls will go through successfully and will be completed over the Internet phone provider networks. Sequence diagram for theft of service attack Another method of attack is by receiving an application in a spam email, or accidentally downloaded from the Internet. This application can direct the phone to call premium rate numbers by installing itself on a softphone (i.e. applications installed on user systems with speakers and microphones). Finally, the reduction in costs for Moves, Adds, and Changes (MAC) in an IP Telephony environment has led to the addition of daemons/services on many vendors IP Telephones. Some of the more popular services include HTTP, SNMP, and Telnet [SATT03]. Attackers may take advantage of the benefits of portability and accessibility introduced by VoIP to perform theft of service. Hoteling is one of the most popular features of VoIP, it consist of moving all the features, including address book, access abilities and personalized speed dial from one phone to another [SATT03]. When using Hoteling, the physical security of the IP phone is no longer enough. Consequences: The success of this attack implies: In order to make expensive calls to premium rate numbers, rogue devices could be attached to an organizations network without the users knowledge. Weaknesses in wireless security policies could also be exploited by rogue devices. Unauthorized phone calls will seem to originate from subscribers inside the attacked VoIP network. Attackers could also steal minutes from VoIP service providers and resell them on the black market. Attackers will be able to register for unauthorized services taking advantage of the virtual communication paths in IP networks. In IP telephony, premium rate numbers will be dialed automatically. Possible sources of failure include: Threats and attacks can be defined and theorized but are difficult to carry out in practice, mainly due to the lack of knowledge and testing opportunities for attackers. 4.4 Call Hijacking in VoIP Purpose: The Call hijacking attack pattern is intended to direct a participant or participants of a VoIP call to a terminal device other than the intended recipient. The hacker is able to trick a remote user into believing one is talking to his/her intended recipient when in fact one is really talking to the hacker. Situation: Two or more call participants exchanging information (signaling information and the packetized voice) between them. This call related information is exposed to a number of possible attacks when traversing public IP networks such as the Internet. Problem: A Call traversing a converged network needs to be redirected to an unintended recipient. This attack can be carried out taking advantage of the following vulnerabilities: SIP messages have no built-in means to insure integrity. SIP does offer limited built-in security. SIP is a technology still in development; it does not provide security built in capabilities. This protocol does not support integrity of the message contents. Sniffing tools are more effective when using SIP, which is text-based protocol. Registration in SIP is normally performed using UDP, which makes it easier to proof requests. Authentication is often not required and if present, its usually weak [BVIS01]. When authentication in SIP is used, it is not strong. Failed registrations are not always logged. SIP proxies will not normally detect directory scanning and registration hijacking attempts [BVIS01]. Since the data packets do not flow over a dedicated connection for the duration of a session, an adversary could manipulate the routing of packets and cause delay in certain paths forcing the packets to take a path chosen by the adversary. [ITVP01]. The signaling messages are sent in the clear, which allows an attacker to collect, modify and replay them as they wish. Attackers who successfully perform Call Interception attacks can compromise wireless networks with improperly configured access points. Solution: Although VoIP is implemented using various signaling protocols, we consider here an attack in an SIP environment. The H.323 attack can be considered a variant of this pattern or separate pattern. In a SIP environment, a proxy server is used to initiate calls on behalf of endpoints and control call routing. The proxy server also performs security functions such as authentication, authorization and network access control. Figure 5.8 shows the components for a SIP-based network, User Agents (UAs), are combinations of User Agent Client (UAC) and User Agent Servers (UAS). The UA is the phone and the register server receives registrations and requests updates to the location server, which keep track of the UAs. A UAC is responsible for initiating a call by sending a URL-addressed INVITE to the intended recipient. A UAS receives requests and sends back responses. The UAC and UAS are identified by SIP addresses. The proxy server is connected to VoIP gateway (to make possible a call from a regular telephone to an IP phone) and to other proxy servers. The registrar and location server may be integrated in the proxy server. The rest of the VoIP architecture is similar to Figure 5.1 and represented by a UML package. Once the call has been established, the RTP media streams ow between the end stations directly. Call Hijacking in VoIP requires breaking into a converged network and interception packets being sent between two or more subscribers participating in voice call conversation (please refer to Call Interception attack pattern). After the IP address or phone number of either party is discovered, malicious users can user this information to hijack the call. This attack is achieved by impersonating a legitimate UA to a SIP register substituting a legitimate IP address with an attacker IP address. The attacker then manipulates the registration associated with the victims SIP URI [VIS03]. In this way, by manipulating outgoing call requests, the attacker is able to substitute a legitimate IP address (of either party) in the header (e.g. the Form header of a SIP request) of the intercepted packet with her own address. The hijacking attack can be also be done by performing a DoS attack against the users device deregistering the user. Generating a registration race-condition in which the attacker sends repeatedly REGISTER requests in a shorter timeframe (such as ever 15 seconds) in order to override the legitimate users registration request [TAAC01]. The class diagram of Figure 5.9 shows the structure for a VoIP Call Hijacking attack in SIP architecture. The sequence diagram of Figure 5.10 shows the sequence of steps necessary to perform this type of attack. The hijack begins with the attacker sending a specially crafted REGISTER request to the target proxy/register, to unbind all existing registrations. If the server requires authentication, it replies to the REGISTER requests with a challenge. Once all legitimate contacts have been deleted, the attacker sends a second REGISTER message containing new Contact header line with the attackers address [BVIS01]. Registration hijacking can also be performed by intercepting and editing REGISTER requests sent between a valid UA and registrar. This attack is possible, but is less of concern than the attack described above [BVIS01].Likewise; the attacker can spoof a SIP response, indicating to the caller that the called party has moved to a rogue SIP address, and hijack the call. Consequences: The success of this attack implies: This attack causes all the victims calls to be received by the attacker or other unauthorized parties. Call hijacking can result in violation of confidentiality to the legitimate endpoint. By performing call hijack in VoIP, an attacker has complete control (i.e. manipulating, blocking, conferencing, and recording) of the call and has access to all SIP messages. The attackers station can also capture authentication or other call related information. Likewise it can masquerade as a voice mail system opening a channel to the attacker. By hijacking the call, the attacker can also perform a Man-In-The-Middle (MITM) attack, where it transparently sits between the calling and called UAs, able to collect and modify both the signaling and media. Another type of MITM attack involves redirection of an inbound call to a media gateway, generation toll fraud [BVIS01]. This attack can be successful even if the remote SIP proxy server requires authentication of user registration, because the SIP messages are transmitted in the clear and can be captured, modified and replayed. Through call hijacking, the attacker can perform various attacks including theft of service in VoIP or message tampering. It will also enhance the DoS vulnerability which will make the users device useless. When this attack is applied to a VoIP network, the Quality of Service (QoS) may be diminished to a noticeable level [ITVP01]. Possible sources of failure include: Successful attacks require that the fake responses coming from the attacker station contains the right header content to be accepted as legitimate. Some fields are especially hard to estimate or intercept and thus mirror [VIS03]. 4.5 IP Spoofing in VoIP Purpose: The VoIP Spoofing pattern is intended to allow hackers (internal or external), to masquerade a legitimate terminal device. Situation: Two or more subscribers are participating in a voice call conversation over a VoIP cannel that may be intercepted. In public IP networks such as the Internet, anyone can capture the packets meant for another user. Problem: An attacker needs to trick a remote user into believing one is talking to his/her intended recipient when in fact they are really talking to the hacker. The attack can be carried out taking advantage of the following vulnerabilities: VoIP devices such as IP phones, Gatekeepers, gateways and Proxy servers inherit the same vulnerabilities of the operation system or firmware [VS05] on top of which they run. Many SIP implementations still user the Universal Datagram Protocol (UDP) for transporting SIP messages, which is an unreliable form of packet transfer. UDP does not use re-transmission or sequence numbers, so it is easier for an attacker to spoof UDP packets [BVIS01]. Attackers may take advantage of the connectionless nature of the UDP protocol to spoof registration requests. Solution: IP spoofing gives attackers the ability to generate an IP packet with an IP source address other than its own. There are two methods of doing this. The hacker can use either an IP address that is within the range of trusted IP addresses for a network or an authorized external trusted IP address that has access to specified resources on a network. With user identification based in the IP layer and the IP layer easily tampered with, it is easy for unauthorized users to impersonate legitimate ones by marking packets sent over these networks with a borrowed IP address. These abuses of services and benefits (e.g. making international calls) occur at the expense of legitimate users, who are often completely unsuspecting until the bill arrives long after the abuser has disappeared [FA01]. IP spoofing is possible because the routing of VoIP packets is based only on the destination address. Due to the fact that that touting mechanism is not based on source addresses, when the packet is delivered to its destination address, the attacker address is that of source and not of the original sender. An IP Softphone can spoof the functionality and appearance of an IP hardphone to the call processing platform. Using tools such as SMAC (Spoof MAC) witch allows users to change MAC address for almost any Network Interface Cards (NIC) on the Windows 2000 and XP systems, the IP softphone can be configured quite easily to assume the full functionality and rights of any extension given only the MAC address of that extension [SATT03]. Some voice mail systems use Caller ID to authenticate administrative access to individual voice mail accounts. IF the Caller ID of an inbound call matches the number assigned to the telephone associated with the voice mailbox, the system assumes that the call is originating from that phone, and call is routed to the voice mailbox with administrative privileges. Caller ID can be readily spoofed using freely available PBX software and a H.323/VoIP gateway service, and possibly via other methods. Caller ID should not be trusted for authentication. [VMS06] Consequence: The success of this attack implies: Attackers can hide their identity for launching DoS attacks. Call hijacking and theft of service can also be accomplished using IP spoofing. When using this attack pattern, malicious users can bypass authentication and filtering in order to cause information leak, data modification, and arbitrary code execution. Without spoof mitigation filter a hacker might be able to spoof the address of the IP-PBX and UDP flood the entire voice segment [FA01]. Attackers will obtain access to sensitive logging data and routing information form subscribers; even if they are not capable of interception VoIP calls. IP spoofing attacks against VoIPoW networks makes other type of attacks possible. Attackers can establish itself as routing node and perform call interception for example. By using IP spoofing, attackers can take advantage of trust relationships based on the caller IP address. IP spoofing can also be used to gain important VoIP logging information in order to modify a call session. When spoofing weak authenticated voicemail systems, attackers can listen to and deleted messages, modify the greeting, and perform other administrative functions [VMS06]. Possible sources of failure include: The Transmission Control Protocol (TCP) is a connection oriented. Guaranteed-delivery transport. TCP is more secure than UDP, because it involves a negotiated setup and tear down, sequence numbers, and retransmissions for lost packets [BVIS01]. Successful attacks require that the forged responses coming from the attacker machines contains the right header content to be accepted as legitimate. Some header fields are especially hard to estimate or intercept and thus mirror [VIS03].

The Personality Disorder ( Ocd ) - 1578 Words

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Kimpton Hotels’ Free Essays

Kimpton Hotels’  EarthCare program brings the business’s philosophy of environmental responsibility straight to its properties, starting with its pioneering Eco Floor at the  Hotel Triton  in San Francisco in 1994. Today EarthCare’s efforts include: * Using environmentally friendly cleaning supplies in all rooms. * Printing corporate collateral on  recycled paper  using  soy-based ink. We will write a custom essay sample on Kimpton Hotels’ or any similar topic only for you Order Now * Usring recycled paper for all printing property-wide. * Serving organic, shade grown, and/or fair trade complimentary beverages in the lobby. * Allowing guests the opt out of towel and linen service. Recycling of glass,  bottles, paper, and cardboard through back of house operations. * Auditing and retrofitting back of house lighting to ensure  energy efficient bulbs  are in place. * Using low flow systmes for faucets, toilets, and showers. * Encouraging guests to  recycle  with in-room  recycling bins. * Stocking the honor bar with organic snacks and drinks. * Encouraging guests to donate unused amenity bottles to local charities. * Other practices, such as  recycling  coat hangers, eliminating styrofoam cups, using paperless checkin/out, purchasing organic flowers, and more. Kimpton properties are found in: * Scottsdale, AZ * Vancourver, BC Whistler, BC * Los Angeles, CA * San Diego, CA * San Francisco, CA * San Jose, CA * Aspen, CO * Denver, CO * Chicago, IL * B oston, MA * Cambridge, MA * New York City, NY * Portland, OR * Dallas, TX * Salt Lake City, UT * Alexandria, VA * Arlington, VA * Seattle, WA * Washington, DC * 1. Kimpton HotelsPresented by:GROUP 4Andrew Taylor, KirillCherepkov, Emily York, Alaina Alms,and Susan GrahamApril 23, 2009 * 2. Case QuestionsWhat further steps should Kimpton take to institutionalize its environmental commitments? ~AndyHow would you measure the success of the EarthCare Program, and how should it be reported to stakeholders? KirillWhat progress has Kimpton made in the four phases of its EarthCare Program sinc the case? ~EmilyWhat is the progress for each of the four phases? ~AlainaWhat is your overall assessment of their progress since the case? ~Susan * 3. How Would You Measure The Success Of The Earthcare Program? KirillCherepkov * 4. SustainabilityEnvironmental mgmt. (measuring success)Environmental audits (reporting) * 5. Environmental Mgmt. in PracticeMeasuring SuccessTop mgmt. w/ a commitment to susta inabilityLong-standing commitment†¦Phase 1 – 2 – 3 – 4 – 5 †¦Line mgmt. nvolvementLocal programsEmployee suggestions * 6. Environmental Mgmt. in Practice (cont. )Measuring SuccessCode of environmental conductâ€Å"Our Philosophy† Our philosophy on environmental responsibility is about more than contributing financially; it;apos;s about embracing behavioral change. This kind of change begins at home, is expanded at work, and now extends to who we choose to do business with†¦Ã¢â‚¬Å"EarthCare program †¦ was the right thing to do. † – Tom LaTour, Chairman and CEOCross-functional teamsJeff Slye, Business Evolution ConsultantEco-champions, co-leads, and program specialists * 7. Environmental AuditsReportingSustainability report:PepsiCo http://www. pepsico. com/Purpose/Sustainability/Sustainability-Report/Environmental-Sustainability. aspxCAT http://www. cat. com/cda/layout? m=199421;x=7Wal-Mart http://walmartstores. com/Sustainability/7951. aspxFordhttp://www. ford. com/micr osites/sustainability-report-2007-08/defaultCost savings:$250,000 per year in waste disposal†¦New business: â€Å"†¦$500,000 in meetings†¦Ã¢â‚¬  * 8. What Progress Has Kimpton Made In The Four Phases Of Its Earthcare Program Since The Case? Emily York * 9. Phase #1 Designed to make hotel staff comfortable with the concept of greener management. Energy Conservation: lighting retrofitted and audited to ensure energy efficient bulbs are in place Recycling: bottles, cans, paper, ; cardboardCleaning Chemicals: tub ; shower, glass, deodorizers, and disinfectantsPromotion Materials: recycled paper and soy-based inkComplimentary Coffee in Lobby: organically grownHonor Bar: includes organic snacks and beveragesTowel/Linen reuse: sheets and towels are replaced only at guest’s request * 10. Phase #2 Focuses on investments in water and energy conservation and organically-grown products. Water Conservation: implementation and auditing of low flow systems for faucets, toilets, and showers Energy Conservation: install motion sensors in rooms, florescent bulbs in corridors and back-of-houseOrganic Coffees ; Teas: served in rooms, meeting rooms, and lobby * 11. Phase #3 Extensive investment in in-room recycling of products and sale of organic/recycled products. In-room Designer Recycling Bins: guests are encouraged to participate in reducing our environmental impact Recycled Papers: for copying, notepads, toilet paper, and tissuesDonation Programs: instead of being thrown away, unused amenity bottles are donated and used by local charities Recycling: of employee dry-cleaned uniform bags and hangers*Guest can now shop the Kimpton Style catalog for eco-friendlyproducts like organic bedding and recycled glassware. * 12. Phase #4 Investment in building materials, labor, and appliances that are more eco-friendly. Energy Star: appliances, computers, and electronicsPaints: low-VOC paintsHeat/Air Conditioning: energy efficient * 13. NEW Phase #5 * 14. â€Å"Helping the environment because it’s the right thing to do. † – April 13, 2009http://www. changemakers. net/node/21543 * 15. Discuss The Specifics Of The Progress For Each Of The Four Phases. Alaina Alms * 16. OverviewWhat has been implementedProducts and Practices for each of the phasesGoalsAccomplishmentsAwards * 17. What has been implementedEarthCare Products and PracticesAs part of Kimpton EarthCare, every hotel adopts tandard environmentally friendly products and practices with high-impact and benefit to our planet. * 18. Products and Practices (Phase 1)Cleaning Supplies: All rooms cleaned with environmentally friendly cleaning products. Honor bar with organic food and beverage options: Honor bars include organic snacks and beverages. Soy Inks: All corporate collateral is printed on recycled paper using soy based ink . Towel/Linen Reuse: Guests have the opportunity to do their part to reduce energy and detergents required for daily washings. Recycling: Back of house recycling programs addressing glass, bottles, paper, cardboard, etc. * 19. Products and Practices (Phase 2)Organic Beverages: All complimentary lobby coffee is organic, shade grown and/or fair trade. Energy Conservation: Back of house lighting retrofitted and audited to ensure energy efficient bulbs are in place. Water Conservation: Implementation and auditing of low flow systems for faucets, toilets, and showers. * 20. Products and Practices (Phase 3)Recycled Paper: Property wide printing on recycled paper. Best Practices: At any hotel you may find environmental activities such as recycling of coat hangers, elimination of Styrofoam cups, paperless check-ins/outs, organic flowers, and more†¦ In-room designer recycling bins: Guests are encouraged to participate in reducing our environmental impact. Donation programs: Instead of being thrown away, unused amenity bottles are donated and used by local charities. Shop the Kimpton Style catalog: for eco-friendly products like organic bedding and recycled glassware. * 21. GoalsReduce waste in landfills by 15%Reduce energy and water usage by 15%Increase employee retention and morale by 10% * 22. Accomplishments;gt; 962,000 lbs of cardboard recycled~ 50,000 gallons of cleaning chemicals replaced with non-toxic alternatives;gt; 253 trees saved from using recycled paperAccomplished in one year in California alone * 23. AwardsCorporate Citizen of the Year. California EPA Awards. Kimpton has been honored with the 2007 California EPA Green Lodging designation. California Governor;apos;s Award. National GeoTourism Award. ttp://www. kimptonhotels. com/programs/earthcare. aspx Kimpton Hotels’ 7 Eco-friendly Best Practices Put Your Commitment in Writing Kimpton Hotels have one of those â€Å"elevator pitch† mission statements to describe their environmental stance. It states: â€Å"Support a sustainable world by using non-intrusive, high quality, eco-friendly products and services at all Kimpton hotels. † It’s short, sweet, descriptiv e and can easily be said to someone in the few seconds it takes to travel between floors in an elevator. Give Your Eco Program a Name Another way to add more credibility to you environmental efforts is to give your program a name. Kimpton calls their environmentally friendly green hotel practices, the â€Å"Earthcare† program. Like the mission statement, the name very succinctly states the corporate policy and carries with it the feeling that the company’s taking an organized, focused approach to preserving the environment and is already succeeding in its efforts. Provide Your Own Green Business Certification On its Earthcare page, Kimpton lists all of the things they do to be eco-friendly. These actions might not be enough to help them qualify for some green certifications, but anyone can see that they’re serious about their commitment to the environment. This strategy also makes it easier for the media to write about them. Today Show travel editor Peter Greenburg reproduced the Kimpton list of Earthcare Products and Practices verbatim when he mentioned Kimpton Hotels in his article on green lodging. Peter Greenburg’s Article: Eco-Friendly Travel: Hotels and the Green Bandwagon Put Your Results in Real Numbers That People Can Understand Advertising copywriters are taught to write about benefits, not features. In this video on the Sundance Channel, not only can Mike Depatie, the CEO and President of Kimpton Hotels, outline the company’s philosophy and detail all the changes the hotels have made, but he can also articulate the impact it’s having on the environment. Here are just a few of the benefits that are mentioned in the video: â€Å"Hotel Triton recycles 60% of waste. † â€Å"Their low flow toilets, shower heads and faucets save 15 – 30,000 gallons of water each year. â€Å"Their environmentally friendly cleaning products save 50,000 gallons of chemicals being dumped into the environment. † † Their recycling efforts and use of recycled paper products have saved over 253 trees and eliminated 18,000 pounds of waste. † Reward Your Customers for Their Conservation Efforts Kimpton Hotels offer discounts for guests arriving in a hybrid vehicle. The perks vary from saving 10% on the room rate at some properties, to saving as much as 50% off the overnight parking rate at others. Gather Multiple Awards As we stated in our article on obtaining a Green Business Certification for your small or medium-sized business, you should seek out â€Å"certification† from as many organizations as possible. Take one look at the Earthcare page, and you’ll see that Kimpton has done just that by gaining recognition, accreditation, and accolades from a variety of sources in government and in the lodging industry. Here’s a list of the various organizations that have recognized Kimpton Hotels for their eco-friendly hotel practices. Local and State Governments The city of Salt Lake City, Utah. San Francisco Green Business program State of California State of California EPA National Trade Associations Travel Industry and Association of America American Hotel Lodging Association International Trade Associations Hotel Association of Canada State Trade Associations Massachusetts Lodging Association Media National Geographic Traveler Magazine USA Today Travel and Leisure Seattle Magazine MSNBC Sundance Channel, Ecobiz Keep It Fresh How to cite Kimpton Hotels’, Papers

Social Processes free essay sample

This paper discusses violent social behavior, and how it is acquired. This paper analyzes the theory of violence and criminal behavior through the explanation of the theories of containment, learning and social strain. The author uses a case study of a juvenile delinquent based on the various social theories relating to the violent behavior. Sociologists try to understand the human behavior within the society. In the past it was assumed that human behavior was a part of the genetic inheritance but as time passed research showed that the human behavior is more affected by the social and physical environment rather than by genetic structure. To explain the different behaviors exhibited by humans, especially those of violence sociologists presented sociological theories on which basis they could predict, evaluate and analyze human behavior. Consider then the Social Learning Theory: This theory pertains to the hypothesis that a human beings act according to the values taught by the society and environment around them. We will write a custom essay sample on Social Processes or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page As a child they learn through the punishment and reward as parents teach them right from wrong. The peer groups and the school settings etc then reinforce the lesson. Social definitions begin to act as cues signaling the socially acceptable behavior and so behavior is organized around seeking pleasure and avoiding pain.