1. Averting loss of quality in performance in traveling swimmers K.M.S. Aziz, Ph.D (Duke)

2. Averting preventable causes What is meant by avertion? –Averting Behaviour refers to actions that people take to reduce damages. –By formally describing (modeling) the averting behaviour we get useful estimates.

3. Problems faced by traveling athletes Infectious diseases Jet lag/ Circadian rhythm Altitude changes Nutritional problems Immunization Stress

4. Causes and Avertion Awareness is needed in order to avert the causes. Defensive behaviour to avert/prevent causes which result in reduced performance.

5. Research issues Damage Cost should be estimated –Damages Loss of performance Cost of treatment Opportunity cost of time lost Loss of potential contracts Psychological cost

6. Infectious diseases Diarrhea –E. coli ETEC/EIEC/EHEC/EPEC –Shigella/Salmonella –Plesiomonas shigelloides –Campylobacter sp. –Vibrionaceae Vibrio cholerae V. parahaemolyticus Aeromonas spp.

7. Parasites/Protozoa Giardia lamblia Entamoeba histolytica Cyclospora cayetanensis Trichomonas hominis Cryptosporidium Malarial parasites

8. Viral Causes Rotavirus Adenovirus

9. Jet lag/ Circadian rhythm Misalignment between the internal circadian timing system and the external environment. –Factors Physiological Behavioral Environmental Fatigue is a powerful predictor of jet lag.

10. Altitude Changes Going to high altitude from Sea level High altitude training is not without cost Living high training High Living high-training low Planning optimal time of arrival

11. Nutritional problems Lack of balance Nutritional supplements Cultural diversity of Food Vomiting tendency/Anorexia/Bulimia

12. Immunizations Update routine childhood immunizations Hepatitis A and B Typhoid Meningitis Cholera Yellow fever

13. Immunosuppression Masters Swimmers Immunocompromised Individuals

14. Stress Cuts across from the time of preparations for travel to pre competition tension. Anorexia nervosa, bulimia are related. Insomnia is common

15. Conclusion Evidence based avertion measures are needed. Research is needed for Evidence. Public policy geared towards athlete’s health mitigation. Ascertain value of a statistical career (VSC).