Matthew Wyon

University of Wolverhampton, Research Centre for Sport, Exercise, and Performance, Faculty Member

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Christos Papakostas

University of Ioannina/Greece

Sebahattin Devecioglu

University of Firat

Bruno Leban

University of Cagliari

Petko Kiriazov

Bulgarian Academy of Sciences

John Sutton

Macquarie University

Evangelos Bebetsos

Democritus University of Thrace

Daniel Ribeiro

University of Otago

Maria Alves

Universidade de Lisboa

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Loyola Marymount University

pasztai zoltan

University of Oradea

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Papers by Matthew Wyon

A Comparison of Strength and Stretch Interventions on Active and Passive Ranges of Movement in Dancers

Journal of Strength and Conditioning Research, Nov 1, 2013

Please provide the middle initial(s) for all the authors in the author group. AU2) Please provide... more Please provide the middle initial(s) for all the authors in the author group. AU2) Please provide the department (if any) for all the affiliations and also check the city name of affiliations 1 and 3. AU3) Please clarify if the "10°" represents the degree of angle in the sentence "They used the end-of-range...". AU4) Please spell out "RPE" at all occurrences in the text. AU5) Please provide the volume number and check the year of publication in Ref. 13. AU6) Please provide the volume number for Refs. 9 and 13. AU7) Please check the year of publication in Ref. 18. AU8) Please update "in press" Ref. 35 and provide the volume number and page range for the same. AU9) Please provide the designator for the footnote "*" in Table 2.

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The Effect of Whole-Body Vibration on Jump Height and Active Range of Movement in Female Dancers

Journal of Strength and Conditioning Research, Mar 1, 2012

Whole-body vibration (WBV) has been shown to have beneficial effects on strength and power indice... more Whole-body vibration (WBV) has been shown to have beneficial effects on strength and power indices in sedentary and moderately trained individuals. The aim of the present study was to investigate the effect of 4 weeks WBV on jump height, active range of motion and leg anthropometry in conservatoire dance students. 17 female dancers were randomly assigned to a control or intervention group. The intervention group trained for 30 seconds per position at 35Hz frequency, 8mm displacement in the first 2 weeks, and 40 seconds at 40Hz for the final two weeks whilst the control group carried out the same exercises but without vibration stimulation. A significant (p<0.01) difference in the intervention group was noted over time for vertical jump and active ROM. No significant changes over time were noted for the anthropometric data. In conclusion WBV can be used as a beneficial supplemental training intervention to increase jump and active flexibility in highly trained dancers without corresponding increases in relative anthropometric data. Response to Reviewers: JSCR-08-1377, entitled "The effect of Whole Body Vibration on jump height and active range of movement in female dancers" Reviewer #1: Interesting paper. Some brief questions for consideration. How did you determine time (sec) at each position on the platform? Was this based on previous literature? Au: yes this was based on previous literature and the references have now been provided. Also how did you determine what frequency (Hz) to set the platform at? Again, was this a collaborative decision or based on previous literature? Au: yes this was based on previous literature and the references have now been provided. Pictures of the positions (the ones performed on the platform) would be helpful and add conceptualization to the article.

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The Effect of a Comprehensive Injury Audit Program on Injury Incidence in Ballet

Clinical Journal of Sport Medicine, Sep 1, 2013

Objective: The aim of this study was to determine whether an intervention with individualized con... more Objective: The aim of this study was to determine whether an intervention with individualized conditioning program based on past injury history and functional movement screening would be effective in reducing ballet injury incidence. Design: Prospective three year epidemiological study. Setting: Professional Ballet Company and its in-house medical facility. Participants: Dancers from a professional ballet company over the three year study period. Participant numbers ranged from 52 to 58 (Year 1: 52; Year 2: 58; Year 3: 53). Interventions: The intervention consisted of individual conditioning programs developed using injury history and functional movement screening. Analysis was undertaken of the all dancers who were present in the company during the study period. The significance of change in injuries over a 3-year period was determined using a Poisson distribution model. Main Outcomes Measurements: To determine whether individual conditioning programs resulted in a decrease in injury incidence over the study period. Results: The injury count reduced significantly in Year 2 and 3 (P<.001). Injury incidence for male dancers declined from Year 1 (4.76/1000hrs) to Year 2 (2.40/1000hrs) and Year 3 (2.22/1000hrs). For females, a reduction in the injury incidence was observed in Year 2 (1.71/1000hrs) and Year 3 (1.81/1000hrs) compared to Year 1 (4.14/1000hrs). Conclusions: Through prospective injury surveillance we were able to demonstrate the benefit of individualized conditioning programs based on injury history and functional Title page The effect of a comprehensive injury audit program on injury incidence in ballet: a 3-year prospective study

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Ankle and Foot Contributions to Extreme Plantar- and Dorsiflexion in Female Ballet Dancers

Foot & Ankle International, Feb 1, 2011

Background: Female ballet dancers require extreme ankle motion. The objective of this study was t... more Background: Female ballet dancers require extreme ankle motion. The objective of this study was to quantify the relative contributions of the ankle and various foot joints to extreme plantarflexion (PF) and dorsiflexion (DF) in female ballet dancers using an X-ray superimposition technique and digital graphics software. Materials and Methods: One asymptomatic ankle was studied in each of seven experienced female ballet dancers. Three lateral weightbearing X-rays were taken of each ballet dancer's ankle: en pointe (maximum PF), in neutral position, and in demi-plié (maximum DF). Using graphics software, a subject's three X-ray images were superimposed and the tall were aligned. On each image the tibia, navicular, intermediate cuneiform, and first metatarsal were marked. Positional differences of a bone's line among the three images demonstrated angular movement of the bone in degrees. The neutral position was the reference from which PF and DF of the bones were calculated. Results: The talocrural joint contributed the most motion of any pair of bones evaluated for both PF and DF, with mean movements of 57.6 ± 5.2 degrees en pointe and 24.6 ± 9.6 degrees in demi-plié. Approximately 70% of total PF and DF were attributable to the talocrural joint, with the remaining 30% coming from motion between adjacent pairs of the studied foot bones. Conclusion: Superimposed X-rays for assessing ankle and foot contributions to the extreme positions required of female ballet dancers offer insight into how these positions are attained that is not available via goniometry. Clinical Relevance: Functional information gained from this study may assist clinicians in assessing ankle and foot pain in these individuals.

Magnetic resonance imaging of the ankle in female ballet dancers <i>en pointe</i>

Acta Radiologica, Jul 1, 2010

Background: Ballet dancers require extreme range of motion of the ankle, especially weight-bearin... more Background: Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion ( en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study. Purpose: To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects. Material and Methods: Nine female ballet dancers (age, 21±2.9 years; dance experience, 16±4.1 years; en pointe dance experience, 7±4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe. Results: Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda’s process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects. Conclusion: This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers.

The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: A controlled study

Journal of Science and Medicine in Sport, 2014

Athletes who train indoors during the winter months exhibit low serum 25-hydroxyvitamin D [25(OH)... more Athletes who train indoors during the winter months exhibit low serum 25-hydroxyvitamin D [25(OH)D] concentrations due to a lack of sunlight exposure. This has been linked to impaired exercise performance. The purpose of this study was to assess the effects of oral vitamin D₃ supplementation on selected physical fitness and injury parameters in elite ballet dancers. Controlled prospective study. 24 elite classical ballet dancers (intervention n=17; control n=7) participated in a controlled 4-month oral supplementation of vitamin D₃ (2000 IU per day). Isometric muscular strength and vertical jump height were measured pre and post intervention. Injury occurrence during the intervention period was also recorded by the in-house medical team. Repeated measures ANOVA and Mann-Whitney-U statistical tests were used and significance was set at p ≤ 0.05. Significant increases were noted for the intervention group for isometric strength (18.7%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and vertical jump (7.1%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). The intervention group also sustained significantly less injuries than the controls during the study period (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Oral supplementation of vitamin D₃ during the winter months has beneficial effects on muscular performance and injury occurrence in elite ballet dancers.

Measurement of the Extreme Ankle Range of Motion Required by Female Ballet Dancers

Foot and Ankle Specialist, Jun 25, 2010

Body Mass Index, Nutritional Knowledge, and Eating Behaviors in Elite Student and Professional Ballet Dancers

Clinical Journal of Sport Medicine, Sep 1, 2014

Objective: It is recognized that there is a high esthetic demand in ballet, and this has implicat... more Objective: It is recognized that there is a high esthetic demand in ballet, and this has implications on dancers' body mass index (BMI) and eating behaviors. The objective of this study was to examine the association between BMI, eating attitudes, and nutritional knowledge of elite student and professional ballet dancers.

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The Effects of the 11+ Dance Neuromuscular Program on Jump Height and Lower Extremity Biomechanics in Female Adolescent Dancers: A Non-Randomized Controlled Pilot Trial

Journal of Dance Medicine & Science

Introduction: Neuromuscular warm-up programs, such as FIFA 11+ were developed as early as 2006. T... more Introduction: Neuromuscular warm-up programs, such as FIFA 11+ were developed as early as 2006. These programs have been effective in reducing the risk of injury in female athletes by decreasing the moments surrounding the knee and improving neuromuscular control during static and dynamic movements such as jumping and landing. In addition, they have been effective for improving jump height in soccer, volleyball, and basketball. Methods: The effects of the 11+ Dance, a dance-specific neuromuscular warm-up program, was examined on jump height and lower extremity biomechanics during bilateral and single leg countermovement jumps in recreational dancers. Twenty female adolescents from 2 dance schools participated in this 2-centered 8-week controlled non-randomized trial. The intervention group (IG) performed the 11+ Dance program 3×/week for 8-weeks during the first 30-minute of their regularly scheduled dance classes. The control group (CG) continued with their regular dance classes ro...

Strengths and Vífeaknesses of Current Methods for Evaluating the Aerobic Power of Dancers

Journal of Dance Medicine & Science

The methods of measuring aerobic power in dance is reviewed. The underlying metabolic pathways us... more The methods of measuring aerobic power in dance is reviewed. The underlying metabolic pathways used during dance class and performance are examined and, in conclusion, dance has been classified as an intermittent form of exercise. The relevancy of measuring maximal oxygen uptake (VO2max) in relation to intermit-tent exercise is discussed with regard to other sports. Previous dance VO2max data is examined in relationship to other exercise forms and it is shown to be comparable to results in other non-endurance sports. The limitations of graded exercise tests with regards to extrapolating oxygen data from heart rates during dance has been highlighted as a flaw in a number of previous research studies and a limitation to be aware of in future re-search. Due to the infancy of dance science, the availability of valid and reliable laboratory and field tests are limited and, therefore, until further research is done, there needs to be a reliance on tests de-veloped in the health and sport ...

Determining Pointe Readiness in Young Adolescent Female Dancers: A Systematic Review

Journal of Dance Medicine & Science

Dancing en pointe is an integral aspect of ballet for female dancers and they start pointe traini... more Dancing en pointe is an integral aspect of ballet for female dancers and they start pointe training in young adolescence. The primary objective of this review was to investigate the screening tests used to determine pointe readiness in young adolescent female dancers, and the secondary objective was to determine the injuries associated with pointe training. The search engines Google Scholar, PubMed, Scopus, and Web of Science were mined using medical subject heading terms "pointe," "pointe readiness," "injury," "young," "adolescent," "female," and "dancer," and a manual search of relevant articles was conducted. The inclusion criteria were: females aged 8 to 20 years, pre-pointe, training en pointe, and pointe-related injury. The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following data were extracted; first author, year of publication, ...

Online Dance Injury Monitoring: The Efficacy of Weekly Reporting and Respondent Compliance Over a 30-Week Period

Journal of Dance Medicine & Science

Background: Previous injury survey recall methods often use one-off questionnaires with varying p... more Background: Previous injury survey recall methods often use one-off questionnaires with varying periods of recall. These methods have proven to show injury incidence inaccuracies and limited information on injury etiology. Purpose: The present study aimed to examine the efficacy of a remote weekly self-report injury incidence and etiology tool. Methods: Two online questionnaires were developed based on the “Fit to Dance 2” survey and sent to volunteers. The first questionnaire was sent once and asked for complete injury history information. The second questionnaire was sent to each respondent on a weekly basis and it focused on new injuries and their causes and whether injuries that occurred in previous weeks were still affecting their dancing. The online survey was opened for full-time dance students from September 2020 to July 2021. All weekly data for each respondent were combined with a unique reference code using their account names, students’ numbers, and schools’ names. The p...

Hip Hop Party Dance: Cardiorespiratory Profile and Responses to a Predefined Sequence

Journal of Dance Medicine & Science

Hip hop is a popular dance genre practiced worldwide that has gained popularity since the 1970s. ... more Hip hop is a popular dance genre practiced worldwide that has gained popularity since the 1970s. Despite this, studies related to the area and its physiological demands are still scarce. The purpose of this study was to report the cardiorespiratory profile of a group of male and female hip hop dancers to determine the zones of intensity of a predefined hip hop party dance sequence. Eight Brazilian professional hip hop dancers, four women and four men, mean age 22 ± 2.3 years, participated in the study. Using a portable gas analyser (Cosmed K5) their cardiorespiratory variables were measured at two different times: first, during a maximal treadmill test and later during a predefined hip hop party dance sequence. Descriptive statistics (mean and standard deviation) were used for calculating the dependent variables: oxygen consumption (VO2), heart rate (HR), and the intensity zones for the predefined hip hop sequence. Data normality was verified using the Shapiro-Wilk test. The Mann-Wh...

Neuromuscular Training in Pre-Professional Ballet Dancers: A Feasibility Randomized Controlled Trial

Journal of Dance Medicine & Science

Introduction: It is well documented that there is high prevalence of injuries in pre-professional... more Introduction: It is well documented that there is high prevalence of injuries in pre-professional and professional ballet dancers. Current evidence from high in quality and quantity research on in- jury prevention in sport indicates that interventions can reduce injury risks by 30% to 50%. Injury prevention research in dance is limited. The aim of this study was to assess the feasibility (adherence, fidelity, and practicality) of a randomized controlled trial for the utilization of neuromuscular training in pre-professional ballet dancers. Methods: A convenience sample of 22 pre-professional ballet dancers were randomized into an intervention and control group. The intervention group took part in a neuromuscular-based training workout, five times per week before the ballet class, for 10 weeks. The intervention was an adaptation of the FIFA 11+, an injury prevention intervention and is called 11+ Dance. The intervention consisted of low intensity bodyweight exercises that lasted 20 t...

The Relationship of Year Group and Sex on Injury Incidence and Countermovement Jump in Adolescent Ballet Dancers: A Cross-Sectional Analysis

Journal of Dance Medicine & Science

Introduction: Pre-professional ballet training involves long training hours from an early age tha... more Introduction: Pre-professional ballet training involves long training hours from an early age that could influence young dancers' physical performance and injury incidence. This cross-sectional analysis investigated the relationship of year group and sex with countermovement jump and injury incidence (primary outcome) in adolescent ballet dancers at a pre-professional dance school. Method: Countermovement jump (CMJ) height was recorded at the start of the academic year for 179 participants (M = 68, F = 111) spread across eight year-groups. Injury etiology and incidence was prospectively recorded over a 6-month period (September through February) by the medical team using a time-loss definition. Results: Between-subject statistically significant differences were reported for sex [F(1, 153) = 101.46; p < 0.001], year group [F(7, 153) = 12.57; p < 0.001], and sex*year group [F(7, 153) = 9.22; p < 0.001]. Mean CMJ across the year groups ranged between 24.7 to 41.3 cm for ma...

Development of the Dance Fitness Indicator©: A High-Intensity Dance Fitness Test: A Preliminary Study

Medical Problems of Performing Artists, 2022

OBJECTIVE: The aim of this study was to develop a contemporary dance technique-specific, high-int... more OBJECTIVE: The aim of this study was to develop a contemporary dance technique-specific, high-intensity dance fitness test and carry out preliminary testing into measuring the physiological intensity and reliability. The choreography of the Dance Fitness Indicator© (DFI) is based upon Humphrey/Limón, Graham, and Cunningham techniques and includes dance elements that relate to fitness elements, that increase in intensity over four levels designed to observe changes in heart rate (HR) and rate of perceived exertion (RPE) as the DFI progresses. Each level lasts for 4 minutes, 16 seconds, with a 1-minute rest between each level; the full DFI lasts for 20 minutes, 12 seconds. METHODS: Twelve contemporary dancers (9 females, age 24±6.86 yrs; 3 males, age 20±0.58 yrs) were taught the DFI in a familiarization session before undertaking two test trials, within a 1-week period. Dependent variables to measure intensity were heart rate (HR), rate of perceived exertion (RPE), and blood lactate (...

Impact Attenuation and Deformation Characteristics of Dance Floors on Jump Kinematics

International Journal of Sports Medicine, 2022

Specialist dance floors have been promoted to reduce impact forces and reduce lower limb injury f... more Specialist dance floors have been promoted to reduce impact forces and reduce lower limb injury for dancers. 18 trained female dancers carried out 70 continuous ballet jumps on 4 different surfaces wearing an XSENS suit. Three specialist dance floors, Floor A (64% force reduction), Floor B (67% force reduction), Floor C (no data) were compared to Floor D (vinyl-covered concrete - control). Dependent variables for each analysed jump (2,3,4, and 67,68,69) were ankle, knee, hip range of movement (ROM); lower and upper leg angular velocities and pelvis vertical acceleration. No main effects were reported for dance floor, first and last jump series. Comparison of the floors against Floor D reported a main effect for the dance floors (p=0.001), first and last jump series (p=0.001). Between-subject effects noted that ankle ROM was significantly greater for trials on floor A (p=0.007) compared to floor D. ROM data significantly decreased between the first and last jump series whilst vertica...

Cross-Training for the Dancer

Performing Arts Medicine, 2019

Nutritional and pharmacological supplementation in dance: Antecedents, prevalence and outcomes

26th Annual Conference of the International Association for Dance Medicine & Science (Wanchai, Ho... more

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Body composition and injuries in professional ballet dancers

Dancers are at a high risk of becoming injured, and most dancers sustain at least one injury per ... more Dancers are at a high risk of becoming injured, and most dancers sustain at least one injury per year. Research into injury risk factors is, therefore, imperative in order to identify strategies for prevention. The aim of this study was to examine professional ballet dancers, investigating their bone mineral density (BMD), body composition (lean and fat mass), menstrual history, company position, incidence and severity of musculoskeletal injury, and the relationships among these variables. One hundred and eleven dancers (39 male and 72 female) volunteered for the study. BMD and body composition were measured by DXA. Questionnaires recorded menstrual, medical and family history, medications, use of oral contraceptives, smoking, and alcohol intake. Injury incidence and severity data were collected using physiotherapy records from the two consecutive years following DXA. Statistical analysis was performed using SPSS, with statistical significance set at p<0.05. Frequency and severit...

A Comparison of Strength and Stretch Interventions on Active and Passive Ranges of Movement in Dancers

Journal of Strength and Conditioning Research, Nov 1, 2013

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The Effect of Whole-Body Vibration on Jump Height and Active Range of Movement in Female Dancers

Journal of Strength and Conditioning Research, Mar 1, 2012

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The Effect of a Comprehensive Injury Audit Program on Injury Incidence in Ballet

Clinical Journal of Sport Medicine, Sep 1, 2013

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Ankle and Foot Contributions to Extreme Plantar- and Dorsiflexion in Female Ballet Dancers

Foot & Ankle International, Feb 1, 2011

Magnetic resonance imaging of the ankle in female ballet dancers <i>en pointe</i>

Acta Radiologica, Jul 1, 2010

The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: A controlled study

Journal of Science and Medicine in Sport, 2014

Measurement of the Extreme Ankle Range of Motion Required by Female Ballet Dancers

Foot and Ankle Specialist, Jun 25, 2010

Body Mass Index, Nutritional Knowledge, and Eating Behaviors in Elite Student and Professional Ballet Dancers

Clinical Journal of Sport Medicine, Sep 1, 2014

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The Effects of the 11+ Dance Neuromuscular Program on Jump Height and Lower Extremity Biomechanics in Female Adolescent Dancers: A Non-Randomized Controlled Pilot Trial

Journal of Dance Medicine & Science

Strengths and Vífeaknesses of Current Methods for Evaluating the Aerobic Power of Dancers

Journal of Dance Medicine & Science

Determining Pointe Readiness in Young Adolescent Female Dancers: A Systematic Review

Journal of Dance Medicine & Science

Online Dance Injury Monitoring: The Efficacy of Weekly Reporting and Respondent Compliance Over a 30-Week Period

Journal of Dance Medicine & Science

Hip Hop Party Dance: Cardiorespiratory Profile and Responses to a Predefined Sequence

Journal of Dance Medicine & Science

Neuromuscular Training in Pre-Professional Ballet Dancers: A Feasibility Randomized Controlled Trial

Journal of Dance Medicine & Science

The Relationship of Year Group and Sex on Injury Incidence and Countermovement Jump in Adolescent Ballet Dancers: A Cross-Sectional Analysis

Journal of Dance Medicine & Science

Medical Problems of Performing Artists, 2022

Impact Attenuation and Deformation Characteristics of Dance Floors on Jump Kinematics

International Journal of Sports Medicine, 2022

Cross-Training for the Dancer

Performing Arts Medicine, 2019

Nutritional and pharmacological supplementation in dance: Antecedents, prevalence and outcomes

26th Annual Conference of the International Association for Dance Medicine & Science (Wanchai, Ho... more

Download

Body composition and injuries in professional ballet dancers

Stretch Intensity vs. Inflammation: A Dose-dependent Association?

by Nikos Apostolopoulos, International Journal of Kinesiology and Sports Science (IJKSS), and Matthew Wyon

The intensity of stretching is rarely reported in scientific literature. In this study, we examin... more The intensity of stretching is rarely reported in scientific literature. In this study, we examined the effects of stretching
intensities at 30%, 60%, and 90% of maximum range of movement (mROM) on the inflammatory response of the right
hamstring muscle. Methods: A randomised within-subject trial was conducted with 11 healthy recreationally active
males over a three week period. Participants were strapped into an isokinetic dynamometer in the supine position, with
the right knee fastened in a knee immobilizer. After randomising the ROM percentages, the hamstring muscle was
moved to one of the three chosen ROM percentages for that week and held there for 5 x 60 seconds followed by a 10
second rest between repetitions. A 5ml blood sample was collected pre-, immediately post, and at 24 hours post
intervention for high sensitivity C-reactive protein (hsCRP) assessments. Results: Significant increases in hsCRP levels
were observed between 30% mROM and 90% mROM (p=0.004) and 60% mROM and 90% mROM (p=0.034), but not
between 30% and 60% (p>0.05). Conclusions: Muscle stretching at submaximal levels does not elicit a significant
systemic inflammatory responses.

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