Sprint cycling rate of torque development associates with strength measurement in trained cyclists.

PURPOSE: A cyclist's rate of force/torque development (RFD/RTD) and peak force/torque can be measured during single-joint or whole-body isometric tests, or during cycling. However, there is limited understanding of the relationship between these measures, and of the mechanisms that contribute to each measure. Therefore, we examined the: (i) relationship between quadriceps central and peripheral neuromuscular function with RFD/RTD in isometric knee extension, isometric mid-thigh pull (IMTP), and sprint cycling; and (ii) relationship among RFD/RTD and peak force/torque between protocols. METHODS: Eighteen trained cyclists completed two familiarisation and two experimental sessions. Each session involved an isometric knee extension, IMTP, and sprint cycling protocol, where peak force/torque, average and peak RFD/RTD, and early (0-100 ms) and late (0-200 ms) RFD/RTD were measured. Additionally, measures of quadriceps central and peripheral neuromuscular function were assessed during the knee extension. RESULTS: Strong relationships were observed between quadriceps early EMG activity (EMG50/M) and knee extension RTD (r or ρ = 0.51-0.65) and IMTP late RFD (r = 0.51), and between cycling early or late RTD and peak twitch torque (r or ρ = 0.70-0.75). Strong-to-very strong relationships were observed between knee extension, IMTP, and sprint cycling for peak force/torque, early and late RFD/RTD, and peak RFD/RTD (r or ρ = 0.59-0.80). CONCLUSION: In trained cyclists, knee extension RTD or IMTP late RFD are related to measures of quadriceps central neuromuscular function, while cycling RTD is related to measures of quadriceps peripheral neuromuscular function. Further, the strong associations among force/torque measures between tasks indicate a level of transferability across tasks.

A systematic literature review of the clinical signs and symptoms of veno-occlusive disease/sinusoidal obstruction syndrome after haematopoietic cell transplantation in adults and children.

Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a rare, serious complication following haematopoietic cell transplantation (HCT). This systematic literature review evaluated differences in clinical manifestations of VOD/SOS post-HCT in adults and children. Medline and Embase were searched up to 4 March 2021 for reports of VOD/SOS post-HCT; VOD/SOS diagnostic guidelines were included. Publications were evaluated based on inclusion of five cardinal clinical features of VOD/SOS (ascites, hepatomegaly, hyperbilirubinaemia, right upper quadrant [RUQ] pain and weight gain ≥5%). Overall, 204 publications were included. At diagnosis, hyperbilirubinaemia was more common in adults (93%) versus children (82%), weight gain ≥5% and hepatomegaly were more common in children (86%, 89%) versus adults (73%, 76%) and ascites and RUQ pain were similar between age groups. While 40% of cases had all five cardinal features, age was not a substantial determinant of the likelihood of missing any single specific feature. The proportion of cases, where hyperbilirubinaemia was the first recorded feature, was higher in children versus adults; weight gain and RUQ pain appeared first in a greater proportion of adults versus children. VOD/SOS diagnosis can be challenging; features may not present in a distinct sequence. This necessitates continuous vigilance by those involved in patient monitoring post-HCT.

Assessing the rate of torque development in sprint cycling: a methodological study.

The present study examined (i) the magnitude of the rate of torque development (RTD) and (ii) the between-day reliability of RTD at the start of a cycling sprint when sprint resistance, sprint duration, and the pedal downstroke were altered. Nineteen well-trained cyclists completed one familiarisation and three testing sessions. Each session involved one set of 1-s sprints and one set of 5-s sprints. Each set contained one moderate (0.3 N m kg-1), one heavy (0.6 N m kg-1), and one very heavy (1.0 N m kg-1) resistance sprint. RTD measures (average and peak RTD, RTD 0-100 ms, and RTD 0-200 ms) were calculated for downstroke 1 in the 1-s sprint. For the 5-s sprints, RTD measures were calculated for each of the first three downstrokes, as an average of downstrokes 1 and 2, and as an average of downstrokes 2 and 3. Whilst RTDs were greatest in downstroke 3 at all resistances, the greatest number of reliable RTD measures were obtained using the average of downstrokes 2 and 3 with heavy or very heavy resistances, where average and peak RTD, and RTD 0-200 ms were deemed reliable (ICC ≥ 0.8, CV ≤ 10%). Since only 1-2 downstrokes can be completed within 1 s, the greatest RTD reliability cannot be achieved using a 1-s sprint; therefore, the average of downstrokes 2 and 3 during a >2-s cycling sprint (e.g. 5-s test) with heavy or very heavy resistance is recommended for the assessment of RTD in sprint cyclists.HighlightsWhilst RTD measures were greatest in pedal downstroke 3 at all resistances, the greatest number of reliable RTD measures were obtained using the average of pedal downstrokes 2 and 3 with heavy or very heavy resistances, with average and peak RTD, and RTD 0-200 ms having acceptable reliability.RTD 0-100 ms and all RTD measurements for downstroke 1 were not reliable and should not be used. As only 1-2 downstrokes can be performed in 1 s, the greatest RTD reliability cannot be achieved using a 1-s sprint. Instead, RTD may be evaluated using a 5-s sprint.

A New Nurse's Unexpected Discovery.

A new nurse makes an important discovery while performing a basic assessment of a newborn.

The Reliability and Magnitude of Time-Dependent Force-Time Characteristics During the Isometric Midthigh Pull Are Affected by Both Testing Protocol and Analysis Choices.

ABSTRACT: Guppy, SN, Kotani, Y, Brady, CJ, Connolly, S, Comfort, P, and Haff, GG. Title: The reliability and magnitude of time-dependent force-time characteristics during the isometric mid-thigh pull are impacted by both testing protocol and analysis choices. J Strength Cond Res 36(5): 1191-1199, 2022-This study aimed to investigate whether the use of short-duration (SHORT) isometric midthigh pull (IMTP) trials resulted in greater reliability and magnitude of time-dependent force-time characteristics than traditionally performed IMTP trials (TRAD). Fourteen subjects with >6 months' training experience with the power clean volunteered to take part in the study. Subjects performed five ∼1-second IMTP trials (SHORT) and five 5-second IMTP trials (TRAD). SHORT resulted in substantially more reliable rate of force development (RFD) measures (intraclass correlation coefficient [ICC] = 0.97-0.99; coefficient of variation [CV] = 2.6-7.0%), particularly during time bands from force-onset to 150 ms, compared with TRAD when trials were selected for analysis based on peak force (ICC = 0.66-0.83; CV = 14.1-38.5%). Selecting TRAD trials based on RFD0-200 resulted in similar reliability compared with SHORT of those same epochs (ICC = 0.97-0.99; CV = 2.5-7.8%). Furthermore, SHORT resulted in significantly greater force at specific time points, RFD, and impulse compared with TRAD trials (p = 0.001-0.033; g = -0.16 to -0.66). Based on these results, strength and conditioning professionals should use specific testing protocols (i.e., TRAD and SHORT) depending on the component of an athlete's force-generating capacity that they wish to assess and remain aware of the effect analysis choices they have on the reliability of IMTP force-time characteristics.

A comparison of manual and automatic force-onset identification methodologies and their effect on force-time characteristics in the isometric midthigh pull.

The aim of this study was to assess the agreement of three different automated methods of identifying force-onset (40 N, 5 SDs, and 3 SDs) with manual identification, during the isometric mid-thigh pull (IMTP). Fourteen resistance-trained participants with >6 months experience training with the power clean volunteered to take part. After three familiarisation sessions, the participants performed five maximal IMTPs separated by 1 min of rest. Fixed bias was found between 40 N and manual identification for time at force-onset. No proportional bias was present between manual identification and any automated threshold. Fixed bias between manual identification and automated was present for force at onset and F150. Proportional but not fixed bias was found for F50 between manual identification and all automated thresholds. Small to moderate differences (Hedges g = -0.487- -0.692) were found for F90 between all automated thresholds and manual identification, while trivial to small differences (Hedges g = -0.122--0.279) were found between methods for F200 and F250. Based on these results, strength and conditioning practitioners should not use a 40 N, 5 SDs, or 3 SDs threshold interchangeably with manual identification of force-onset when analysing IMTP force-time curve data.

Logistical and structural challenges are the major obstacles for family medicine physicians' ability to administer adult vaccines.

PURPOSE: This study was conducted to characterize the vaccination practices and challenges of family medicine physicians in Los Angeles County, California. METHODS: The Los Angeles Academy of Family Physicians (LA AFP) sent out electronic surveys to all of their active members (N = 1121) between December 2017 and January 2018, and asked them to answer questions about themselves, their practice, their patient population, and their immunization practices and challenges. We then analyzed the results through basic statistical calculations and Pearson's chi-squared tests. RESULTS: Seventy-four people (6.6%) responded to the survey, and 75% of responders stated that they administer all Advisory Committee on Immunization Practices (ACIP) recommended vaccines. The lowest vaccine administration rates were for the high-dose influenza vaccine, which 66.2% (n = 49) of respondents reported to administer, followed by the meningococcal B vaccine (68.9%; n = 51). The respondents who belonged to practices with more than 11 providers, were part of a large hospital or healthcare system, had electronic medical records (EMRs), and used the California Immunization Registry (CAIR) were more likely to report to vaccinate. The number one responding physician-reported challenge to vaccination was limited time and resources to address patient resistance followed by vaccine cost and lack of infrastructure to store vaccines. CONCLUSIONS: In this pilot study, structural and logistical challenges appeared to make the biggest impact on adult vaccination for the responding family medicine physicians. Solutions addressing these challenges will help improve the adult immunization rates.

The Number of Stimulus-Onset Asynchronies Affects the Perception of the Sound-Induced Flash Illusion in Young and Older Adults.

The sound-induced flash illusion is a multisensory illusion occurring when one flash is presented with two beeps and perceived as two flashes. Younger individuals are largely susceptible to the illusion when the stimulus onset asynchrony between the first and the second beep falls within the temporal window of integration, but the susceptibility falls dramatically outside of this short temporal range. Older individuals, in particular older adults prone to falling and/or mild cognitive impairment, show an extended susceptibility to the illusion. This suggests that they have inefficient multisensory integration, particularly in the temporal domain. In the present study, we investigated the reliability of the illusion across younger and older people, guided by the hypothesis that the experimental context, i.e., exposure to a wider or smaller number of stimulus onset asynchronies, would modify the intra-personal susceptibility to the illusion at shorter asynchronies vs. longer asynchronies, likely due to the gathering of model evidence based on Bayesian inference. We tested 22 young adults and 29 older adults and verified these hypotheses. Both groups showed higher susceptibility to the illusion when exposed to a smaller range of asynchronies, but only for longer ones, not within the 100 ms window. We discuss the theoretical implications in terms of online perceptual learning and practical implications in terms of standardisation of the experimental context when attempting to find normative values.

Immediate post-abortion insertion of intrauterine contraceptives (IUC) in a diverse urban population.

Ethnic minority women have a higher incidence of unintended pregnancy and abortion than Caucasian women, with significant individual and social implications. Post-abortion intrauterine contraceptive (IUC) use may reduce future unintended pregnancy. This was a retrospective review of 265 women undergoing abortion at a Los Angeles County Reproductive Options Clinic. Demographic factors, reproductive history, and post-abortion contraceptive choice were evaluated and analyzed. The population was predominantly Latina (73%) and single, with a mean age of 27. Immediate post-abortion IUC insertion was chosen by 48% overall and more frequently by Latinas (55%) than by African Americans (33%) or Asians (43%) (p = 0.02). IUC use increased with age, undesired future fertility, increasing gravidity, and history of previous abortion in univariate analysis. In multivariate analysis, IUC use increased with Latina ethnicity and increasing gravidity. In a clinic serving low-income urban women in Los Angeles, post-abortal IUC uptake is highest among Latinas and those with prior pregnancies. Future research should examine reasons for and barriers to IUC uptake in diverse communities and methods to improve post-abortion IUC uptake to prevent subsequent unintended pregnancies.

Urban farming: a non-traditional intervention for HIV-related distress.

As individuals with HIV are living longer with less morbidity, developing interventions that address co-morbidities are essential. Psychological distress symptoms fluctuate throughout HIV infection and interrupt self-care practices. This pilot study was conducted to test the implementation of a clinic-recruited sample to participate in a community-based urban farming intervention, and assess the efficacy of reducing psychological distress symptoms. While the changes were not statistically significant, participants reported less distress symptoms, improved overall general health, and reduced frequency of illicit drug use. These findings support the development of a larger scale study to examine the impact of this nontraditional intervention.

International normalized ratio increase before warfarin-associated hemorrhage: brief and subtle.

OBJECTIVE: To determine the relationship between serial international normalized ratios (INRs) in patients who have been undergoing long-term anticoagulation and the onset of warfarin-associated bleeding complications. METHODS: The study cohort consisted of 2391 patients treated in the Anticoagulation Service at Brigham and Women's Hospital, Boston, Mass, from April 1999 through July 2003. For each patient with a bleeding event, we selected 2 controls who were matched for age, sex, indication for warfarin therapy, and duration of enrollment in our Anticoagulation Service. RESULTS: Warfarin-related hemorrhage occurred in 32 patients (1.3%). The mean +/- SD INRs at the time of the bleeding event or matched patient's event date (5.9 +/- 5.9 vs 2.3 +/- 0.7; P<.001) and the mean+/-SD last INRs before the bleeding event or matched patient's event date (3.0 +/- 1.2 vs 2.1 +/- 0.8; P<.001) were higher in the patients than in the controls. The last INRs before the bleeding event were obtained an average of 11.6 +/- 17.8 (mean +/- SD) days before the event in the patients and 18.3 +/- 28.0 (mean +/- SD) days before the matched date in the controls (P = .22). The mean second-to-last INRs were similar in both groups (2.8 +/- 2.1 vs 2.3 +/- 0.8; P = .11). When the INRs were plotted in relation to the time before the onset of bleeding, a marked increase in the patients' INRs was observed shortly before the bleeding began. CONCLUSIONS: Serial INRs are poor predictors of hemorrhagic events. There appears to be only a brief warning period during which a slightly elevated INR predicts an imminent bleeding event.