Differential improvements between men and women in repeated CrossFit open workouts.

INTRODUCTION: The CrossFit® Open (CFO) acts a preliminary round that qualifies men and women for later stages of its annual Games competition. The CFO typically consists of 4-6 workouts that variably challenge an athlete's weightlifting strength, gymnastic skill, and endurance capacity. Except for differences in prescribed intensity loads, workouts are designed the same for men and women to elicit a similar challenge. While all workouts within a single year are unique to each other, one has been repeated from a previous CFO each year between 2012 and 2021. Because previous CFO workouts are often integrated into training, improvements are expected when a workout is officially repeated. However, besides documented record performances, it is unclear whether most athletes are improving, if these improvements affect ranking, or if differences exist between men and women. PURPOSE: To examine sex-division differences and performance changes across repeated CFO workouts, as well as their effect on CFO and workout ranking. METHODS: Eleven separate samples of 500 men and 500 women, who were representative of the same overall percent rank within each year involving one of the nine repeated CFO workouts (2011-2021) were drawn for this study. Each athlete's age (18-54 years), rank (overall and within each workout), and reported workout scores were collected from the competition's publicly-available leaderboard. Each sample had excluded any athlete who had not met minimum performance criteria (e.g., at least one completed round) for all prescribed (Rx) workouts within a given year (including those not analyzed). Since some workouts could be scored as repetitions completed or time-to-completion (TTC), and because programming was often scaled between men and women, all scores were converted to a repetition completion rate (repetitions divided by TTC [in minutes]). RESULTS: Separate sex-division x time analyses of variance with repeated measures revealed significant (p < 0.05) interactions in all but one repeated workout comparison. Initially, men were faster in four workouts (~18.5%, range = 3.9-35.0%, p < 0.001), women in two (~7.1%, range = 5.2-9.0%, p < 0.001), and they tied in the remaining three workouts. When workouts were repeated in subsequent years, men were faster in three workouts (~5.4%, range = 0.9-7.8%, p < 0.05), while women were faster in two (~3.8%, range = 3.5-4.1%, p < 0.01). Though performance improved in seven of the nine workouts (~14.3%, p < 0.001) and percentile rank was controlled, athletes earned a lower rank (overall and within workout) on each repeated workout (p < 0.001). CONCLUSIONS: Performance (measured as repetition completion rate) has improved in most repeated CFO workouts, particularly for women. However, improvements seen among all athletes, along with increased participation, have made it more difficult for athletes to improve their overall rank. To rank higher, individual athletes must improve their pace to a greater degree than the average improvements seen across the competitive field.

Evidence for a Multimodal Pain Management Regimen in Reduction of Postoperative Opioid Use in Pediatric Patients Receiving Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: This project aims to evaluate the relationship between increased use of intraoperative nonopioid analgesics, muscle relaxers, and anesthetics and postoperative outcomes, including opioid utilization, time until ambulation, and hospital length of stay. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine that occurs in otherwise healthy adolescents, occurring with a frequency of 1% to 3%. Up to 60% of patients receiving spinal surgeries, particularly posterior spinal fusion (PSF), experience at least 1 day of moderate-to-severe pain after surgery. PATIENTS AND METHODS: This is a retrospective chart review of pediatric patients aged 10 to 17 having received PSF with >5 levels fused for AIS at a dedicated children's hospital and a regional tertiary referral center with a dedicated pediatric spine program between January 2018 and September 2022. A linear regression model was used to evaluate the influence of baseline characteristics and intraoperative medications on the total amount of postoperative morphine milligram equivalents received. RESULTS: There were no significant differences in the background characteristics of the two patient populations. Patients receiving PSF at the tertiary referral center received equivalent or greater amounts of all nonopioid pain medications and demonstrated decreased time until ambulation (19.3 vs . 22.3 h), postoperative opioid use (56.1 vs . 70.1 MME), and postoperative hospital length of stay (35.9 vs . 58.3 h). Hospital location was not individually associated with a difference in postoperative opioid use. There was not a significant difference in postoperative pain ratings. When accounting for all other variables, liposomal bupivacaine had the greatest contribution to the decrease in postoperative opioid use. CONCLUSION: Patients receiving greater amounts of nonopioid intraoperative medications utilized 20% fewer postoperative morphine milligram equivalents, were discharged 22.3 hours earlier and had earlier recorded evidence of mobility. Postoperatively, nonopioid analgesics were as effective as opioids in the reduction of subjective pain ratings. This study further demonstrates the efficacy of multimodal pain management regimens in pediatric patients receiving PSF for AIS.

Outcomes and Adverse Effects of Baricitinib Versus Tocilizumab in the Management of Severe COVID-19.

OBJECTIVES: The National Institutes of Health and Infectious Diseases Society of America guidelines recommend tocilizumab or baricitinib in the management of severe COVID-19. Despite clinical trials on the individual agents, there are no large-scale studies comparing the two agents to guide the selection of one versus the other. The purpose of this study was to compare the outcomes and adverse effects of baricitinib versus tocilizumab in the management of severe COVID-19. DESIGN: Retrospective, observational cohort study. SETTING: Eleven acute care hospitals in a large health system in Georgia. PATIENTS: Adult patients with severe COVID-19 who received at least one dose of either baricitinib or tocilizumab between June 2021 and October 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was in-hospital mortality. The key secondary outcome was occurrence rate of adverse effects. A total of 956 patients were identified. The median age was 57 years, and 53% were of male sex. The median body mass index was 33.5, and more than 94% of the population was unvaccinated. Propensity score matching by baseline characteristics resulted in a total of 582 patients, 291 in each group. There was no difference in mortality between the two groups; however, the occurrence rate of adverse effects was significantly higher in the tocilizumab group compared with baricitinib: secondary infections (32% vs 22%; p < 0.01); thrombotic events (24% vs 16%; p < 0.01); and acute liver injury (8% vs 3%; p < 0.01). CONCLUSIONS: Our propensity score-matched, retrospective, observational study in patients hospitalized with severe COVID-19 showed no difference in mortality but significantly fewer adverse effects with baricitinib compared with tocilizumab. Our data suggest that baricitinib may be a better choice when treating patients with severe COVID-19, but additional prospective, randomized trials are needed to help clinicians choose the most optimal drug.

Normative Scores for CrossFit® Open Workouts: 2011-2022.

To create normative scores for all CrossFit® Open (CFO) workouts and compare male and female performances, official scores were collected from the official competition leaderboard for all competitors of the 2011-2022 CFO competitions. Percentiles were calculated for athletes (18-54 years) who completed all workouts within a single year 'as prescribed' and met minimum scoring thresholds. Independent t-tests revealed significant (p < 0.05) sex differences for 56 of 60 workouts. In workouts scored by repetitions completed, men completed more repetitions in 18 workouts by small to large differences (d = 0.22-0.81), whereas women completed more repetitions in 6 workouts by small to medium differences (d = 0.36-0.77). When workouts were scored by time to completion, men were faster in 10 workouts by small to large differences (d = 0.23-1.12), while women were faster in 3 workouts by small differences (d = 0.46). In three workouts scored by load lifted, men lifted more weight by large differences (d = 2.00-2.98). All other differences were either trivial or not significant. Despite adjusted programming for men and women, the persistence of performance differences across all CFO workouts suggests that resultant challenges are not the same. These normative values may be useful for training and research in male and female CrossFit® athletes.

Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa.

BACKGROUND: Diabetes prevalence, as well as that of pre-diabetes, is rapidly increasing in South Africa. Individuals with pre-diabetes have a high risk of developing type 2 diabetes, which is reversible with a change in lifestyle. If left untreated, diabetes can lead to serious health complications. Our objective was to assess the prevalence of diabetes and pre-diabetes, and to investigate the associated risk factors of each in the South African population. METHOD: This study made use of the South African Demographic Health Survey 2016 data. The study participants included 6442 individuals aged 15 years and older. A generalized additive mixed model was employed to account for the complex survey design of the study as well as well spatial autocorrelation in the data. RESULTS: The observed prevalence of pre-diabetes and diabetes was 67% and 22%, respectively. Among those who had never been tested for diabetes prior to the survey, 10% of females and 6% of males were found to be diabetic, and 67% of both males and females were found to be pre-diabetic. Thus, a large proportion of the South African population remains undiagnosed. The model revealed both common and uncommon factors significantly associated with pre-diabetes and diabetes. This highlights the importance of considering diabetic status as a three-level categorical outcome, rather than binary. In addition, significant interactions between some of the lifestyle factors, demographic factors and anthropometric measures were revealed, which indicates that the effects each these factors have on the likelihood of an individual being pre-diabetic or diabetic is confounded by other factors. CONCLUSION: The risk factors for diabetes and pre-diabetes are many and complicated. Individuals need to be aware of their diabetic status before health complications arise. It is therefore important for all stakeholders in government and the private sector of South Africa to get involved in providing education and creating awareness about diabetes. Regular testing of diabetes, as well as leading a healthy lifestyle, should be encouraged.