Maturational and social factors contributing to relative age effects in school sports: Data from the London Youth Games.

Few studies have investigated whether relative age effects (RAEs) exist in school sport. None have sought to test the competing maturational and social-agent hypotheses proposed to explain the RAE. We aimed to determine the presence of RAEs in multiple school sports and examine the contribution of maturational and social factors in commonplace school sports. We analyzed birth dates of n=10645 competitors (11-18 years) in the 2013 London Youth Games annual inter-school multisport competition and calculated odds ratio (OR) for students competing based on their yearly birth quarter (Q1-Q4). Multivariate logistic regression was used to determine the relative contribution of constituent year (Grade) and relative age in netball and football which used multiyear age groupings. In girls, RAEs were present in the team sports including hockey, netball, rugby union, cricket and volleyball but not football. In boys, RAEs were stronger in common team sports (football, basketball cricket) as well as athletics and rowing. In netball and football teams with players from two constituent years, birth quarter better-predicted selection than did constituent year. Relatively older players (Q1) from lower constituent years were overrepresented compared with players from Q3 and Q4 of the upper constituent years. RAEs are present in the many sports commonplace in English schools. Selection of relatively older players ahead of chronologically older students born later in the selection year suggests social agents contribute to RAEs in school sports.

Situational awareness - what it means for clinicians, its recognition and importance in patient safety.

A thorough understanding of the role of human factors in error in health care for improving patient safely is paramount. One area particularly crucial for optimising clinical performance is the recognising the importance of situational awareness. Loss of situation awareness can occur in many different settings, particularly during stressful and unexpected situations. Tunnel vision is a classic example where clinicians focus on one aspect of care, often to the detriment of overall patient management. Loss of situational awareness can result in serious compromise to patient safety if it is not recognised by either the individual or clinical team. We provide an introduction to situational awareness for those not familiar with it, including some important theory which explains how awareness can be lost, and discuss the important approaches we use in our day-to-day practice to safeguard both patients and clinicians in the workplace environment.

Variation in Responses to Sprint Training in Male Youth Athletes: A Meta-analysis.

The trainability of youths and the existence of periods of accelerated adaptation to training have become key subjects of debate in exercise science. The purpose of this meta-analysis was to characterise youth athletes' adaptability to sprint training across PRE-, MID-, and POST-peak height velocity (PHV) groups. Effect sizes were calculated as a measure of straight-line sprinting performance with studies qualifying based on the following criteria: (a) healthy male athletes who were engaged in organised sports; (b) groups of participants with a mean age between 10 and 18 years; (c) sprint training intervention duration between 4 and 16 weeks. Standardised mean differences showed sprint training to be moderately effective (Effect size=1.01, 95% confidence interval: 0.43-1.59) with adaptive responses being of large and moderate magnitude in the POST- (ES=1.39; 0.32-2.46) and MID- (ES=1.15; 0.40-1.9) PHV groups respectively. A negative effect size was found in the PRE group (ES=-0.18; -1.35-0.99). Youth training practitioners should prescribe sprint training modalities based on biological maturation status. Twice weekly training sessions should comprise up to 16 sprints of around 20 m with a work-to-rest ratio of 1:25 or greater than 90 s.

Athletic performance and birth month: is the relative age effect more than just selection bias?

The aim of this study was to determine if month of birth affects performance in 3 tests of physical function in children and adolescents. We measured cardiorespiratory fitness, handgrip strength and lower-body power expressed them relative to (whole year) age then compared scores between calendar year birth-months. We also expressed test performance as the likelihood of achieving criterion-referenced fitness standards. There were significant main effects of birth-month for cardiorespiratory fitness (F=4.54, p<0.001), strength (F=6.81, p<0.001) and power (F=3.67, p<0.001). Children born in November were fitter and more powerful than those born at other times, particularly the summer months (April, May and June). October-born children were stronger than those born in all months except September and November. This relationship was evident despite controlling for decimal age and despite no significant inter-month differences in anthropometric characteristics.There is a clear physical advantage for those born in the autumn and this may explain some of the bias in sports selection attributed to the relative age effect, particularly when the British school-year (September) cut-off is used.

Caffeine: benefits and drawbacks for technical performance.

Surgical and minimally-invasive procedures, including cardiac and radiological, have high-stake patient outcomes. Working pressures, altering shift rotas, and ever-increasing demands have led to worsening sleep patterns for surgeons and allied professionals. Sleep deprivation alone has harmful consequences in relation to clinical outcomes and the physical and mental health of the surgeon, and to offset fatigue, some surgeons use legal stimulants such as caffeine and energy drinks. This stimulant use, however, may come at the cost of negative effects on cognitive and physical function. We aimed to explore evidence behind the use of caffeine, and its consequences on technical performance and clinical outcomes.

Abbreviation use decreases effective clinical communication and can compromise patient safety.

Clear communication is paramount for achieving the safest and best patient outcomes, for maximising time efficiency, and lowering clinician workload. Multiple factors contribute to communication efficacy, including knowledge of topics between those communicating, interpersonal familiarity, and available time. Information exchange is growing faster and more frequent due to evolving communication technology, and communication is expanding as a response to increasing workloads. The number of referrals between specialties and the general practitioner (GP) is rising. The use of abbreviations has expanded in clinical communications and is likely to lead to misunderstanding, increased workload, and worse patient outcomes. In this article, we explore the use of abbreviations in the clinical setting.

Intermediate filament structure.

In the past year, several new developments concerning the structure of intermediate filament proteins and their assembly into intact intermediate filaments have been made: the coiled-coil structure of a rod domain has been elucidated; the basis of the chain interaction and its role in intermediate filament assembly has been specified; the organization of nearest-neighbour molecules in keratin intermediate filaments has been determined; and the glycine loop structures of the terminal domains of epidermal keratin chains have been defined. In addition, mutations in intermediate filament chains that promote pathology have been reported for the first time.

Hypomaturation amelogenesis imperfecta due to WDR72 mutations: a novel mutation and ultrastructural analyses of deciduous teeth.

BACKGROUND: Mutations in WDR72 have been identified in autosomal recessive hypomaturation amelogenesis imperfecta (AI). OBJECTIVE: to describe a novel WDR72 mutation and report the ultrastructural enamel phenotype associated with a different WDR72 mutation. METHODS: A family segregating autosomal recessive hypomaturation AI was recruited, genomic DNA obtained and WDR72 sequenced. Four deciduous teeth from one individual with a previously published WDR72 mutation, extracted as part of clinical care, were subjected to scanning electron microscopy, energy-dispersive X-ray analysis and transverse microradiography. RESULTS: A novel homozygous nonsense mutation, R897X, was identified in WDR72 in a family originating from Pakistan. Ultrastructural analysis of enamel from the deciduous teeth of an AI patient with the WDR72 mutation S783X revealed energy-dispersive X-ray analysis spectra with normal carbon and nitrogen peaks, excluding retention of enamel matrix protein. However, transverse microradiography values were significantly lower for affected teeth when compared to normal teeth, consistent with reduced mineralisation. On scanning electron microscopy the enamel rod form observed was normal, yet with inter-rod enamel more prominent than in controls. This appearance was unaltered following incubation with either α-chymotrypsin or lipase. CONCLUSIONS: The novel WDR72 mutation described brings the total reported WDR72 mutations to four. Analyses of deciduous tooth enamel in an individual with a homozygous WDR72 mutation identified changes consistent with a late failure of enamel maturation without retention of matrix proteins. The mechanisms by which intracellular WDR72 influences enamel maturation remain unknown.

Ultrastructural analyses of deciduous teeth affected by hypocalcified amelogenesis imperfecta from a family with a novel Y458X FAM83H nonsense mutation.

BACKGROUND: Nonsense mutations in FAM83H are a recently described underlying cause of autosomal dominant (AD) hypocalcified amelogenesis imperfecta (AI). OBJECTIVE: This study aims to report a novel c.1374C>A p.Y458X nonsense mutation and describe the associated ultrastructural phenotype of deciduous teeth. METHODS: A family of European origin from the Iberian Peninsula with AD-inherited AI was ascertained. Family members were assessed through clinical examination and supporting investigations. Naturally exfoliated deciduous teeth from 2 siblings were investigated by scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX) and transverse microradiography (TMR). RESULTS: On clinical and radiographic investigation the appearances of the affected deciduous and permanent teeth were consistent with hypocalcified AI with small focal areas of more normal looking enamel. DNA sequencing identified a novel c.1374C>A p.Y458X FAM83H nonsense mutation in affected, but not in either unaffected family members or unrelated controls. Exfoliated teeth were characterised by substantial post-eruptive enamel loss on gross examination. Irregular, poor quality enamel prisms were observed on SEM. These were coated in amorphous material. TMR and EDX confirmed reduced mineral and increased organic content in enamel, respectively. CONCLUSIONS: FAM83H nonsense mutations have recently been recognised as a cause of AD hypocalcified AI. We report a novel nonsense FAM83H mutation and describe the associated preliminary ultrastructural phenotype in deciduous teeth. This is characterised by poorly formed enamel rods with inappropriate retention of amorphous material, which is likely to represent retained organic matrix that contributes to the overall hypomineralised phenotype.

A comparison of antibody testing, permeability testing, and zonulin levels with small-bowel biopsy in celiac disease patients on a gluten-free diet.

Active celiac disease is associated with positive endomysial (EMA) and tissue transglutaminase (TTG) antibodies, elevated zonulin levels, and increased intestinal permeability. There is little known about what happens to these immunologic and structural abnormalities in patients on a gluten-free diet and their correlation with small-bowel biopsy changes. Adult patients previously diagnosed with celiac disease and on a gluten-free diet for greater than 1 year were considered for the study. All patients underwent the following: measurement of EMA and TTG antibodies, serum zonulin levels, intestinal permeability (IP) testing with lactulose/mannitol ratios, food diary analysis for gluten ingestion and small- bowel biopsy. A total of 21 patients on a gluten-free diet for a mean of 9.7 years completed the study. There were ten patients who had normalization of intestinal biopsies, IP and TTG, and EM antibodies. Six patients had Marsh type 2 or 3 lesions and all had either abnormal IP (5/6) or TTG antibody (4/6). In patients with Marsh type 3 lesions, there was a correlation between IP and zonulin levels. A subgroup of patients with celiac disease on a gluten-free diet has complete normalization of intestinal biopsies, intestinal permeability defects, and antibody levels. Patients with Marsh type 3 lesions have abnormal TTG antibodies and intestinal permeability with zonulin levels that correlate with IP. These abnormalities may be due to continued gluten ingestion. Further study is needed to determine the clinical utility of TTG antibodies and IP testing in following patients with celiac disease.

Sternothyroid receives a supplementary innervation separate to the ansa cervicalis: a case report of a variation.

We report on an additional innervation to the sternothyroid that, to our knowledge, has not been previously described. During a cadaveric neck dissection, we found an aberrant nerve to the sternothyroid in addition to the normal innervation. The classical innervation to the sternothyroid is through the ansa cervicalis (C1-C3), and the sternothyroid muscle is important for depression of the thyroid cartilage that is involved with swallowing and speech. The cervical plexus is difficult and time consuming to elucidate in fixed cadavers, which limits knowledge of variations from this source. Branches of the plexus are delicate and can be damaged during operations on the neck. Awareness of variations in innervation during operation reduces the chance of damage to nerves and prevents functional changes postoperatively.

Haemostatic and fibrinolytic factors in men with a small abdominal aortic aneurysm.

BACKGROUND: : The presence of an abdominal aortic aneurysm (AAA) independently predicts cardiovascular disease (CVD) and its complications. Levels of plasma markers of fibrin turnover are raised in men with a large AAA (at least 5.5 cm) and predict CVD risk in healthy subjects. This study examined fibrin turnover in men with a small AAA. METHODS: : Seventy-five men with a small AAA (30-55 mm) were compared with 90 controls matched for age, sex and race. Haemostatic and fibrinolytic parameters were assessed. RESULTS: : Men with a small AAA had higher mean levels of fibrinogen (2.92 versus 2.59 g/l; P = 0.019), thrombin-antithrombin (TAT) complex (4.57 versus 1.89 ng/ml; P < 0.001), prothrombin F1 + 2 (1.13 versus 0.82 ng/ml; P = 0.004) and D-dimer (346.7 versus 120.2 ng/ml; P < 0.001). All markers correlated with maximum aortic diameter determined by ultrasonography. On multivariable regression the association between presence of an AAA and fibrinogen, TAT complex, prothrombin F1 + 2 and D-dimer levels remained significant after adjustment for confounding influences. CONCLUSION: : Fibrin turnover was increased in these men with a small AAA, independently of concomitant CVD, conventional risk factors and inflammatory markers. Enhanced fibrin turnover may contribute to the risk of cardiac complications in this group.

Electron microscope autoradiography of erythroid cells using radioactive iron.

The "circle analysis" method of Williams (1969) and a new improved method employing hypothetical grains described in the previous paper have been used to analyze the distribution of autoradiographic grains over erythroid bone marrow cells labeled with radioactive iron, (55)Fe. The resolution obtainable with this isotope was determined by measuring the distribution of grains about a thin line source. This distribution was also used in calculation of the circle size for the Williams's analysis and the distances of hypothetical grains for the new method. The new method provides estimates for the amount of activity in the regions of condensed and extended nuclear chromatin and for the concentration of isotope at the junction between these two areas. The possible significance of activity in this junctional region is discussed.

A new method for analyzing electron microscope autoradiographs using hypothetical grain distributions.

A new method for the analysis of electron microscope autoradiographs is described which has two advantages over other methods. This method provides estimates for the activity in different regions of the section and takes into account the actual geometrical shape and position of different regions within the section. Use is made of the measured distribution of grains about a thin line source to construct a hypothetical distribution of autoradiographic grains which is then compared with the actual distribution of grains. Different activities are then ascribed to various regions until a satisfactory agreement with the autoradiographic grains is obtained using the chi(2) significance. In the next paper, an example of the use of this method is given for the distribution of grains in the nucleus of erythroid bone marrow cells labeled with radioactive iron, (55)Fe.

Periplakin, a novel component of cornified envelopes and desmosomes that belongs to the plakin family and forms complexes with envoplakin.

The cornified envelope is a layer of transglutaminase cross-linked protein that is assembled under the plasma membrane of keratinocytes in the outermost layers of the epidermis. We have determined the cDNA sequence of one of the proteins that becomes incorporated into the cornified envelope of cultured epidermal keratinocytes, a protein with an apparent molecular mass of 195 kD that is encoded by a mRNA with an estimated size of 6.3 kb. The protein is expressed in keratinizing and nonkeratinizing stratified squamous epithelia and in a number of other epithelia. Expression of the protein is upregulated during the terminal differentiation of epidermal keratinocytes in vivo and in culture. Immunogold electron microscopy was used to demonstrate an association of the 195-kD protein with the desmosomal plaque and with keratin filaments in the differentiated layers of the epidermis. Sequence analysis showed that the 195-kD protein is a member of the plakin family of proteins, to which envoplakin, desmoplakin, bullous pemphigoid antigen 1, and plectin belong. Envoplakin and the 195-kD protein coimmunoprecipitate. Analysis of their rod domain sequences suggests that the formation of both homodimers and heterodimers would be energetically favorable. Confocal immunofluorescent microscopy of cultured epidermal keratinocytes revealed that envoplakin and the 195-kD protein form a network radiating from desmosomes, and we speculate that the two proteins may provide a scaffolding onto which the cornified envelope is assembled. We propose to name the 195-kD protein periplakin.

In vitro assembly and structure of trichocyte keratin intermediate filaments: a novel role for stabilization by disulfide bonding.

Intermediate filaments (IF) have been recognized as ubiquitous components of the cytoskeletons of eukaryotic cells for 25 yr. Historically, the first IF proteins to be characterized were those from wool in the 1960s, when they were defined as low sulfur keratins derived from "microfibrils." These proteins are now known as the type Ia/type IIa trichocyte keratins that constitute keratin IF of several hardened epithelial cell types. However, to date, of the entire class of >40 IF proteins, the trichocyte keratins remain the only ones for which efficient in vitro assembly remains unavailable. In this paper, we describe the assembly of expressed mouse type Ia and type IIa trichocyte keratins into IF in high yield. In cross-linking experiments, we document that the alignments of molecules within reduced trichocyte IF are the same as in type Ib/IIb cytokeratins. However, when oxidized in vitro, several intermolecular disulfide bonds form and the molecular alignments rearrange into the pattern shown earlier by x-ray diffraction analyses of intact wool. We suggest the realignments occur because the disulfide bonds confer substantially increased stability to trichocyte keratin IF. Our data suggest a novel role for disulfide bond cross linking in stabilization of these IF and the tissues containing them.

Cingulin contains globular and coiled-coil domains and interacts with ZO-1, ZO-2, ZO-3, and myosin.

We characterized the sequence and protein interactions of cingulin, an M(r) 140-160-kD phosphoprotein localized on the cytoplasmic surface of epithelial tight junctions (TJ). The derived amino acid sequence of a full-length Xenopus laevis cingulin cDNA shows globular head (residues 1-439) and tail (1,326-1,368) domains and a central alpha-helical rod domain (440-1,325). Sequence analysis, electron microscopy, and pull-down assays indicate that the cingulin rod is responsible for the formation of coiled-coil parallel dimers, which can further aggregate through intermolecular interactions. Pull-down assays from epithelial, insect cell, and reticulocyte lysates show that an NH(2)-terminal fragment of cingulin (1-378) interacts in vitro with ZO-1 (K(d) approximately 5 nM), ZO-2, ZO-3, myosin, and AF-6, but not with symplekin, and a COOH-terminal fragment (377-1,368) interacts with myosin and ZO-3. ZO-1 and ZO-2 immunoprecipitates contain cingulin, suggesting in vivo interactions. Full-length cingulin, but not NH(2)-terminal and COOH-terminal fragments, colocalizes with endogenous cingulin in transfected MDCK cells, indicating that sequences within both head and rod domains are required for TJ localization. We propose that cingulin is a functionally important component of TJ, linking the submembrane plaque domain of TJ to the actomyosin cytoskeleton.

Communication between the transverse cervical nerve (C2,3) and marginal mandibular branch of the facial nerve: a cadaveric and clinical study.

Several branches of the facial nerve are known to anastomose with branches of the cervical plexus, other cranial nerves, and the trigeminal nerve. Communication between the sensory transverse cervical nerve (C2, 3) and marginal mandibular nerve is, however, less well known, and in a previous study of 86 neck dissections we reported a 2.3% incidence of anastomoses between them. In this prospective study, we meticulously searched for more examples using both formalin-fixed cadavers and neck dissections. A total of 102 necks were included (both sides of 36 cadavers (n=72 necks), and 30 patients who had neck dissection for the management of squamous cell carcinoma). We found communications between these nerves on one side of a cadaver and in one neck dissection. When combined with the numbers from our previous study, the overall incidence was 2.1% in 188 necks. The marginal mandibular nerve was inseparable from the anastomosis with the transverse cervical nerve, and the variant should not be forgotten if we are to reduce the chance of postoperative weakness of the lower lip, particularly when operative exposure is more limited (such as during removal of the submandibular gland).