New care pathway to enable ambulances transfer patients to a model 2 hospital medical assessment unit.

BACKGROUND: Reconfiguration of the Irish acute hospital sector resulted in the establishment of a Medical Assessment Unit (MAU) in Mallow General Hospital (MGH). We developed a protocol whereby certain patients deemed to be low risk for clinical deterioration could be brought by the National Ambulance Service (NAS) to the MAU following a 999 or 112 call. AIMS: The aim of this paper is to report on the initial experience of this quality improvement initiative. METHODS: The Plan-Do-Study-Act (PDSA) Cycle for quality improvement was implemented when undertaking this project. A pathway was established whereby, following discussion between paramedic and physician, patients for whom a 999 or 112 call had been made could be brought directly to the MAU in MGH. Strict inclusion and exclusion criteria were agreed. The protocol was implemented from the 1st of September 2022 for a 3-month pilot period. RESULTS: Of 39 patients discussed, 29 were accepted for review in the MAU. One of the 29 accepted patients declined transfer to MAU. Of 28 patients reviewed in the MAU, 7 were discharged home. One patient required same day transfer to a model 4 centre. Twenty patients were admitted to MGH with an average length of stay of 8 days. Frailty and falls accounted for 7 of the admissions and the mean length of stay for these patients was 12 days. CONCLUSIONS: Our results have demonstrated the safety, feasibility and effectiveness of this pathway. With increased resourcing, upscaling of this initiative is possible and should be considered.

Coaches' Perceptions of Common Planning Concepts Within Training Theory: An International Survey.

BACKGROUND: The planning of training is a popular yet controversial topic among coaches and sports scientists. Periodisation is often presented in the literature as the most efficacious approach to planning training. While historically surveys of coaches appeared to support this a key failing was that no unified definition of periodisation exists. Recent surveys offering a periodisation definition and an alternative planning methodology found many choosing the alternative therefore questioning periodisation's wide acceptance. The current survey looked to explore how coaches perceived specific concepts, drawn from the literature, that relate to the planning of training. METHODS: 106 coaches [age range: 18-65+ years, 31% 15+ years coaching, 58% individual-events/sports and 32% international level] from across the world completed a novel cross-sectional online survey on the planning of training and the training process. Topics included use of periodisation, division of time into discrete periods, assignment of goals and training to pre-determined periods and the adaptability of pre-established plans. RESULTS: The majority described their planning approach as training periodisation (71%). Similarly, there was strong agreement with the necessity to determining a goal for the season (85%) and divide the season into distinct manageable periods of time (73%). When examining whether physical adaptations are achievable within specific and fixed timeframes only a minority (33%) agreed, a similar result was found for training physical capacities in a sequential order (37%). Finally, there was limited support for training targets remaining fixed over a training period (10%). CONCLUSIONS: As a tool for the planning of athlete's training, periodisation is often presented as the best and most popular approach. Recent research however has highlighted possible discrepancies in its usage among practitioners. The results of this survey echo this and question the acceptance of periodisation concepts even among periodisation users. In part this may be due to key tenets of periodisation no longer being supported by research or practice. A lingering question then is whether the beliefs of coaches, developed through experience and supported by research, will continue to be marginalized. If sports scientists wish to aid coaches then they need to be engaged in future research initiatives as co-collaborators.

Developing Decision-Making Expertise in Professional Sports Staff: What We Can Learn from the Good Judgement Project.

Success within performance sports is heavily dependent upon the quality of the decisions taken by educated and experienced staff. Multi-disciplinary teams (MDTs) typically collate voluminous data, and staff typically undergo extensive and rigorous technical and domain-specific training. Although sports professionals operate in sometimes volatile, uncertain, complex and ambiguous decision-making environments, a common assumption seems to be that education and experience will automatically lead to enhanced and effective decision-making capabilities. Accordingly, there are few formal curriculums, in coaching or sports science contexts, focussed on translating the extensive research on judgement and decision-making expertise to professional sports staff. This article aims to draw on key research findings to offer insights and practical recommendations to support staff working within professional performance contexts. Through this distillation, we hope to enhance understanding of the factors underpinning effective decision-making in dynamic, high-stakes professional sporting environments. Broadly, the conclusions of this research demonstrate that decision-making efficacy is enhanced through application of three specific strategies: (i) Design of more engaging professional cultures harnessing the power of collectives encouraging diverse opinions and perspectives, and fostering and promoting collaborative teamwork, (ii) education specifically targeting debiasing training, designed to counter the most common cognitive pitfalls and biases and, (iii) the implementation of evaluation strategies integrating rigorous testing and real-time feedback.

Coaches' Perceptions of Factors Driving Training Adaptation: An International Survey.

OBJECTIVE: We surveyed coaches' views on topics related to the training process to elucidate whether their opinions are aligned with the current literature. Here the results for a sub-set of questions regarding factors affecting the training adaptation process are presented and discussed. METHODS: 106 coaches [age range 18-65 + years, 31% 15 + years coaching, 58% individual-events/sports and 32% international level] from a number of countries completed a novel cross-sectional online survey about the planning of training and the training process. RESULTS: Only 28% of participants indicated that physical training was the most important factor in determining sport performance; whereas 99% indicated non-physical factors influence physical training response. The top five factors in modifying an athlete's ability to physically adapt to a training plan, as rated 'absolutely essential', were 'coach-athlete relationship' (56%), 'life stress' (41%), 'athletes' belief in the plan' (37%), 'psychological and emotional stress' (35%) and 'physical training' (33%). CONCLUSIONS: Amongst coaches surveyed less than a third rated physical training as the most important factor in determining sports performance. Non-physical factors were acknowledged by the majority to exert an influence on physical training response and adaptation, despite the lack of discussion in training research, though there was no consensus on the relative importance of each individual factor. We echo previous sentiments that coaches need to be engaged in the research process. If training research continues as present the field runs the risk of not only becoming detached but increasingly irrelevant to those it is trying to help.

Measuring maximal horizontal deceleration ability using radar technology: reliability and sensitivity of kinematic and kinetic variables.

Radar technology has the potential for providing new insights into maximal horizontal deceleration ability. This study aimed to investigate the intra- and inter-day reliability and sensitivity of kinematic and kinetic variables obtained from a novel, maximal horizontal deceleration test, using radar technology. Thirty-eight university sport athletes completed testing for intra-day analysis. Twelve of these participants also completed the deceleration test on a second day for inter-day analysis. The maximal horizontal deceleration test required participants to decelerate maximally following 20 m maximal horizontal sprint acceleration. Reliability was assessed using the intraclass correlation coefficient (ICC) and coefficient of variation (CV%). Sensitivity was evaluated by comparing typical error (TE) to the smallest worthwhile change (SWC). A number of kinematic and kinetic variables had good (ICC > 0.75, CV < 10%) overall intra-day reliability, and were sensitive to detect small-to-moderate changes in deceleration performance after a single familiarisation session. Only kinetic variables had good overall inter-day reliability and were sensitive to detect moderate changes in deceleration performance. The utilisation of this test protocol to assess maximal horizontal deceleration can provide new insights into individual maximal horizontal deceleration capabilities. Future work using this or similar approaches may provide insights into the neuromuscular performance qualities needed to decelerate maximally.

Biomechanical and Neuromuscular Performance Requirements of Horizontal Deceleration: A Review with Implications for Random Intermittent Multi-Directional Sports.

Rapid horizontal accelerations and decelerations are crucial events enabling the changes of velocity and direction integral to sports involving random intermittent multi-directional movements. However, relative to horizontal acceleration, there have been considerably fewer scientific investigations into the biomechanical and neuromuscular demands of horizontal deceleration and the qualities underpinning horizontal deceleration performance. Accordingly, the aims of this review article are to: (1) conduct an evidence-based review of the biomechanical demands of horizontal deceleration and (2) identify biomechanical and neuromuscular performance determinants of horizontal deceleration, with the aim of outlining relevant performance implications for random intermittent multi-directional sports. We highlight that horizontal decelerations have a unique ground reaction force profile, characterised by high-impact peak forces and loading rates. The highest magnitude of these forces occurs during the early stance phase (< 50 ms) and is shown to be up to 2.7 times greater than those seen during the first steps of a maximal horizontal acceleration. As such, inability for either limb to tolerate these forces may result in a diminished ability to brake, subsequently reducing deceleration capacity, and increasing vulnerability to excessive forces that could heighten injury risk and severity of muscle damage. Two factors are highlighted as especially important for enhancing horizontal deceleration ability: (1) braking force control and (2) braking force attenuation. Whilst various eccentric strength qualities have been reported to be important for achieving these purposes, the potential importance of concentric, isometric and reactive strength, in addition to an enhanced technical ability to apply braking force is also highlighted. Last, the review provides recommended research directions to enhance future understanding of horizontal deceleration ability.

Integrative Proposals of Sports Monitoring: Subjective Outperforms Objective Monitoring.

Current trends in sports monitoring are characterized by the massive collection of tech-based biomechanical, physiological and performance data, integrated through mathematical algorithms. However, the application of algorithms, predicated on mechanistic assumptions of how athletes operate, cannot capture, assess and adequately promote athletes' health and performance. The objective of this paper is to reorient the current integrative proposals of sports monitoring by re-conceptualizing athletes as complex adaptive systems (CAS). CAS contain higher-order perceptual units that provide continuous and multilevel integrated information about performer-environment interactions. Such integrative properties offer exceptional possibilities of subjective monitoring for outperforming any objective monitoring system. Future research should investigate how to enhance this human potential to contribute further to athletes' health and performance. This line of argument is not intended to advocate for the elimination of objective assessments, but to highlight the integrative possibilities of subjective monitoring.

Cosmetic tourism during the COVID-19 pandemic: Dealing with the aftermath.

BACKGROUND: Despite government restrictions during the coronavirus (COVID-19) pandemic, cosmetic tourism continued to occur. The authors present the impact of cosmetic tourism on their plastic surgery unit. METHODS: Retrospective case note review of two cohorts was performed: COVID-19 (March 2020-April 2021) and a pre COVID-19 comparator (January 2019-February 2020). Patients presenting with complications from cosmetic tourism were included and their hospital notes were reviewed. RESULTS: Seven patients were identified in the COVID-19 cohort compared with four patients in the comparator. In the COVID-19 patient group, six underwent their procedure overseas. The final patient was operated on in the UK by a visiting surgeon. Cases consisted of two abdominoplasties, two breast augmentations, two gluteal augmentations, and the final patient had a hernia repair. The most common presenting complaint in the COVID-19 cohort was a post-operative wound infection (n = 5), of which two had deeper associated collections, with two further wound dehiscences. In the pre-pandemic group, four patients underwent their procedure overseas. Cases consisted of an abdominoplasty, a blepharoplasty, a breast augmentation and a gluteal augmentation. Two patients presented with a wound infection, and two with simple wound dehiscence. CONCLUSION: Cosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. These patients are a potentially vulnerable group who exhibit risk-taking behaviours, such as going abroad amidst a pandemic and acceptance of not having appropriate follow up care.

Drop jump neuromuscular performance qualities associated with maximal horizontal deceleration ability in team sport athletes.

The purpose of this study was to investigate associations between, and within, drop jump (DJ) neuromuscular performance (NMP) qualities and maximal horizontal deceleration ability. We also compared DJ NMP qualities in "high" versus "low" horizontal deceleration ability athletes. Twenty-nine university athletes performed: (1) DJs on force plates from 20 (DJ20) and 40 cm (DJ40) heights and (2) maximal horizontal deceleration, measured using radar, following a 20 m acceleration. Maximal horizontal deceleration was evaluated using deceleration (HDEC; m·s-2), across the entire deceleration phase and during early and late deceleration sub-phases. Of the DJ variables assessed, DJ20 and DJ40 reactive strength index (RSI) and concentric mean force had the largest correlations with HDEC (r = -0.54 to -0.61) and the largest differences between high and low HDEC groups (d = 1.20 to 1.40). These correlations were stronger with the early than late HDEC sub-phase (r = -0.54 to -0.66 vs. r = -0.24 to -0.40). Notably, eccentric mean force in DJ40 had large correlations with both DJ20 and DJ40 concentric mean force (r = 0.67 to 0.77), whereas at DJ20 these correlations were small (r = 0.22 to 0.40). Similarly, DJ40 eccentric mean force had a much larger difference between the high and low HDEC groups than DJ20 (d = 1.11 vs. 0.51). These findings suggest DJ RSI from either height may be used as a proxy for HDEC ability, while DJ kinetic analyses should use a higher height to distinguish those with a better capacity to generate eccentric braking forces under increased eccentric loading demands. HIGHLIGHTSPlayers with greater drop jump reactive strength index (RSI) demonstrated superior horizontal deceleration ability.Drop jump RSI had a greater association with the early compared to the late horizontal deceleration sub-phase.Of the drop jump kinetic variables examined, concentric mean force had the largest associations with horizontal deceleration ability.

The post 16 gap: how do young people conceptualise PE? An exploration of the barriers to participation in physical education, physical activity and sport in senior school pupils.

Previous studies have identified several key barriers to Physical Education, Physical activity and Sport (PEPAS). However, there is a paucity of qualitative evidence investigating why young people do and do not participate in PA and the relationship between their levels of participation at different stages of life. This study builds on a previous study and aims to investigate the barriers to PEPAS in adolescents at transition stage. The extant literature highlights that instilling regular PA throughout life strongly relies on developing physical literacy through participation in high quality physical education. Despite the understanding of the importance of high quality physical education, there is an over emphasis on the short term outcomes of physical education (PE) sessions which have been noted to overemphasise immediate physical activity rather than focus on educational outcomes important to physical literacy. Anecdotally, the recent Covid 19 Global pandemic and subsequent lockdown has resulted in a digitalisation of PE in schools and a subsequent reliance of PA programmes based on adult fitness classes, which may not necessarily be categorised as PE in its true sense. Twenty-four respondents aged 16-19 were divided into five focus groups. Data were analysed verbatim using NVivo following the guidelines by Braun and Clark (2006) on thematic analysis. The findings indicated that most respondents equated PE with team sports. Findings suggest that Physical Educators need to acknowledge how past and present experience of PE impacts young people's future motivation to continue PA beyond school. Delivery of traditional PE lessons, prioritising sporting ability, can act as a participation barrier to pupils who consider themselves "non-sporty". Accordingly, a shift towards inclusive pedagogical models with an emphasis on a holistic approach, may best promote the physical literacy necessary for the competence and confidence to continue movement in a lifelong capacity.

Why Are Masters Sprinters Slower Than Their Younger Counterparts? Physiological, Biomechanical, and Motor Control Related Implications for Training Program Design.

Elite sprint performances typically peak during an athlete's 20s and decline thereafter with age. The mechanisms underpinning this sprint performance decline are often reported to be strength-based in nature with reductions in strength capacities driving increases in ground contact time and decreases in stride lengths and frequency. However, an as-of-yet underexplored aspect of Masters sprint performance is that of age-related degradation in neuromuscular infrastructure, which manifests as a decline in both strength and movement coordination. Here, the authors explore reductions in sprint performance in Masters athletes in a holistic fashion, blending discussion of strength and power changes with neuromuscular alterations along with mechanical and technical age-related alterations. In doing so, the authors provide recommendations to Masters sprinters-and the aging population, in general-as to how best to support sprint ability and general function with age, identifying nutritional interventions that support performance and function and suggesting useful programming strategies and injury-reduction techniques.

The accuracy of different modalities of perforator mapping for unilateral DIEP flap breast reconstruction: A systematic review and meta-analysis.

BACKGROUND: Perforator mapping may be performed prior to deep inferior epigastric perforator (DIEP) flap breast reconstruction to guide perforator selection. However, the accuracy of different imaging modalities remains unknown. This review aimed to evaluate the accuracy of different modalities for locating perforators for unipedicled DIEP flap breast reconstruction. METHODS: MEDLINE and EMBASE were searched from inception to 24th September 2019 for studies concerning adult women undergoing DIEP flap breast reconstruction with preoperative perforator mapping. The index test was pre-operative imaging and the reference standard was intraoperative identification. RESULTS: 21 articles with 1146 women were included. Six methods were described; handheld doppler, colour doppler (duplex) ultrasonography, computed tomography angiography, magnetic resonance angiography (MRA), direct infrared thermography with and without doppler. Meta-analysis revealed 94% (95% CI 88-99%) of DIEPs identified as the 'dominant perforator' on imaging were chosen as dominant perforators intraoperatively. Colour doppler (Duplex) ultrasonography had the lowest agreement (mean 74% [95% CI 67-81%]) whilst MRA had the highest agreement (mean 97% [95% CI 86-100%]). There was no statistically significant difference in the performance of different tests. All studies were subject to bias as the operators had knowledge of the index test prior to conducting the reference standard. CONCLUSIONS: Based upon limited evidence, cross sectional (CT/MR) imaging modalities for preoperative DIEP mapping appear to have similar accuracy and perform better than ultrasound.

Posterior ischemic optic neuropathy following a major burn injury and review of the literature.

Posterior ischemic optic neuropathy following burns is a rare but devastating condition that can result in total bilateral visual loss. Numerous treatment modalities have been trialed, yet there is no effective therapy to delay or reverse the disease. Hence, it is imperative for burns surgeons to be aware of the potential risk factors and have a high index of suspicion right from the outset to prevent this outcome. Here, we discuss the case of a patient that developed posterior ischemic optic neuropathy subsequent to a major burn injury. We also present a literature review on optic neuropathies following burns to describe the etiology, clinical signs, and potential management.

Relationships Between Eccentric and Concentric Knee Strength Capacities and Maximal Linear Deceleration Ability in Male Academy Soccer Players.

ABSTRACT: Harper, DJ, Jordan, AR, and Kiely, J. Relationships between eccentric and concentric knee strength capacities and maximal linear deceleration ability in male academy soccer players. J Strength Cond Res 35(2): 465-472, 2021-The purpose of this study was to investigate the relationships between maximal linear deceleration ability, and knee flexor (KF) and knee extensor (KE) strength. Fourteen male academy soccer players completed a 30-m linear sprint, a maximal linear deceleration test, and eccentric and concentric KF and KE contractions in both dominant leg (DL) and nondominant leg (NDL) at slower (60°·s-1) and faster (180°·s-1) angular velocities on an isokinetic dynamometer. Maximal linear deceleration ability was evaluated using distance-to-stop (DEC-DTS) and time-to-stop (DEC-TTS), with isokinetic peak torque representing KF and KE strength capacity. Relationships were established using Pearson's correlation coefficients (r) with magnitude-based inferences used to describe the uncertainty in the correlation. Both concentric KE and KF strength at 180°·s-1 in the NDL had the highest correlations with deceleration ability (r = -0.76 and r = -0.78, respectively). In the DL, concentric KE and KF strength at 180°·s-1 also had very likely large correlations with deceleration ability (r = -0.54 and -0.55, respectively). All correlations between eccentric KF strength and deceleration ability were unclear. At 180°·s-1, correlations between eccentric KE strength and deceleration ability were also unclear; however, at 60°·s-1, both DL (r = -0.63 to -0.64) and NDL (r = -0.54 to -0.55) had very likely large correlations with deceleration ability. These findings provide novel insights into the unilateral KF and KE strength capacities underpinning the ability to decelerate rapidly from high-sprint velocities.

The relationship between eccentric hamstring strength and dynamic stability in elite academy footballers.

OBJECTIVES: Previous research describes dynamic stability and functional strength as key aetiological risk factors associated with lower limb non-contact musculoskeletal injury. Due to the multifactorial nature of injury risk, relationships between the two factors will inform injury management and training design. METHODS: A total of 59 elite academy footballers from two English premier league category 1-status academies completed the study. All players completed measures of eccentric hamstring strength and dynamic stability. Relationships between directional stability (Anteroposterior (Ant), Posteromedial (PM) and Posterolateral (PL)) and eccentric strength metrics (PkT, AvT, PkF, AvF and Ɵ) bilaterally were identified for analysis. RESULTS: Significant correlations were identified bilaterally for functional hamstring strength metrics and PM and PL stability (P ≤. 0.05). No significant relationships were identified between anterior stability and eccentric hamstring strength parameters (P > 0.05). CONCLUSIONS: Eccentric hamstring strength has a positive influence on directional stability through two planes, PM and PL. The lack of influence of eccentric hamstring strength on Ant directional stability could be attributed to increased ACL risk. Careful consideration of the significance of the relationships between eccentric hamstring strength and directional stability must be given when quantifying injury risk in elite academy footballers.