Assessing the nutritional status and impact of a series of nutritional interventions on elderly inpatients using bioelectrical impedance analysis: A service evaluation.

BACKGROUND: The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat-free mass index (FFMI). METHODS: A prospective, comparative, single-centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. RESULTS: A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. CONCLUSIONS: BIA is quick, non-invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning.

Child Soccer Players' Perceptions of Strength and Conditioning Training: A Multimethod Approach Using Write, Draw, Show and Tell.

PURPOSE: The use of strength and conditioning training in childhood is a hot topic surrounded by myths and misconceptions. Despite scientific evidence supporting the safety and benefits of this training for children, the lack of representation of their voices poses a challenge in designing training programs that meet their specific needs and requirements. METHODS: Children's views, experiences, and perceptions of strength and conditioning training were explored by Write, Draw, Show and Tell techniques. Sixteen grassroots soccer players aged 11-12 years took part in one of 3 focus groups exploring the topic. Data were analyzed following an inductive approach enabling themes to be explored and later deductive analyses using the Youth Physical Activity Promotion model to create pen profile diagrams. RESULTS: Strength and conditioning were frequently associated with muscle growth, coordination, endurance, and rest. Enabling factors included autonomy, resilience, physical development, and training opportunities. Reinforcing factors included social support, social interference, coaches' communication, role models, and the ways of implementation. CONCLUSIONS: Participants favor integrating strength and conditioning into their soccer training rather than conducting it as a separate session, which is reflected in their enjoyment. Nonetheless, children remain apprehensive about the potential effects of this type of training on their growth.

Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study.

BACKGROUND/OBJECTIVES: Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation. METHODS: Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation. RESULTS: Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement. CONCLUSION: Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

The influence of angle-specific torque of the knee flexors and extensors on the angle-specific dynamic control ratio in professional female soccer players.

The purpose of this study was to assess whether dynamic torque ratios (DCR) from isokinetic strength assessments of eccentric knee flexors (eccKF) and concentric knee extensors (conKE) display differences when stratified into specific angle-specific DCR (DCRAST) groups. Fifty-two professional female soccer players (age 21.30 ± 4.44 years; height 166.56 ± 5.17 cm; mass 61.55 ± 5.73 kg) from the English Women's Super League completed strength assessments of both lower limbs on an isokinetic dynamometer at 60°âˆ™s-1. Angle-specific torque (AST) were used to calculate DCRAST to create sub-groups using clustering algorithms. The results identified for the dominant side that the Medium DCRAST group elicited significantly higher conKE AST when compared to Low and High DCRAST groups at increased knee extension (P ≤ 0.05). For the non-dominant side, the High DCRAST group had significantly higher and lower eccKF and conKE AST compared to the Low DCRAST group at increased knee extension (P ≤ 0.05). This study highlights that the inclusion of AST data may subsequently help practitioners to prescribe exercise that promotes strength increases at targeted joint angles. In turn, these approaches can be used to help reduce injury risk, identify rehabilitation responses and help inform return to play.

Bone biopsy results in patients with a history of malignancy: a case series of 378 patients.

OBJECTIVE: The value of a bone biopsy in patients who present with a bone lesion and past medical history of malignancy is uncertain. The objective of this study was to evaluate the outcome of bone biopsies in patients with a history of a malignancy undergoing bone biopsy of a lesion in a regional bone tumour unit. Secondary outcomes include the assessment of survival in the different outcome groups. MATERIALS AND METHODS: This was a retrospective study of patients, with a previous malignancy and suspicious bone lesions, who underwent bone biopsy for final diagnosis between March 2010 and September 2019. Results of the biopsy were summarized into 3 groups: confirmed original malignancy, confirmed benign diagnosis, and confirmed new malignancy. Survival analysis of each group was also undertaken. RESULTS: A total of 378 patients met the inclusion criteria (mean age 64 years, 216 females (57%)). In 250 cases (66%), the original malignancy was confirmed on the bone biopsy; in 128 cases, an alternative diagnosis was confirmed (benign diagnosis in 69 (18%)), and 59 had a new malignancy (16%). Survival was significantly greater for those in whom a benign diagnosis was confirmed (logrank test p = 0.0100). CONCLUSION: This study shows that for patients presenting with a suspicious bone lesion, together with a history of malignancy, in a third of cases, the bone biopsy will confirm an alternative diagnosis of a benign lesion or a new malignancy. Survival of these patients will vary significantly depending on the biopsy outcome.

The prevalence and practices of caffeine use as an ergogenic aid in English professional soccer.

The ergogenic properties of caffeine are well established, with evidence supporting beneficial effects for physical and technical elements of performance required for successful soccer match play. Despite this, recommended caffeine practices for professional soccer have not been established. Therefore, the present study aimed to evaluate the use and behaviours surrounding caffeine use in elite English soccer clubs. Representatives of 36 clubs from the top four tiers of English professional football (40%) completed an online survey that sought to determine if, when, how and why caffeine was prescribed to players as a means of improving sports performance. Of the clubs sampled, 97% indicated that caffeine is provided to players as a means of improving performance. Caffeine is most commonly administered prior to (> 94%) and during a game (> 48%), with frequency uninfluenced by time of matches. There was a broad range and lack of consistency in the timing, dose and mode of caffeine administration, but doses were typically low. Evidence from the present study indicate a translational gap between science and practice, highlighting a need for future work to better understand how caffeine consumption can be optimised with respect to the specific demands and constraints in professional soccer.

Isometric Midthigh Pull Characteristics in Elite Youth Male Soccer Players: Comparisons by Age and Maturity Offset.

Morris, RO, Jones, B, Myers, T, Lake, J, Emmonds, S, Clarke, ND, Singleton, D, Ellis, M, and Till, K. Isometric midthigh pull characteristics in elite youth male soccer players: Comparisons by age and maturity offset. J Strength Cond Res 34(10): 2947-2955, 2020-The purpose of this study was to (a) provide comparative isometric midthigh pull (IMTP) force-time characteristics for elite youth soccer players and (b) determine the effect of age and maturation on IMTP force-time characteristics. Elite male youth soccer players (U12 n = 51; U13 n = 54; U14 n = 56; U15 n = 45; U16 n = 39; and U18 n = 48) across 3 maturity offset groups (Pre n = 117; circa n = 84; and Post-peak height velocity n = 92) performed 2 maximal IMTP trials on a portable force platform (1,000 Hz). Absolute and relative values for peak force (PF) and impulse over 100 and 300 ms were analyzed. A full Bayesian regression model was used to provide probable differences similar to that of a frequentist p value. Advanced age and maturation resulted in superior IMTP force-time characteristics. Peak force demonstrated high probabilities of a difference between all consecutive age groups (p > 0.95). For absolute and relative impulse (100 and 300 ms), only 2 consecutive age groups (U14-15's and U16-18's) demonstrated high probabilities of a difference (p > 0.95) with large effects (d = 0.59-0.93). There were high probable differences between all maturity offset groups for PF and impulse with medium to large effects (d = 0.56-3.80). These were also reduced when expressed relative to body mass (relative PF and relative impulse). This study provides comparative IMTP force-time characteristics of elite male youth soccer players. Practitioners should consider individual maturation status when comparing players given the impact this has on force expression.

The use of intermittent pneumatic compression of the thigh to affect arterial and venous blood flow proximal to a chronic wound site.

Intermittent pneumatic compression of the lower limbs has been shown to have beneficial effects in patients with chronic ulceration. However, the intermittent compression cuff will normally be applied over the wound, which may produce discomfort or interfere with other treatments. Thigh-only approaches to intermittent pneumatic compression could solve this problem. This study aimed to demonstrate if such a system would have positive effects on venous and arterial blood flow distal to the compression site, but proximal to wound sites. The distal venous and arterial effects of a prototype thigh-only 3-chamber sequential intermittent pneumatic compression system were tested in 20 healthy volunteers, and 13 patients with ulcers of various aetiologies using Doppler ultrasound. The system produced hyperaemic responses in the arterial flow of both test groups. The peak venous velocity on deflation of the first and second chambers of the cuff was also greater in the patients with ulceration than in the healthy volunteers (11.6 cm/s vs 8.3 cm/s, P = .1). This work demonstrates that compression of the thigh alone can produce positive haemodynamic effects in the calves of patients with chronic wounds, and that this approach should be investigated as a therapy to improve blood flow to wound sites.

The use of personalised patient information leaflets to improve patients' perceived understanding following open fractures.

Open tibial fractures can have devastating long-term effects. In our centre, these patients are followed up in a multidisciplinary Orthoplastic Research Clinic. To improve patient comprehension of information, we have developed personalised information leaflets. This study determines patients' views on these. The leaflet was completed during clinic visits and its role explained. At their next appointment, patients were given anonymised feedback forms, adapted from previously published questionnaires, to complete on their views and use of the leaflet. During the study period, 48 new patients attended clinic; 40 completed questionnaires and were analysed. A majority of patients (39) self-reported improved understanding of their condition, and 11 patients used the information leaflet to improve communication with other healthcare professionals. A majority of patients (34) wished to receive the information leaflet on discharge. The majority of patients in this study felt the leaflet improved their knowledge of their injuries and management.

Validity of an Isometric Midthigh Pull Dynamometer in Male Youth Athletes.

Till, K, Morris, R, Stokes, K, Trewartha, G, Twist, C, Dobbin, N, Hunwicks, R, and Jones, B. Validity of an isometric midthigh pull dynamometer in male youth athletes. J Strength Cond Res 32(2): 490-493, 2018-The purpose of this study was to investigate the validity of an isometric midthigh pull dynamometer against a criterion measure (i.e., 1,000-Hz force platform) for assessing muscle strength in male youth athletes. Twenty-two male adolescent (age 15.3 ± 0.5 years) rugby league players performed 4 isometric midthigh pull efforts (i.e., 2 on the dynamometer and 2 on the force platform) separated by 5-minute rest in a randomized and counterbalanced order. Mean bias, typical error of estimate (TEE), and Pearson correlation coefficient for peak force (PF) and peak force minus body weight (PFBW) from the force platform were validated against peak force from the dynamometer (DynoPF). When compared with PF and PFBW, mean bias (with 90% confidence limits) for DynoPF was very large (-32.4 [-34.2 to -30.6] %) and moderate (-10.0 [-12.8 to -7.2] %), respectively. The TEE was moderate for both PF (8.1 [6.3-11.2] %) and PFBW (8.9 [7.0-12.4]). Correlations between DynoPF and PF (r 0.90 [0.79-0.95]) and PFBW (r 0.90 [0.80-0.95]) were nearly perfect. The isometric midthigh pull assessed using a dynamometer underestimated PF and PFBW obtained using a criterion force platform. However, strong correlations between the dynamometer and force platform suggest that a dynamometer provides an appropriate alternative to assess isometric midthigh pull strength when a force platform is not available. Therefore, practitioners can use an isometric midthigh pull dynamometer to assess strength in the field with youth athletes but should be aware that it underestimates peak force.

Sedaconda ACD-S for Sedation with Volatile Anaesthetics in Intensive Care: A NICE Medical Technologies Guidance.

Intensive care unit (ICU) patients receive highly complex care and often require sedation as part of their management. ICU sedation has traditionally been delivered using intravenous (IV) agents due to the impractical use of anaesthetic machines in this setting, which are used to deliver volatile sedation. Sedaconda anaesthetic conserving device (ACD)-S (previously known as AnaConDa-S) is a device which allows for the delivery of volatile sedation via the majority of mechanical ventilators by being inserted in the breathing circuit where the heat and moisture exchanger is normally placed. The National Institute of Health and Care Excellence (NICE), as part of the Medical Technologies Evaluation Programme, considered the potential benefits of using Sedaconda ACD-S compared to standard IV sedation in ICU patients. Here we describe the evidence evaluation undertaken by NICE on this technology, supported by CEDAR. CEDAR considered the evidence present in 21 publications that compared the clinical outcomes of patients receiving Sedaconda ACD-S-delivered sedation and IV sedation, and critiqued the economic model provided by the manufacturer. Clinical expert input during the evaluation process was used extensively to ensure that the relevant clinical evidence was captured and that the economic model was suitable for the UK setting. Due to the uncertainty of the evidence, sensitivity analysis was carried out on the key economic inputs to ensure the reliability of the results. Economic modelling has shown that Sedaconda ACD-S-delivered isoflurane sedation is cost saving on a 30-day horizon compared to IV sedation by £3833.76 per adult patient and by £2837.41 per paediatric patient. Clinical evidence indicated that Sedaconda ACD-S-delivered isoflurane sedation is associated with faster patient wake-up times than standard of care. Consequently, NICE recommended Sedaconda ACD-S as an option for delivering sedation in the ICU setting, but noted that further research should inform whether Sedaconda ACD-S-delivered sedation is of benefit to any particular subgroup of patients.

Coeliac axis thrombosis and acute hepatic failure in a patient with dilated cardiomyopathy.

We present the case of a female patient in her 40s who presented with jaundice, orthopnoea, paroxysmal nocturnal dyspnoea and bilateral pedal oedema. After extensive investigations, she was diagnosed with hepatic dysfunction, dilated cardiomyopathy (DCM) and coeliac axis thrombosis. Her case was further complicated with episodes of torsades de pointes due to metabolic disturbance, with consequent sudden cardiac arrest. In this case report, we explore the clinical features, pathophysiology and treatment of acute hepatic failure and coeliac axis thrombosis, secondary to DCM and alcoholic liver disease.

Observations of Player (de)Selection Within a Professional UK Soccer Academy.

The present study engaged in an ethnographical observation of the processes used to determine player (de)selections within a professional academy. English category-2 youth academy players (n = 96) from U10-U16 age groups undertook anthropometric profiling (height, mass and somatic maturation) and fitness assessments (10 m, 20 m & 30 m linear sprints, 505-agility test, countermovement and squat jumps). Each players lead coach (n = 4) subjectively graded players utilising a red, amber and green (RAG) rating system on a weekly (current performance) and quarterly (perceived potential) basis, across 25 weeks. A MANCOVA, controlling for maturation, was applied to determine differences in (de)selection by physical performance. Mann Whitney-U tests were used to distinguish difference in (de)selection by subjective grading (weekly and quarterly). The key finding was that quarterly subjective gradings established a higher cumulative score of green ratings in selected players and a low cumulative score of red ratings, and vice versa for deselected players (P ≤ 0.001 to 0.03). However, whilst these findings suggest that quarterly subjective grades of potential were able to provide the best predictors for player (de)selection, the findings should be viewed with caution due to high potential for confirmatory bias.

Agreement between Force Platform and Smartphone Application-Derived Measures of Vertical Jump Height in Youth Grassroots Soccer Players.

Given the importance of vertical jump assessments as a performance benchmarking tool, the assessment of neuromuscular function and indicator of health status, accurate assessment is essential. This study compared countermovement jump (CMJ) height assessed using MyJump2 (JHMJ) to force-platform-derived jump height calculated from time in the air (JHTIA) and take-off velocity (JHTOV) in youth grassroots soccer players. Thirty participants (Age: 8.7 ± 0.42 yrs; 9 females) completed bilateral CMJs on force platforms whilst jump height was simultaneously evaluated using MyJump2. Intraclass correlation coefficients (ICC), Standard error of measurement (SEM), coefficient of variance (CV) and Bland-Altman analysis were used to compare performance of MyJump2 to force-platform-derived measures of CMJ height. The median jump height was 15.5 cm. Despite a high level of agreement between JHTIA and JHTOV (ICC = 0.955), CV (6.6%), mean bias (1.33 ± 1.62 cm) and 95% limits of agreement (LoA -1.85-4.51 cm) were greater than in other comparisons. JHMJ performed marginally better than JHTIA when compared to JHTOV (ICC = 0.971; 95% CI's = 0.956-0.981; SEM = 0.3 cm; CV = 5.7%; mean bias = 0.36 ± 1.61 cm; LoA = -3.52-2.80 cm). Irrespective of method, jump height did not differ between males and females (p > 0.381; r < 0.093), and the comparison between assessment tools was not affected by sex. Given low jump heights achieved in youth, JHTIA and JHMJ should be used with caution. JHTOV should be used to guarantee accuracy in the calculation of jump height.

UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update.

Lower urinary tract symptoms (LUTS) commonly occur as a consequence of benign prostatic hyperplasia (BPH), also known as prostate enlargement. Treatments for this can involve electrosurgical removal of a section of the prostate via transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), or prostatic urethral lift using the UroLift system. The UroLift system implants to pull excess prostatic tissue away so that it does not narrow or block the urethra. In this way, the device is designed to relieve symptoms of urinary outflow obstruction without cutting or removing tissue. National guidance recommending the use of UroLift in the UK NHS was first issued in 2015 by the National Institute for Health and Care Excellence (NICE MTG26). We now report on the process to update the economic evaluation of UroLift, leading to updated NICE guidance published in May 2021 (NICE MTG58). The conclusions of the available clinical evidence were mixed and suggested that whilst UroLift improves symptoms over time, this improvement is smaller than that of TURP for symptom severity (IPSS) and urological outcomes. However, UroLift appears to be superior to Rezum for symptom severity and measures of erectile dysfunction and ejaculatory dysfunction. The updated economic model estimated that using UroLift as a day-case procedure for people with prostate of volume 30-80 mL creates a saving of £981 per person compared with bipolar TURP, £1242 compared with monopolar TURP, and £1230 compared with HoLEP.

The Effects of Soccer Specific Exercise on Countermovement Jump Performance in Elite Youth Soccer Players.

The aims of the study were to examine the test−retest reliability of force-time (F-T) characteristics and F-T curve waveform of bilateral and unilateral countermovement jumps (CMJ) in elite youth soccer players and to evaluate the effects of competitive match-play on CMJ performance. 16 male youth soccer players completed CMJs on two separate occasions to determine reliability, and immediately pre, post and 48 h following a competitive match. Coefficient of variation (CV%), Intra-class correlation coefficient (ICC) and limits of agreement were used to assess reliability of discreate CMJ variables. Single factor repeated measures ANOVA were used to determine the effects of match play. Statistical parametric mapping was used to evaluate the repeatability of the CMJ force-time waveform and the effects of match play. Jump height had limited reliability in all three jumps and only a select few jump specific F-T variables were found to be reliable (CV < 10%, ICC > 0.5). Select variables were reduced immediately post game but recovered 48 h post game. The F-T curve waveform was found to be repeatable but did not differ following match-play. This study suggest that select F-T variables change following match-play and may be suitable tools to allow practitioners to detect decrements in performance. These data may help inform practitioners to use the most appropriate F-T variables to assess fatigue and recovery, with implications for performance and injury risk.

The Dose-Response Relationship Between Training-Load Measures and Changes in Force-Time Components During a Countermovement Jump in Male Academy Soccer Players.

PURPOSE: To manage physical performance in soccer, practitioners monitor the training load (TL) and the resulting fatigue. A method frequently used to assess performance is the countermovement jump (CMJ). However, the efficacy of CMJ to detect fatigue from soccer matches and training remains uncertain, as does the relationship between TL and change in CMJ performance. The aims of the present study were 2-fold. One was to observe the changes of CMJ force-time components and jump height (JH). The second was to examine dose-response relationships between TL measures and CMJ over a 6-week preseason. METHODS: Twelve male academy soccer players (17 [1] y, 71.2 [5.6] kg, and 178 [5.8] cm) were recruited. Daily changes in CMJ were assessed against baseline scores established before preseason training, along with internal and external TL measures. A series of Bayesian random intercept models were fitted to determine probability of change above/below zero and greater than the coefficient of variation established at baseline. Jumps were categorized into match day minus (MD-) categories where the higher number indicated more time from a competitive match. RESULTS: JH was lowest on MD - 3 (28 cm) and highest on MD - 4 (34.6 cm), with the probability of change from baseline coefficient of variation highly uncertain (41% and 61%, respectively). Changes to force-time components were more likely on MD - 3 (21%-99%), which provided less uncertainty than JH. Bayes R2 ranged from .22 to .57 between TL measures and all CMJ parameters. CONCLUSIONS: Force-time components were more likely to change than JH. Practitioners should also be cautious when manipulating TL measures to influence CMJ performance.

Fundamental movement skills and perceived competence, but not fitness, are the key factors associated with technical skill performance in boys who play grassroots soccer.

OBJECTIVE: This study examined the association between fitness, fundamental movement skills (FMS) and perceived competence on technical skills in boys engaged in grassroots soccer. Methods: Sixty boys (8-12 years of age, Mean ± SD = 10 ± 1 years) undertook assessment of FMS, perceived competence, physical fitness (15m sprint speed, standing long jump distance and seated 1kg medicine ball throw as a composite z-score) and technical skills (dribbling, passing and shooting as a composite z-score). RESULTS: Multiple backwards linear regression was used to determine to amount of variance in technical skill explained by FMS, perceived competence and fitness. Results indicated a significant model (F 3,58= 42.04, P = .0001, Adj R2 = .680) which explained 68% of the variance in technical skills. Perceived competence (ß=.316, P =.001), Total FMS (ß=.140, P =.002), and chronological age (ß=.863), P =.001) significantly contributed to the model. CONCLUSION: This study demonstrates that better technical skills (passing, dribbling, shooting) in youth soccer are explained, alongside age, by being competent in FMS and having a more positive perception of competence. Coaches should therefore seek to encourage development of these factors during childhood for the benefit of technical skill performance.

How Repeatable Is the Ergogenic Effect of Caffeine? Limited Reproducibility of Acute Caffeine (3 mg.kg-1) Ingestion on Muscular Strength, Power, and Muscular Endurance.

This study aimed to determine the effect of 3 mg.kg−1 acute caffeine ingestion on muscular strength, power and strength endurance and the repeatability of potential ergogenic effects across multiple trials. Twenty-two university standard male rugby union players (20 ± 2 years) completed the study. Using a double-blind, randomized, and counterbalanced within-subject experimental design. Participants completed six experimental trials (three caffeine and three placebo) where force time characteristic of the Isometric Mid-Thigh Pull (IMTP), Countermovement Jump (CMJ) and Drop Jumps (DJ) were assessed followed by assessments of Chest Press (CP), Shoulder Press (SP), Squats (SQ), and Deadlifts (DL) Repetitions Until Failure (RTF at 70% 1 RM). ANOVA indicated that caffeine improved both the CMJ and DJ (p < 0.044) and increased RTF in all RTF assessments (p < 0.002). When individual caffeine trials were compared to corresponding placebo trials, effect sizes ranged from trivial-large favoring caffeine irrespective of a main effect of treatment being identified in the ANOVA. These results demonstrate for the first time that the performance enhancing effects of caffeine may not be repeatable between days, where our data uniquely indicates that this is in part attributable to between sessions variation in caffeine's ergogenic potential.

Neonatal digital chest radiography- should we be using additional copper filtration?

OBJECTIVES: Copper filtration removes lower energy X-ray photons, which do not enhance image quality but would otherwise contribute to patient radiation dose. This study explores the use of additional copper filtration for neonatal mobile chest imaging. METHODS: A controlled factorial-designed experiment was used to determine the effect of independent variables on image quality and radiation dose. These variables included: copper filtration (0 Cu, 0.1 Cu and 0.2 Cu), exposure factors, source-to-image distance and image receptor position (direct / tray). Image quality was evaluated using absolute visual grading analysis (VGA) and contrast-to-noise ratio (CNR) and entrance surface dose (ESD) was derived using an ionising chamber within the central X-ray beam. RESULTS: VGA, CNR and ESD significantly reduced (p < 0.01) when using added copper filtration. For 0.1 Cu, the percentage reduction was much greater for ESD (60%) than for VGA (14%) and CNR (20%), respectively. When compared to the optimal combinations of parameters for incubator imaging using no copper filtration, an increase in kV and mAs when using 0.1-mm Cu resulted in better image quality at the same radiation dose (direct) or, equal image quality at reduced dose (in-tray). The use of 0.1-mm Cu for neonatal chest imaging with a corresponding increase in kV and mAs is therefore recommended. CONCLUSION: Using additional copper filtration significantly reduces radiation dose (at increased mAs) without a detrimental effect on image quality. ADVANCES IN KNOWLEDGE: This is the first study, using an anthropomorphic phantom, to explore the use of additional Cu for digital radiography neonatal chest imaging and therefore helps inform practice to standardise and optimise this imaging examination.