Challenges and considerations for reproducibility of STARR-seq assays.

High-throughput methods such as RNA-seq, ChIP-seq, and ATAC-seq have well-established guidelines, commercial kits, and analysis pipelines that enable consistency and wider adoption for understanding genome function and regulation. STARR-seq, a popular assay for directly quantifying the activities of thousands of enhancer sequences simultaneously, has seen limited standardization across studies. The assay is long, with more than 250 steps, and frequent customization of the protocol and variations in bioinformatics methods raise concerns for reproducibility of STARR-seq studies. Here, we assess each step of the protocol and analysis pipelines from published sources and in-house assays, and identify critical steps and quality control (QC) checkpoints necessary for reproducibility of the assay. We also provide guidelines for experimental design, protocol scaling, customization, and analysis pipelines for better adoption of the assay. These resources will allow better optimization of STARR-seq for specific research needs, enable comparisons and integration across studies, and improve the reproducibility of results.

Post-Activation Performance Enhancement of Punch Force and Neuromuscular Performance in Amateur Boxing: Toward a More Individualized and "Real-World" Approach.

ABSTRACT: Finlay, MJ, Greig, M, Bridge, CA, and Page, RM. Post-activation performance enhancement of punch force and neuromuscular performance in amateur boxing: Toward a more individualized and "real-world" approach. J Strength Cond Res 38(6): 1063-1071, 2024-Previous research on post-activation performance enhancement has been applied in several sporting settings, although this is lacking in a boxing setting. This study explored the effectiveness of 2 upper-body conditioning activities in improving punch-specific performance during an amateur boxing-simulated bout. On 3 separate occasions, 10 male senior elite amateur boxers performed the following conditioning activities before a boxing-specific simulation protocol: isometric (ISO) punch, elastic resistance (ER) punch, and a control trial. Boxers performed maximal punches against a vertically mounted force plate, and countermovement jumps (CMJ) at baseline, before round 1, after each round, and 4 minutes after the simulation. Both conditioning activities, but not the control trial, produced small worthwhile increases (effect size ≥ 0.20; equal to or greater than the smallest worthwhile change) in punch force, although worthwhile increases in rate of force development were limited to the cross during the ISO trial. No group-based improvements in CMJ performance were observed. Individual analysis revealed that 6 boxers improved punch-specific performance to the greatest extent in the ISO trial; in contrast, only 1 boxer did so in the ER trial. Three boxers exhibited similar performance increases across trials. In conclusion, both conditioning activities may be applied to an amateur boxer's warm-up to acutely enhance punch-specific performance. The ISO conditioning activity seems most effective; however, the interindividual variability suggests a need for protocols to be individualized to each athlete. The conditioning activities in the present study may be applied to sparring, competitive bouts, or to other combat sports.

Treatment of dyslipidemia in allogeneic hematopoietic stem cell transplant patients.

As survival rates in allogeneic hematopoietic stem cell transplantation (HSCT) continue to improve, attention to long-term complications, including cardiovascular disease, becomes a major concern. Cardiovascular disease and dyslipidemia are a common, yet often overlooked occurrence post-HSCT that results in significant morbidity and mortality. Also, increasing evidence shows that several anti-hyperlipidemia medications, the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in particular, may have a role in modulating graft-versus-host disease (GVHD). However, factors such as drug-drug interactions, adverse effect profiles, and the relative efficacy in lowering cholesterol and triglyceride levels must be taken into account when choosing safe and effective lipid-lowering therapy in this setting. This review seeks to provide guidance to the clinician in the management of dyslipidemia in the allogeneic HSCT population, taking into account the recently published American College of Cardiology/American Heart Association guidelines on hyperlipidemia management, special considerations in this challenging population, and the evidence for each agent's potential role in modulating GVHD.

A trial of an impedance threshold device in out-of-hospital cardiac arrest.

BACKGROUND: The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest. METHODS: We compared the use of an active ITD with that of a sham ITD in patients with out-of-hospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Patients, investigators, study coordinators, and all care providers were unaware of the treatment assignments. The primary outcome was survival to hospital discharge with satisfactory function (i.e., a score of ≤3 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating greater disability). RESULTS: Of 8718 patients included in the analysis, 4345 were randomly assigned to treatment with a sham ITD and 4373 to treatment with an active device. A total of 260 patients (6.0%) in the sham-ITD group and 254 patients (5.8%) in the active-ITD group met the primary outcome (risk difference adjusted for sequential monitoring, -0.1 percentage points; 95% confidence interval, -1.1 to 0.8; P=0.71). There were also no significant differences in the secondary outcomes, including rates of return of spontaneous circulation on arrival at the emergency department, survival to hospital admission, and survival to hospital discharge. CONCLUSIONS: Use of the ITD did not significantly improve survival with satisfactory function among patients with out-of-hospital cardiac arrest receiving standard CPR. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.).

Clinical events and treatment in prehospital patients with ST-segment elevation myocardial infarction.

BACKGROUND: Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting. OBJECTIVES: We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED). METHODS: We reviewed 487 consecutive community patients with STEMI between May 2008 and June 2009. All patients were geographically within a single large "third-service" urban emergency medical services (EMS) system and were transported by paramedics with an advanced care scope of practice. We recorded predefined clinically important events and advanced care treatment that occurred in patients being transported directly to a PCI laboratory or ED (group 1) or interfacility transfer to a PCI laboratory (group 2). RESULTS: One or more clinically important events occurred in 92 of 342 (26.9%) group 1 patients and nine of 145 (6.2%) group 2 patients. The most common were sinus bradycardia, hypotension, and cardiac arrest. Additionally, 33 of 342 (9.6%) group 1 and nine of 145 (6.2%) group 2 patients received one or more advanced care treatments. The most common were administration of morphine and administration of atropine. Eight group 1 patients and three group 2 patients received cardiopulmonary resuscitation (CPR) or defibrillation. CONCLUSIONS: Clinically important events and advanced care treatment are common in community STEMI patients undergoing prehospital transport or interfacility transfer to a PCI center. Several patients required CPR or defibrillation. Further research is needed to define the clinical experience of STEMI patients during the out-of-hospital phase and the scope of practice required of EMS providers to safely manage these patients.

Test-retest reliability and sensitivity of senior elite amateur boxers maximal punch force, as quantified by a vertically mounted force plate.

An ecologically valid, reliable and sensitive method of quantifying punch force variables would be useful for coaches and practitioners monitoring combat-specific performance. The present study utilised a vertically mounted force plate to quantify the peak punch force and rate of force development (RFD) of amateur boxers. Ten male senior elite amateur boxers performed maximal jab, cross, and hook punches across two separate days. The force plate showed excellent within-day and good-to-excellent between-day reliability for peak punch impact force and RFD (ICC 0.89-0.99). The CV% for all punch force variables were similar on day 1 (3-9%) and day 2 (4-10%). Standard error of measurement (SEM) and smallest worthwhile changes (SWC) revealed the force plate can detect small-to-moderate changes in punch performance. The greatest impact forces and RFD were found in the rear hook (2624 ± 581 N, 296448 ± 101823 N.s-1), followed by the lead hook (2524 ± 532 N, 256813 ± 81735 N.s-1), cross 2425 ± 545 N, 193004 ± 62671 N.s-1) and jab (1645 ± 537 N, 116675 ± 41577 N.s-1). The vertically mounted force plate is a reliable and sensitive test of punch performance, thus may be useful in determining the efficacy of training interventions.

Effects of conditioning activity mode, rest interval and effort to pause ratio on post-activation performance enhancement in taekwondo: a randomized study.

Introduction: The present study assessed the effects of conditioning activities, using different effort-to-pause ratios and rest intervals, on taekwondo physical performance. Methods: Twenty-one athletes (13 males and 8 females) (Mean ± SD; age = 20.4 ± 1.4 years) performed a control (CC) and twelve experimental conditions. Each condition contained a standard warm-up (i.e., CC: running at 9 km/h for 10 min) and conditioning activities comprising plyometrics P) or repeated high-intensity techniques (RT) using 1:6, 1:9 and self-selected rest (SSR) ratios, and two rest intervals (3 and 7 min). Athletes then performed a battery of fitness tests: countermovement jump (CMJ), taekwondo specific agility (TSAT), 10s and multiple frequency speed kick test (FSKT-10s and FSKT-mult, respectively). Results: All of the preloads provided higher performance outputs compared to the control trial (all p < 0.05). For CMJ, 1:6 ratio with 3 min induced lower values with RT compared to P (p = 0.037) and 1:9 ratio using 3 min induced higher values with RT compared to P (p = 0.027). Additionally, 1:6 ratio using 7 min induced higher values with RT compared to P (p = 0.016). For FSKT-10, 3 min using 1:6 induced higher values with P compared to RT, while RT induced higher values with 7 min using 1:6 ratio compared to P (both p < 0.001). Moreover, 3 min using 1:9 ratio induced higher values with P compared to RT (p = 0.034), while RT induced higher values with 1:9 ratio using 7 min compared to P (p < 0.001). Finally, 3 min using SSR ratio induced higher values with RT compared to P (p = 0.034). Conclusion: Plyometrics and RT activities improved performance with plyometrics requiring shorter rest interval to induce potentiation effects compared to RT, which required longer interval.

Repeated High-Intensity Technique Training and Repeated Sprint Training Elicit Similar Adjustment in Physiological Responses But Divergent Perceptual Responses and Combat-Related Performances in Adolescent Taekwondo Matches.

PURPOSE: This study investigated the effects of 4 weeks of repeated sprint training (RST) versus repeated high-intensity technique training (RTT) on the physiological responses (ie, blood lactate), mean and peak heart rate, rating of perceived exertion, technical-tactical performance, and time-motion variables during simulated taekwondo combats. METHODS: Twenty-four taekwondo athletes (18 male and 6 female; age: 16 [1] y) were randomly and equally assigned to RST (10 × 35-m running sprints interspersed by 10-s rest) or RTT (10 × 6-s bandal-tchagui kicking executions interspersed by 10-s rest) groups in addition to their regular training. Both groups performed simulated combats before and after training. RESULTS: Delta lactate and peak heart rate were attenuated following training (P < .001 and P = .03, respectively), with no differences identified between RTT and RST conditions. Rating of perceived exertion decreased after training only in the RTT (P = .002). Time fighting and preparatory activities increased following training (P < .001), with higher values observed following RTT than RST (P < .001). Nonpreparatory time decreased after training (P < .001), with more pronounced reductions observed following RTT when compared to RST (P < .001). The number of single attacks decreased only following RST (P < .001), whereas combined attacks increased only after RTT training (P < .001). CONCLUSIONS: Similar adjustments in the physiological responses to combat were observed following 4 weeks of either RST or RTT, but RTT elicited more favorable perceptual responses and combat-related performance. This highlights the importance of specificity of training and its effective transfer to combat.

Listening to Preferred and Loud Music Enhances Taekwondo Physical Performances in Adolescent Athletes.

In this study, we aimed to investigate the effects of warm-up music preference and loudness on physical performance, perceived exertion (RPE), and enjoyment in young taekwondo athletes. In a crossover counterbalanced design, 20 taekwondo athletes (10 male, 10 female) performed a battery of physical tasks specific to taekwondo under the following five conditions: (a) No music (NM), (b) Preferred music-Soft (60 dB; PMS), (c) Preferred music-Loud (80 dB; PML), (d) Non-preferred music-Soft (60 dB; NPMS), and (e) Non-preferred music-Loud (80 dB; NPML). On each lab visit, participants completed a taekwondo-specific agility test (TSAT), a10-second kick test (KSKT-10s) and a multiple frequency speed of kick tests (FSKT) within each music condition. Pre-exercise enjoyment was assessed using the Physical Activity Enjoyment Scale (PACES) after the warm-up, while we obtained RPE scores after each test. The PML condition resulted in significantly better agility test times on the TSAT compared to PMS (p < .001), and NPML (p < .001). Furthermore, PML led to a greater number of total kicks during the FSKT-10s test compared to the PMS (p < .001), and NPML (p < .001) conditions. The decrement index on the FSKT was lower in PML than in PMS and NPML conditions (p < .001). For RPE, values were significantly lower with preferred than non-preferred music (p < .001). These findings lend support to ergogenic benefits of listening to PML prior to taekwondo physical tasks, with important implications for enhancing taekwondo training and performance.

Acute effects of caffeine supplementation on taekwondo performance: the influence of competition level and sex.

The purpose of this study was to assess the effects of acute caffeine supplementation on physical performance and perceived exertion during taekwondo-specific tasks in male and female athletes with varying expertise. In a double-blinded, randomized, placebo-controlled crossover study design, 52 young athletes from elite (n = 32; 16 males and 16 females) and sub-elite competitive level (n = 20; 10 males and 10 females) participated. Athletes performed taekwondo-specific tasks including the taekwondo-specific agility test (TSAT), 10 s frequency speed of kick test (FSKT-10 s) and multi-bout FSKT (FSKT-multi) under the following conditions: (1) Caffeine (CAF; 3 mg kg-1), placebo (PLA), and no supplement control (CON). Session rating of perceived exertion (s-RPE) was determined after the tests. Findings show that regardless of condition, males performed better than females (p < 0.05) and elite athletes had superior performance compared to their sub-elite counterparts (p < 0.05). For the TSAT (p < 0.001), FSKT-10s (p < 0.001), and FSKT-multi (p < 0.001), CAF enhanced performance in elite female athletes compared to sub-elite females. Likewise, CAF ingestion resulted in superior performance in elite males compared to sub-elite males for FSKT-10s (p = 0.003) and FSKT-multi (p < 0.01). The ergogenic potential of CAF during taekwondo-specific tasks appears to be related to a competitive level, with greater benefits in elite than sub-elite athletes.

Serial prehospital 12-lead electrocardiograms increase identification of ST-segment elevation myocardial infarction.

BACKGROUND: Many prehospital protocols require acquisition of a single 12-lead electrocardiogram (ECG) when assessing a patient for ST-segment elevation myocardial infarction (STEMI). However, it is known that ECG evidence of STEMI can evolve over time. OBJECTIVES: To determine how often the first and, if necessary, second or third prehospital ECGs identified STEMI, and the time intervals associated with acquiring these ECGs and arrival at the emergency department (ED). METHODS: We retrospectively analyzed 325 consecutive prehospital STEMIs identified between June 2008 and May 2009 in a large third-service emergency medical services (EMS) system. If the first ECG did not identify STEMI, protocol required a second ECG just before transport and, if necessary, a third ECG before entering the receiving ED. Paramedics who identified STEMI at any time bypassed participating local EDs, taking patients directly to the percutaneous coronary intervention (PCI) center. Paramedics used computerized ECG interpretation with STEMI diagnosis defined as an "acute MI" report by GE/Marquette 12-SL software in ZOLL E-series defibrillator/cardiac monitors (ZOLL Medical, Chelmsford, MA). We recorded the time of each ECG, and the ordinal number of the diagnostic ECG. We then determined the number of cases and frequency of STEMI diagnosis on the first, second, or third ECG. We also measured the interval between ECGs and the interval from the initial positive ECG to arrival at the ED. Results. STEMI was identified on the first prehospital ECG in 275 cases, on the second ECG in 30 cases, and on the third ECG in 20 cases (cumulative percentages of 84.6%, 93.8%, and 100%, respectively). For STEMIs identified on the second or third ECG, 90% were identified within 25 minutes after the first ECG. The median times from identification of STEMI to arrival at the ED were 17.5 minutes, 11.0 minutes, and 0.7 minutes for STEMIs identified on the first, second, and third ECGs, respectively. CONCLUSIONS: A single prehospital ECG would have identified only 84.6% of STEMI patients. This suggests caution using a single prehospital ECG to rule out STEMI. Three serial ECGs acquired over 25 minutes is feasible and may be valuable in maximizing prehospital diagnostic yield, particularly where emergent access to PCI exists.

The impact of distance on triage to trauma center care in an urban trauma system.

BACKGROUND: Urban trauma systems are characterized by high population density, availability of trauma centers, and acceptable road transport times (within 30 minutes). In such systems, patients meeting field trauma triage (FTT) criteria should be transported directly to a trauma center, bypassing closer non-trauma centers. OBJECTIVE: We evaluated emergency medical services (EMS) triage practices to identify opportunities for improving care delivery. OBJECTIVE: Specifically, we evaluated the effect of the additional distance to a trauma center, compared with a closer non-trauma center, on the noncompliance with trauma destination criteria by EMS personnel in an urban environment. METHODS: This was a retrospective cohort study of adults having at least one physiologic derangement and meeting Toronto EMS field trauma triage criteria from 2005 to 2010. Road travel distances between the site of injury, the closest non-trauma center, and the closest trauma center were estimated using geographic information systems. For patients who were transported to non-trauma centers, we estimated "differential distance": the additional travel distance required to transport directly to a trauma center. Logistic regression was used to analyze the effect of differential distance on triage decisions, adjusting for other patient characteristics. RESULTS: Inclusion criteria identified 898 patients; 53% were transported directly to a trauma center. Falls, female gender, and age greater than 65 years were associated with transport to non-trauma centers. Differential distances greater than 1 mile were associated with a decreased likelihood of triage to a trauma center. CONCLUSION: Differential distance between the closest non-trauma center and the closest trauma center was associated with lower compliance with triage protocols, even in an urban setting where trauma centers can be accessed within approximately 30 minutes. Our findings suggest that there are opportunities for reducing the gap between ideal and actual application of field trauma triage guidelines through a process of education and feedback.

The prevalence of pre-conditioning and recovery strategies in senior elite and non-elite amateur boxing.

OBJECTIVES: A variety of acute strategies around competition are used to prepare and promote physical and mental restoration in athletes. However, to date, no research exists on the prevalence of such methods in amateur boxing. Therefore, this study aimed to 1) examine the prevalence of pre-conditioning and recovery strategies in amateur boxing; 2) ascertain whether this was discriminated against at competitor level. METHODS: This study surveyed 101 senior amateur boxers (Senior Elite SEB n = 59; Senior Development SDB n = 42), on their application and perceptions of pre-conditioning and recovery strategies. RESULTS: The reported findings determined a significantly greater number of SEB performed resistance priming activity up to 48 hours prior to competition (11, 19% vs 2, 5%; P = 0.040), and post-activation performance enhancement (PAPE) activity in the pre-competition warm-up (18, 31% vs 1, 2%; P < 0.001), compared to SDB. Likewise, SEB reported they were also significantly more likely to utilize massage (SEB 35, 59%, SDB 11, 29%, P = 0.001) and cold-water immersion (CWI) (SEB 28, 47%, SDB 10, 29%, P = 0.016) as recovery modes, compared to their SDB counterparts. CONCLUSIONS: This study was the first to provide data on the use of PAPE, priming and recovery methods around amateur boxing bouts. Increased access to multi-disciplinary staff could be expected in SEB, possibly explaining the greater prevalence of evidence-based methods around competition. Once athlete responsiveness to PAPEand longer-term priming methods are initially assessed, these strategies could be implemented to improve punch-specific performance, though more research is needed on their efficacy. Likewise, boxers could utilize evidence-based recovery modes where possible, with increased importance during repeat-bout scenarios, such as domestic tournaments. Coaches and practitioners may use this data to implement pre-conditioning and recovery strategies, to optimize performance and reduce the risk of injury of amateur boxers.

Upper-Body Post-activation Performance Enhancement for Athletic Performance: A Systematic Review with Meta-analysis and Recommendations for Future Research.

BACKGROUND: Research on post-activation performance enhancement (PAPE) is dominated by lower-body conditioning activities/performance test complexes. Despite the contribution of the upper body to many sporting actions, no review on upper-body PAPE currently exists. OBJECTIVES: The aim of this systematic review with meta-analysis was to provide a synthesis of the available research on the inclusion of upper-body PAPE conditioning activities to improve athletic performance. METHODS: A review of the literature was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, including a literature search of EBSCOhost, SPORTDiscus, PubMed and Google Scholar databases. A total of 127 studies were identified through database searches, and were assessed against the following criteria: (1) randomised controlled trial or pre-and-post study design; (2) studies explored the effects of prior voluntary muscle activity, and not electrically induced contractions, (3) evidence, or lack thereof, of PAPE was quantified by the monitoring of individual performance to commonly applied physical tests or sport-specific tasks; (4) conditioning activities and performance tests were primarily upper-body; (5) detailed description of a standardised warm-up; and (6) full-text versions of studies could be accessed in English language peer-reviewed journals. Studies were quality assessed for methodological quality via the PEDro scale and ranked accordingly. RESULTS: Thirty-one studies met the inclusion criteria. Studies were classified into different conditioning activity modes: bench press variations, sport-specific (modified implement throws, swing-specific, cable pulley, elastic resistance, combination) and bodyweight activity. Acute performance enhancement in several movement-specific combinations was found. A meta-analysis revealed that bench press at ≥ 80% one repetition maximum significantly (p = 0.03; ES = 0.31) improves subsequent power output in the ballistic bench throw at 30-40% one repetition maximum, following 8-12 min recovery. Additionally, sport-specific overweight implement throws improved subsequent throwing distance at competition weight by ~ 1.7-8.5%; ES = 0.14-0.33, following 3 min recovery. Sport-specific lighter weighted bat swings and swing-specific isometrics resulted in improved subsequent competition weight bat swing velocities, ranging from ~ 1.3-4.9%; ES = 0.16-0.57. CONCLUSIONS: This review presents several upper-body movement-specific conditioning activities that could be considered by coaches and practitioners as part of complex or contrast training, or used in pre-competition warm-ups to acutely enhance performance.

Relationship Between Intraoperative Electrocochleography and Hearing Preservation.

OBJECTIVES: To compare intraoperative intracochlear electrocochleography (ECochG) with hearing preservation outcomes in cochlear implant (CI) subjects. DESIGN: Intraoperative electrocochleography was performed in adult CI subjects who were recipients of Advanced Bionics' Bionics LLC precurved HiFocus MidScala or straight HiFocus SlimJ electrode arrays. ECochG responses were recorded from the most apical electrode contact during insertion. No changes to the insertions were made due to ECochG monitoring. No information about insertion resistance was collected. ECochG drops were estimated as the change in amplitude from peak (defined as maximum amplitude response) to drop (largest drop) point after the peak during insertion was measured following the peak response. Audiometric thresholds from each subject were obtained before and approximately 1 month after CI surgery. The change in pure tone average for frequencies between 125 Hz and 500 Hz was measured after surgery. No postoperative CT scans were collected as part of this study. RESULTS: A total of 68 subjects from five surgical centers participated in the study. The study sample included 30 MidScala and 38 SlimJ electrodes implanted by approximately 20 surgeons who contributed to the study. Although a wide range of results were observed, there was a moderate positive correlation (Pearson Correlation coefficient, r = 0.56, p < 0.01) between the size of the ECochG drop and the magnitude of pure tone average change. This trend was present for both the MidScala and SlimJ arrays. The SlimJ and MidScala arrays produced significantly different hearing loss after surgery. CONCLUSION: Large ECochG amplitude drops observed during electrode insertion indicated poorer hearing preservation. Although the outcomes were variable, this information may be helpful to guide surgical decision-making when contemplating full electrode insertion and the likelihood of hearing preservation.

Methodology for the development of a Canadian national EMS research agenda.

BACKGROUND: Many health care disciplines use evidence-based decision making to improve patient care and system performance. While the amount and quality of emergency medical services (EMS) research in Canada has increased over the past two decades, there has not been a unified national plan to enable research, ensure efficient use of research resources, guide funding decisions and build capacity in EMS research. Other countries have used research agendas to identify barriers and opportunities in EMS research and define national research priorities. The objective of this project is to develop a national EMS research agenda for Canada that will: 1) explore what barriers to EMS research currently exist, 2) identify current strengths and opportunities that may be of benefit to advancing EMS research, 3) make recommendations to overcome barriers and capitalize on opportunities, and 4) identify national EMS research priorities. METHODS/DESIGN: Paramedics, educators, EMS managers, medical directors, researchers and other key stakeholders from across Canada will be purposefully recruited to participate in this mixed methods study, which consists of three phases: 1) qualitative interviews with a selection of the study participants, who will be asked about their experience and opinions about the four study objectives, 2) a facilitated roundtable discussion, in which all participants will explore and discuss the study objectives, and 3) an online Delphi consensus survey, in which all participants will be asked to score the importance of each topic discovered during the interviews and roundtable as they relate to the study objectives. Results will be analyzed to determine the level of consensus achieved for each topic. DISCUSSION: A mixed methods approach will be used to address the four study objectives. We anticipate that the keys to success will be: 1) ensuring a representative sample of EMS stakeholders, 2) fostering an open and collaborative roundtable discussion, and 3) adhering to a predefined approach to measure consensus on each topic. Steps have been taken in the methodology to address each of these a priori concerns.

Prehospital evaluation and economic analysis of different coronary syndrome treatment strategies--PREDICT--rationale, development and implementation.

BACKGROUND: A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI) includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist in some communities. The main objective is to compare prehospital care strategies for time to treatment and survival outcomes as well as cost effectiveness. METHODS/DESIGN: PREDICT is a multicentre, prospective population-based cohort study of all chest pain patients 18 years or older presenting within 30 mins to 6 hours of symptom onset and treated with nitroglycerin, transported by paramedics in a number of different urban and rural regions in Ontario. The primary objective of this study is to compare the proportion of study subjects who receive reperfusion within the target door-to-reperfusion times in subjects obtained after four prehospital strategies: 12-lead ECG and advance emergency department (ED) notification or 3-lead ECG monitoring and alert to dispatch prior to hospital arrival; either with or without the opportunity to bypass to a PCI centre. DISCUSSION: We anticipate four challenges to successful study implementation and have developed strategies for each: 1) diversity in the interpretation of the ethical and privacy issues across 47 research ethics boards/committees covering 71 hospitals, 2) remote oversight of data guardian abstraction, 3) timeliness of implementation, and 4) potential interference in the study by concurrent technological advances. Research ethics approvals from academic centres were obtained initially and submitted to non academic centre applications. Data guardians were trained by a single investigator and data entry is informed by a detailed data dictionary including variable definitions and abstraction instructions and subjected to error and logic checks. Quality oversight provided by a single investigator. The window of the trial in each community has been confirmed with the base-hospital medical director to correspond to the planned technological advances of the system of care. We hope this comparative analysis across treatment strategies for clinical outcomes and cost will provide sufficient evidence to implement the superior strategy across all communities and improve outcomes for all STEMI patients.

Recolonization by Slugs: Vertical and Horizontal Dispersal by the Field Slug, Deroceras reticulatum.

Following treatment with molluscicides or other controls, slugs can recolonize a site very quickly, but the proportion of the colonizing slugs moving from adjacent areas (horizontal dispersal) and the proportion from within the soil (vertical dispersal) has not previously been established. At a grassland site, barriers were used to exclude and trap slugs in order to estimate horizontal and vertical movement over a period of 32 months. For the first 15 months vertical movement made a significant contribution to the slugs recolonizing a grassland area. The ecological mechanisms occurring and the implications for the control of slugs are discussed.

The association between competitor level and the physical preparation practices of amateur boxers.

Physical training, testing, and monitoring are three key constitutes of athlete physical performance; however, there is a currently a lack of information on the prevalence of such methods in amateur boxing. This study aimed to explore the physical preparation practices of senior elite (SEB) and senior development (SDB) amateur boxers, and to determine whether these practices were discriminated by competitor level. One hundred and one amateur boxers (SEB n = 59, SDB n = 42) were surveyed on their understanding, perceptions and application of physical training, monitoring, and testing practices. SEB were associated with strength/power training (SEB 78%, SDB 50%, P = 0.005), monitor of training intensities (SEB 68%, SDB 40%, P = 0.006), and performing regular fitness testing (SEB 76%, SDB 50%, P = 0.006), compared to SDB. Likewise, SEB were twice as likely (56%) to have their physical preparation managed by a strength and conditioning (S&C) coach or sport scientist, compared to SDB (26%; P = 0.005). For the first time, these data demonstrate the extent to which competitor level is associated with preparatory practices in amateur boxing. Cost was identified as the main barrier in implementing several forms of scientific support in SDB. These data serve as a framework to enhance preparatory practices across different competitor levels in amateur boxing. This might include boxer and coach education on the benefits to a more scientific approach, and the use of cost-effective methods to develop, monitor and assess amateur boxers physical performance. This may be of particular importance where boxers are not funded, such as the SDB in the current study. However, this work may also be used to emphasise the importance of strength/power training, physical fitness testing and monitoring at the elite level of amateur boxing.

Evidence-based optimization of urban firefighter first response to emergency medical services 9-1-1 incidents.

INTRODUCTION: Many emergency medical services (EMS) systems dispatch nonparamedic firefighter first responders (FFRs) to selected EMS 9-1-1 calls, intending to deliver time-sensitive interventions such as defibrillation, cardiopulmonary resuscitation (CPR), and bag-mask ventilation prior to arrival of paramedics. Deciding when to send FFRs is complicated because critical cases are rare, paramedics often arrive before FFRs, and lights-and-siren responses by emergency vehicles are associated with the risk of en-route traffic collisions. OBJECTIVE: To describe a methodology allowing EMS systems to optimize their own FFR programs using local data, and reflecting local medical oversight policy and local risk-benefit opinion. METHODS: We constructed a generalized input-output model that retrospectively reviews EMS dispatch and electronic prehospital clinical records to identify a subset of Medical Priority Dispatch System (MPDS) call categories ("determinants") that maximize the opportunities for FFR interventions while minimizing unwarranted responses. Input parameters include local FFR interventions, the local FFR "first-on-scene" rate, and the locally acceptable ratio of risk to benefit. The model uses a receiver-operating characteristic (ROC) curve to identify the optimal mix of response specificity and sensitivity achieved by sending FFRs to progressively more categories of EMS calls while remaining within a defined risk-benefit ratio. The model was applied to a 16-month retrospective sample of 220,358 incidents from a large urban EMS system to compare the model's recommendations with the system's current practices. RESULTS: The model predicts that FFR lights-and-siren responses in the sample could be reduced by 83%, from 93,058 to 16,091 incidents, by confining FFR responses to 27 of 509 MPDS dispatch determinants, representing 7.3% of incidents but 58.9% of all predicted FFR interventions. Of the 93,058 incidents, another 58,275 incidents could be downgraded to safer nonemergency FFR responses and 18,692 responses could be eliminated entirely, improving the specificity of FFR response from 57.8% to 93.0%. CONCLUSIONS: This model provides a robust generalized methodology allowing EMS systems to optimize FFR lights-and-siren responses to emergency medical calls. Further validation is warranted to assess the model's generality.