American Society of Biomechanics Journal of Biomechanics Award 2021: Exploring the Functional Boundaries and Metabolic Consequences of Triceps Surae Force-Length Relations during Walking.

The relationship between individual muscle dynamics and whole-body metabolic cost is not well established. Here we use biofeedback to modulate triceps surae (TS) activity during walking to test the following hypotheses based on basic principles of muscle physiology: (1) increased TS activity would increase metabolic cost via shorter muscle fascicle lengths and thus reduced force capacity and (2) decreased TS activity would decrease metabolic cost via longer muscle fascicle lengths and thus increased force capacity. 23 young adults walked on an instrumented treadmill at 1.25 m/s using electromyographic (EMG) biofeedback to match targets corresponding to ±20 and ±40% TS activity during push-off (late stance). B-mode ultrasound imaged the medial gastrocnemius (MG). Participants increased net metabolic power up to 85% and 21% when targeting increased and decreased TS activity, respectively (p < 0.001). At the instant of peak gastrocnemius force, MG fascicle length was 7% shorter (p < 0.001) and gastrocnemius force was 6% larger (p < 0.001) when targeting + 40% TS activity. Fascicle length was 3% shorter (p = 0.004) and force was 7% lower (p = 0.010) when targeting -40% TS activity; participants were unable to achieve decreased activation targets. MG fascicle length and activity mediated 11.7% (p = 0.036) and 57.2% (p = 0.006) of the changes in net metabolic power, respectively. MG force did not mediate changes in net metabolic power (p = 0.948). These findings suggest that changes in the functional operating length of muscle, induced here by volitional changes in TS activity, mediated changes in the metabolic cost of walking, relatively independently of force. Thus, shifts to shorter fascicle lengths (e.g., aging) may mediate activity-induced increases in metabolic cost.

"Appraisal of state-of-the-art" The 2021 Distinguished Service Award of the Safety Pharmacology Society: Reflecting on the past to tackle challenges ahead.

This appraisal of state-of-the-art manuscript highlights and expands upon the thoughts conveyed in the lecture of Dr. Jean-Pierre Valentin, recipient of the 2021 Distinguished Service Award of the Safety Pharmacology Society, given on the 2nd December 2021. The article reflects on the strengths, weaknesses, opportunities, and threats that surrounded the evolution of safety and secondary pharmacology over the last 3 decades with a particular emphasis on pharmaceutical drug development delivery, scientific and technological innovation, complexities of regulatory framework and people leadership and development. The article further built on learnings from past experiences to tackle constantly emerging issues and evolving landscape whilst being cognizant of the challenges facing these disciplines in the broader drug development and societal context.

"Living High-Training Low" for Olympic Medal Performance: What Have We Learned 25 Years After Implementation?

BACKGROUND: Altitude training is often regarded as an indispensable tool for the success of elite endurance athletes. Historically, altitude training emerged as a key strategy to prepare for the 1968 Olympics, held at 2300 m in Mexico City, and was limited to the "Live High-Train High" method for endurance athletes aiming for performance gains through improved oxygen transport. This "classical" intervention was modified in 1997 by the "Live High-Train Low" (LHTL) model wherein athletes supplemented acclimatization to chronic hypoxia with high-intensity training at low altitude. PURPOSE: This review discusses important considerations for successful implementation of LHTL camps in elite athletes based on experiences, both published and unpublished, of the authors. APPROACH: The originality of our approach is to discuss 10 key "lessons learned," since the seminal work by Levine and Stray-Gundersen was published in 1997, and focusing on (1) optimal dose, (2) individual responses, (3) iron status, (4) training-load monitoring, (5) wellness and well-being monitoring, (6) timing of the intervention, (7) use of natural versus simulated hypoxia, (8) robustness of adaptative mechanisms versus performance benefits, (9) application for a broad range of athletes, and (10) combination of methods. Successful LHTL strategies implemented by Team USA athletes for podium performance at Olympic Games and/or World Championships are presented. CONCLUSIONS: The evolution of the LHTL model represents an essential framework for sport science, in which field-driven questions about performance led to critical scientific investigation and subsequent practical implementation of a unique approach to altitude training.

Before you call the midwife.

The 2022 Lasker-DeBakey Clinical Medical Research Award is presented to Yuk Ming Dennis Lo of the Chinese University of Hong Kong for the discovery of fetal DNA in maternal blood, leading to development of noninvasive prenatal testing for Down syndrome.

The Multidisciplinary Physical Preparation of a Multiple Paralympic Medal-Winning Cyclist.

PURPOSE: This case study aims to describe the multidisciplinary preparation of a multiple medal-winning Paralympic cyclist active in the C5 class. Specifically, it describes the 12-month preparation period toward the Tokyo 2020 Paralympic Games. METHOD: The participant (height 173 cm; weight approximately 63 kg) is active in the C5 para-cycling class (right arm impairment) and was preparing for the individual pursuit, road time trial, and mass-start race in the Tokyo Paralympic Games. The participant was supported by a multidisciplinary practitioner team focusing on multiple facets of athletic preparation. Morning resting heart rate (HR) and HR variability, as well as daily training data, were collected during the 12 months prior to Tokyo. Weekly and monthly trends in training, performance, and morning measures were analyzed. Training intensity zones were divided into zone 1 (lactate threshold, critical power). RESULTS: The participant won a silver (individual pursuit) and a bronze (time trial) medal at the Paralympic Games. Annual sums of volume and total work (in kilojoules) were, respectively, 1039 hours and 620,715 kJ. Analyzing all road sessions, 85% was spent in zone 1, 9% in zone 2, and 6% in zone 3. Physiological (eg, high training loads, hypoxic stimuli) and psychological stressors (ie, significant life events) were clearly reflected in morning HR and HR-variability responses. CONCLUSIONS: This case study demonstrates how a multidisciplinary team of specialist practitioners successfully prepared an elite Paralympic cyclist utilizing a holistic approach to training and health using data to manage allostatic load.

Relative and Chronological Age in Successful Athletes at the World Taekwondo Championships (1997-2019): A Focus on the Behaviour of Multiple Medallists.

The aims of this study were to investigate the relative and chronological age among taekwondo world medal winners (by gender, Olympic 4-year period, Olympic weight category; N = 740), and to study the behaviour of multiple medallists (N = 156) to monitor changes in weight categories and wins over time. The observed birth quartile distribution for the heavyweight category was significantly skewed (p = 0.01). Female athletes (22.2 ± 3.5 years) achieve success at a significantly younger age (p = 0.01) than their male counterparts (23.6 ± 3.3 years). In the weight categories, female flyweights were significantly younger than those welterweights (p = 0.03) and heavyweight (p = 0.01); female featherweights were significantly younger than those heavyweights (p = 0.03). Male flyweights and featherweights were significantly younger than those welterweights and heavyweights (p = 0.01). When a taekwondo athlete won a medal several times, he/she did so within the same Olympic weight category group and won two medals in his/her career (p = 0.01). Multiple medallists of the lighter and heavier groups did not differ in the number of medals won but in the time span in which they won medals (p = 0.02). The resources deployed by stakeholders to achieve success in these competitions highlight an extremely competitive environment. In this sense, the information provided by this study can be relevant and translated into key elements.

Optimizing anterior cruciate ligament reconstruction: Individualizing the decision-making process using data from the Kaiser Permanente ACLR Registry: 2018 OREF award paper.

Despite years of study, controversy remains regarding the optimal graft for anterior cruciate ligament reconstruction (ACLR), suggesting that a single graft type is not ideal for all patients. A large community based ACLR Registry that collects prospective data is a powerful tool that captures information and can be analyzed to optimize surgery for individual patients. The studies highlighted in this paper were designed to optimize and individualize ACLR surgery and have led to changes in surgeon behavior and improvements in patient outcomes. Kaiser Permanente (KP) is an integrated health care system with 10.6 million members and more than 50 hospitals. Every KP member who undergoes an ACLR is entered into the Registry, and prospectively monitored. The Registry uses a variety of feedback mechanisms to disseminate Registry findings to the ACLRR surgeons and appropriately influence clinical practices and enhance quality of care. Allografts were found to have a 3.0 times higher risk of revision than bone-patellar tendon-bone (BPTB) autografts. Allograft irradiation >1.8 Mrad, chemical graft processing, younger patients, BPTB allograft, and male patients were all associated with a higher risk of revision surgery. By providing feedback to surgeons, overall allograft use has decreased by 27% and allograft use in high-risk patients ≤21 years of age decreased 68%. We have identified factors that influence the outcomes of ACLR. Statement of Clinical Significance: We found that information derived from an ACLR Registry and shared with the participating surgeons directly decreased the use of specific procedures and implants associated with poor outcomes.

Implementation strategies for improving vitamin D status and increasing vitamin D intake in the UK: current controversies and future perspectives: proceedings of the 2nd Rank Prize Funds Forum on vitamin D.

A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose-response and dietary modelling studies indicate dairy products, bread, hens' eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for 'real-world' cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D's importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.

[A posthumous tribute to Alejandro Goic, M.D. (1929-2021), Editor Emeritus]. / Homenaje póstumo al Doctor Alejandro Goic (1929-2021), Editor Emérito.

Alejandro Goic, M.D., son of Croatian immigrants, graduated as M.D. in 1955, studying at the Catholic University of Chile Medical School. After a residency in internal medicine, he followed post graduate studies in psychosomatic medicine at the University of Oklahoma and in gastroenterology at Harvard University. Upon his return to Chile he had a brilliant career as clinician and medical educator, becoming a leader and advisor in medical education, clinical ethics and public health. Elected Dean of the University of Chile School of Medicine (1986-1994), he promoted important changes in undergraduate studies as well as in Magister and PhD programs in Biomedical Sciences. During the difficult years of the military government intervention in Chilean universities, he was one of the leaders of critical opposition. In parallel he was chief editor of Revista Médica de Chile (1976-1996), improving the editorial process according to the recommendations of ICMJE and WAME. In 1989 he was elected member of the Chilean Academy of Medicine and became its President (2000-2010). He was awarded honors and membership in prominent national and foreign institutions. In 2006 he received the National Prize in Medicine, the highest medical distinction in Chile. His wise thinking and enthusiasm gave origin to several books that have become classics in Medicine and Medical Education, permeating our institutions.

JOSPT Names 2020 Award Recipients.

During the American Physical Therapy Association's virtual Combined Sections Meeting held throughout the month of February 2021, JOSPT recognized the authors of the most outstanding research manuscript published in the Journal in 2020. The JOSPT Guy G. Simoneau Excellence in Research Award was presented to Fábio Franciscatto Stieven, Giovanni Esteves Ferreira, Matheus Wiebusch, Francisco Xavier de Araújo, Luis Henrique Telles da Rosa, and Marcelo Faria Silva for their August 2020 article, "Dry Needling Combined With Guideline-Based Physical Therapy Provides No Added Benefit in the Management of Chronic Neck Pain: A Randomized Controlled Trial." J Orthop Sports Phys Ther 2021;51(4):155. doi:10.2519/jospt.2021.0105.

Homenaje póstumo al Doctor Alejandro Goic (1929-2021), Editor Emérito / A posthumous tribute to Alejandro Goic, M.D. (1929-2021), Editor Emeritus

Alejandro Goic, M.D., son of Croatian immigrants, graduated as M.D. in 1955, studying at the Catholic University of Chile Medical School. After a residency in internal medicine, he followed post graduate studies in psychosomatic medicine at the University of Oklahoma and in gastroenterology at Harvard University. Upon his return to Chile he had a brilliant career as clinician and medical educator, becoming a leader and advisor in medical education, clinical ethics and public health. Elected Dean of the University of Chile School of Medicine (1986-1994), he promoted important changes in undergraduate studies as well as in Magister and PhD programs in Biomedical Sciences. During the difficult years of the military government intervention in Chilean universities, he was one of the leaders of critical opposition. In parallel he was chief editor of Revista Médica de Chile (1976-1996), improving the editorial process according to the recommendations of ICMJE and WAME. In 1989 he was elected member of the Chilean Academy of Medicine and became its President (2000-2010). He was awarded honors and membership in prominent national and foreign institutions. In 2006 he received the National Prize in Medicine, the highest medical distinction in Chile. His wise thinking and enthusiasm gave origin to several books that have become classics in Medicine and Medical Education, permeating our institutions.

BADGES/PINS OF NURSING AND MIDWIFERY SCHOOLS IN SLOVENIA FROM 1925 UNTIL EARLY 1980s.

INTRODUCTION: Many nursing and midwifery schools in many countries around the world awarded or still award graduation badges or pins to their graduates. All graduates from different parts of the former Kingdom of Yugoslavia and later the Republic of Yugoslavia educated in Slovenian healthcare schools received badges from these schools. Some of the graduates later employed in medical institutions across former Yugoslavia wore these badges on their uniforms. The main purpose of this historical research was to establish which Slovenian health care schools awarded the graduation badges and what they looked like. It was also investigated why the badges ceased to be awarded and what motivated Angela Boskin Faculty of Health Care in Jesenice to reintroduce awarding the badges. METHODS: Due to a lack of written sources, we conducted 393 face to face and telephonic interviews with former badge recipients across Slovenia. Their existing badges were photographed. On the authors' initiative, a private collection of badges was started. RESULTS: It has been established that in the 20th century all Slovenian secondary health schools awarded badges. The Nursing College, Ljubljana also awarded graduation badges. Five different types of badges in many variants were issued. The first badges were awarded to graduates by Slovenian oldest Nursing School, Ljubljana in 1925. The badges ceased to be awarded in the late 1970s and the early 1980s. Some questions about probable reasons for cessation of awarding badges remain unanswered. Less than a fifth of interviewees kept their badges. Graduating nursing badges were reintroduced in Slovenia in 2017 with a new badge which is presented and depicted in this article. The motivation for the reintroduction of graduating badges is also investigated. DISCUSSION AND CONCLUSION: Unfortunately, many Slovenian nurses and midwives are not sufficiently aware of the meaning and importance of their badges. Although badges are important for professional image and identity of nurses, badges as a symbol of nursing have become almost completely forgotten. Graduation badges are miniature works of art and are proof of the existence and development of Slovenian healthcare schools. Nursing badges present a part of nursing history as well as being our cultural heritage. The badges deserve to be written and talked about and should be displayed in a planned future Slovenian Health Care Museum.

Demonstrating the influence of HTA: INAHTA member stories of HTA impact.

A central function of health technology assessment (HTA) agencies is the production of HTA reports to support evidence-informed policy and decision making. HTA agencies are interested in understanding the mechanisms of HTA impact, which can be understood as the influence or impact of HTA report findings on decision making at various levels of the health system. The members of the International Network of Agencies for HTA (INAHTA) meet at their annual Congress where impact story sharing is one important activity. This paper summarizes four stories of HTA impact that were finalists for the David Hailey Award for Best Impact Story.The methods to measure impact include: document review; claims analysis and review of reimbursement status; citation analysis; qualitative evaluation of stakeholders' views; and review of media response. HTA agency staff also observed changes in government activities and priorities based on the HTA. Impact assessment can provide information to improve the HTA process, for example, the value of patient and clinician engagement in the HTA process to better define the assessment question and literature reviews in a more holistic and balanced way.HTA reports produced by publicly funded HTA agencies are valued by health systems around the globe as they support decision making regarding the appropriate use, pricing, reimbursement, and disinvestment of health technologies. HTAs can also have a positive impact on information sharing between different levels of government and across stakeholder groups. These stories show how HTA can have a significant impact, irrespective of the health system and health technology being assessed.

Double-blinding of an acupuncture randomized controlled trial optimized with clinical translational science award resources.

BACKGROUND: Clinical trial articles often lack detailed descriptions of the methods used to randomize participants, conceal allocation, and blind subjects and investigators to group assignment. We describe our systematic approach to implement and measure blinding success in a double-blind phase 2 randomized controlled trial testing the efficacy of acupuncture for the treatment of vulvodynia. METHODS: Randomization stratified by vulvodynia subtype is managed by Research Electronic Data Capture software's randomization module adapted to achieve complete masking of group allocation. Subject and acupuncturist blinding assessments are conducted multiple times to identify possible correlates of unblinding. RESULTS: At present, 48 subjects have been randomized and completed the protocol resulting in 87 subject and 206 acupuncturist blinding assessments. DISCUSSION: Our approach to blinding and blinding assessment has the potential to improve our understanding of unblinding over time in the presence of possible clinical improvement.