Hydrolyzed collagen supplementation prior to resistance exercise augments collagen synthesis in a dose-response manner in resistance-trained, middle-aged men.

Resistance exercise (RE) increases collagen synthesis in young and older men, whereas hydrolyzed collagen (HC) ingestion improves this response to RE in a dose-response manner in young men. However, the collagen synthesis response to RE with and without HC in middle-aged men is unknown. Eight resistance-trained men (age: 49 ± 8 yr; height: 1.78 ± 0.02 m; mass: 90 ± 4 kg) took part in this double-blind, crossover design study and undertook 4 × 10 repetitions of lower-limb RE at maximum load, after consuming 0 g, 15 g, or 30 g vitamin C-enriched HC. We analyzed venous blood samples for N-terminal propeptide of type 1 pro-collagen (PINP), ß-isomerized C-terminal telopeptide of type 1 collagen (ß-CTx), and 18 collagen amino acids throughout all three interventions. The serum PINP concentration × time area-under-the-curve (AUC) was higher following 30 g (169 ± 28 µg/mL × h) than 15 g (134 ± 23 µg/mL × h, P < 0.05) HC ingestion, and both 15 g and 30 g were higher than 0 g HC (96 ± 23 µg/mL × h, P < 0.05). RE with 0 g HC showed no change in serum PINP concentration. The AUCs for glycine, proline, hydroxyproline, alanine, arginine, lysine, serine, leucine, valine, and isoleucine were greater with 30 g than 15 g and 0 g HC ingestion (P < 0.05) and greater with 15 g than 0 g HC ingestion (P < 0.05). Plasma ß-CTx concentration decreased after RE independently of HC dose. Our study suggests connective tissue anabolic resistance to RE in middle-aged men but ingesting 15 g HC rescues the collagen synthesis response and 30 g augments that response further. This dose response is associated with the increased bioavailability of collagen amino acids in the blood, which stimulate collagen synthesis.NEW & NOTEWORTHY This study is the first to document the dose-response effect of hydrolyzed collagen (HC) ingestion before resistance exercise (RE) on collagen turnover in middle-aged, resistance-trained men. Strikingly, RE alone did not increase collagen synthesis (suggesting connective tissue anabolic resistance), but ingesting 15 g HC rescued the collagen synthesis response and 30 g augmented that response further. These results were associated with the increased bioavailability of collagen amino acids in the blood, which stimulate collagen synthesis.

Effects of resistance exercise, collagen ingestion and circulating oestrogen concentration on collagen synthesis in a female athlete: A case report.

We investigated the effects of resistance exercise (RE), hydrolysed collagen (HC) ingestion and circulating oestrogen concentration on collagen synthesis in a naturally menstruating female CrossFit athlete. In a double-blind, randomised cross-over design, the participant (36 years; height 1.61 m; mass 82.6 kg) consumed 0 or 30 g HC prior to performing back-squat RE when endogenous circulating oestrogen concentration was low (onset of menses, OM) and high (late follicular phase, LF) during two consecutive menstrual cycles. Ten 5-mL blood samples were collected during each of the four interventions to analyse concentrations of serum 17ß-oestradiol, and biomarkers of type I collagen turnover, that is serum procollagen type I N-terminal propeptide (PINP, a biomarker of collagen synthesis) and plasma ß-isomerised C-terminal telopeptide of type I collagen (ß-CTX, a biomarker of collagen breakdown), as well as the serum concentration of 18 collagen amino acids. 17ß-Oestradiol concentration was 5-fold higher at LF (891 ± 116 pmol L-1) than OM (180 ± 13 pmol L-1). The PINP concentration × time area under the curve (AUC) was higher in the 30 g HC OM intervention (201 µg L-1 h) than the 30 g HC LF (144 µg L-1 h), 0 g HC OM (151 µg L-1 h) and 0 g HC LF (122 µg L-1 h) interventions. ß-CTX concentration decreased 1.4-fold from pre-RE to 6 h post-RE in all interventions. Thus, high circulating oestrogen concentration was associated with lower collagen synthesis following RE in this female athlete. Ingesting 30 g HC, however, augmented the collagen synthesis response at LF and particularly at OM. HIGHLIGHTS: What is the central question of this study? Does resistance exercise-induced collagen synthesis vary according to circulating oestrogen concentration in a naturally menstruating female athlete, and if so, does hydrolysed collagen ingestion have any impact? What is the main finding and its importance? Exercise-induced collagen synthesis was low when circulating oestrogen concentration was high and vice versa. However, ingesting 30 g hydrolysed collagen prior to exercise reduced the negative effect of oestrogen on collagen synthesis. As high circulating oestrogen has been associated with greater injury risk in females, supplementing exercise with hydrolysed collagen may help protect these tissues from injury.

Training loads and microcycle periodisation in Italian Serie A youth soccer players.

Microcycles are fundamental structures for training prescription and load management, helping to optimise training effects and performance. This study quantified external and internal loads of Italian Serie A youth soccer players across competitive weeks and their periodisation within microcycles. Data were collected from 90 players belonging to four age groups (under-19, -17, -16, -15) across a season. Methods of monitoring external [duration and global navigation satellite systems (GNSS)] and internal load [heart rate (HR) and rating of perceived exertion (RPE)] were employed. Linear mixed models determined differences in training loads across age groups, training days and player positions. Under-19 and under-17 players trained five times per week, while younger players trained four times. Late-stage academy players (under-19 and -17) demonstrated higher weekly accumulated external and sRPE training load compared to their younger counterparts (p < 0.05 between groups). Weekly accumulated HR internal loads were higher in under-15 players (p < 0.05 between groups). Marked fluctuations of daily load were observed across microcycles in under-19 and under-17 groups (p < 0.05 between days). These findings highlight progressive increases in training load throughout the development pathway, with late-stage academy players training with higher frequency, volume and marked periodisation compared to younger players.

The Collagen Synthesis Response to an Acute Bout of Resistance Exercise Is Greater when Ingesting 30 g Hydrolyzed Collagen Compared with 15 g and 0 g in Resistance-Trained Young Men.

BACKGROUND: Resistance exercise (RE) stimulates collagen synthesis in skeletal muscle and tendon but there is limited and equivocal evidence regarding an effect of collagen supplementation and exercise on collagen synthesis. Furthermore, it is not known if a dose-response exists regarding the effect of hydrolyzed collagen (HC) ingestion and RE on collagen synthesis. OBJECTIVE: To determine the HC dose-response effect on collagen synthesis after high-intensity RE in resistance-trained young men. METHODS: Using a double-blind, randomized crossover design, 10 resistance-trained males (age: 26 ± 3 y; height: 1.77 ± 0.04 m; mass: 79.7 ± 7.0 kg) ingested 0 g, 15 g, or 30 g HC with 50 mg vitamin C 1 h before performing 4 sets' barbell back squat RE at 10-repetition maximum load, after which they rested for 6 h. Blood samples were collected throughout each of the 3 interventions to analyze procollagen type Ⅰ N-terminal propeptide (PINP) and ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX) concentration, and the concentration of 18 collagen amino acids. RESULTS: The serum PINP concentration × time area under the curve (AUC) was greater for 30 g (267 ± 79 µg·L-1·h) than for 15 g (235 ± 70 µg·L-1·h, P = 0.013) and 0 g HC (219 ± 88 µg·L-1·h, P = 0.002) but there was no difference between 0 and 15 g HC (P = 0.225). The AUCs of glycine and proline were greater for 30 g than for 15 and 0 g HC (P < 0.05). Plasma ß-CTX concentration decreased from -1 to +6 h (P < 0.05), with no differences between interventions. CONCLUSIONS: Ingesting 30 g HC before high-intensity RE augments whole-body collagen synthesis more than 15 g and 0 g HC in resistance-trained young males.

The Effects of an Acute Dose of New Zealand Blackcurrant Extract on 5-km Running Performance.

This study investigated the effects of an acute dose (900 mg) of New Zealand Blackcurrant (NZBC) extract on 5-km running performance, alongside associated physiological and metabolic responses. Sixteen trained male runners (age 26 ± 5 years, stature 173.4 ± 7.3 cm, body mass 73.7 ± 6.9 kg, maximal oxygen consumption [V˙O2max] 55.4 ± 6.1 ml·kg-1·min-1) ingested either capsules containing NZBC extract (3 × 300 mg CurraNZ, 315 mg anthocyanins) or a matched placebo (3 × 300 mg gluten-free flour) 2 hr before exercise in a double-blind, randomized, crossover design. Performance time, physiological, and metabolic responses were assessed in a 5-km time trial, preceded by 10-min exercise at the lactate threshold on a treadmill. NZBC extract did not alter the physiological or metabolic responses to exercise at the lactate threshold (oxygen uptake, respiratory exchange ratio, minute ventilation, carbohydrate oxidation, fat oxidation, heart rate, blood lactate, or rating of perceived exertion, p > .05). The 5-km time trial was completed in a faster time in the NZBC extract condition compared with placebo (NZBC: 1,308.96 ± 122.36 s, placebo: 1,346.33 ± 124.44, p = .001, d = -0.23, confidence interval range = [-0.46, 0.00 s]). No differences in physiological or metabolic responses were apparent between conditions for the 5-km time trial (p > .05). Ingesting 900 mg of NZBC extract as an acute dose improves performance in trained male runners without altering physiological or metabolic responses to exercise. Further research is needed to assess a wider range of possible mechanisms (e.g., cardiovascular function, metabolite profiles) to advance insight into improved performance following supplementation.

How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health.

It is estimated 6.4% of males and 1.6% of females globally use anabolic-androgenic steroids (AAS), mostly for appearance and performance enhancing reasons. In combination with resistance exercise, AAS use increases muscle protein synthesis resulting in skeletal muscle hypertrophy and increased performance. Primarily through binding to the androgen receptor, AAS exert their hypertrophic effects via genomic, non-genomic and anti-catabolic mechanisms. However, chronic AAS use also has a detrimental effect on metabolism ultimately increasing the risk of cardiovascular disease (CVD). Much research has focused on AAS effects on blood lipids and lipoproteins, with abnormal concentrations of these associated with insulin resistance, hypertension and increased visceral adipose tissue (VAT). This clustering of interconnected abnormalities is often referred as metabolic syndrome (MetS). Therefore, the aim of this review is to explore the impact of AAS use on mechanisms of muscle hypertrophy and markers of MetS. AAS use markedly decreases high-density lipoprotein cholesterol (HDL-C) and increases low-density lipoprotein cholesterol (LDL-C). Chronic AAS use also appears to cause higher fasting insulin levels and impaired glucose tolerance and possibly higher levels of VAT; however, research is currently lacking on the effects of AAS use on glucose metabolism. While cessation of AAS use can restore normal lipid levels, it may lead to withdrawal symptoms such as depression and hypogonadism that can increase CVD risk. Research is currently lacking on effective treatments for withdrawal symptoms and further long-term research is warranted on the effects of AAS use on metabolic health in males and females.

Workload and Injury in Professional Soccer Players: Role of Injury Tissue Type and Injury Severity.

The purpose of the present study was to examine the influence of workload prior to injury on injury (tissue type and severity) in professional soccer players. Twenty-eight days of retrospective training data prior to non-contact injuries (n=264) were collated from 192 professional soccer players. Each injury tissue type (muscle, tendon and ligament) and severity (days missed) were categorised by medical staff. Training data were recorded using global positioning system (GPS) devices for total distance (TD), high speed distance (HSD,>5.5 m/s-1), and sprint distance (SPR,>7.0 m/s-1). Accumulated 1, 2, 3, 4-weekly loads and acute:chronic workload ratios (ACWR) (coupled, uncoupled and exponentially weighted moving average (EWMA) approaches) were calculated. Workload variables and injury tissue type were compared using a one-way ANOVA. The association between workload variables and injury severity were examined using a bivariate correlation. There were no differences in accumulated weekly loads and ACWR calculations between muscle, ligament, and tendon injuries (P>0.05). Correlations between each workload variable and injury severity highlighted no significant associations (P>0.05). The present findings suggest that the ability of accumulated weekly workload or ACWR methods to differentiate between injury type and injury severity are limited using the present variables.

A Narrative Review on Female Physique Athletes: The Physiological and Psychological Implications of Weight Management Practices.

Physique competitions are events in which aesthetic appearance and posing ability are valued above physical performance. Female physique athletes are required to possess high lean body mass and extremely low fat mass in competition. As such, extended periods of reduced energy intake and intensive training regimens are used with acute weight loss practices at the end of the precompetition phase. This represents an increased risk for chronic low energy availability and associated symptoms of relative energy deficiency in sport, compromising both psychological and physiological health. Available literature suggests that a large proportion of female physique athletes report menstrual irregularities (e.g., amenorrhea and oligomenorrhea), which are unlikely to normalize immediately postcompetition. Furthermore, the tendency to reduce intakes of numerous essential micronutrients is prominent among those using restrictive eating patterns. Following competition, reduced resting metabolic rate, and hyperphagia, is also a concern for these female athletes, which can result in frequent weight cycling, distorted body image, and disordered eating/eating disorders. Overall, female physique athletes are an understudied population, and the need for more robust studies to detect low energy availability and associated health effects is warranted. This narrative review aims to define the natural female physique athlete, explore some of the physiological and psychological implications of weight management practices experienced by female physique athletes, and propose future research directions.

The effect of concurrent training organisation in youth elite soccer players.

PURPOSE: This study compared the adaptive responses to two concurrent training programmes frequently used in professional soccer. METHODS: Fifteen youth soccer players (17.3 ± 1.6 years, 1.82 ± 0.06 m, 77.0 ± 7.3 kg; VO2 peak, 62.0 ± 4.7 ml(-1) kg(-1) min(-1)) who compete in the English Premier League volunteered for this study. In addition to completing their habitual training practices, the participants were asked to alter the organisation concurrent training by performing strength (S) training either prior to (S + E, n = 8) or after (E + S, n = 7) soccer-specific endurance training (E) 2d wk(-1) for 5 wk(-1). RESULTS: With the exception of 30 m sprint, IMVC PF, quadriceps strength (60°/s(CON), 180°/s(CON), 120°/s(ECC)) pooled data revealed training effects across all other performances measures (P < 0.05). Whilst ANCOVA indicated no significant interaction effects for training condition, the difference between the means divided by the pooled standard deviation demonstrated large effect sizes in the E + S condition for in HBS 1-RM [S + E vs E + S; -0.54 (9.6 %) vs -1.79 (19.6 %)], AoP-M [-0.72 (7.9 %) vs -1.76 (14.4 %)], SJ [-0.56, (4.4 %), vs -1.08, (8.1 %)], IMVC-LR; [-0.50, (20.3 %) vs -1.05 (27.3 %)], isokinetic hamstring strength 60°/s (CON) [-0.64, (12.2 %) vs -0.95 (19.2 %)], 120°/s(ECC) [-0.78 (27.9 %) vs -1.55 (23.3 %)] and isokinetic quadriceps strength 180°/s (CON) [-0.23 (2.5 %) vs -1.52 (13.2 %)]. CONCLUSION: Results suggest the organisation of concurrent training, recovery time allocated between training bouts and the availability nutrition may be able to modulate small but clinically significant changes in physical performance parameters associated with match-play. This may have practical implications for practitioners who prescribe same day concurrent training protocols.

Treatment of a simulated child with anaphylaxis: an in situ two-arm study.

AIM: This study aims to determine whether junior medical staff correctly identify and treat paediatric anaphylaxis and whether the presence or absence of hypotension influenced the treatment, using a standardised simulated patient encounter. METHODS: Junior medical staff from the emergency department of a large paediatric tertiary hospital were invited to participate in a two-armed cohort study to assess recognition and management of anaphylaxis in a standardised scenario using a simulated patient with and without hypotension. The primary outcome measure was administration of adrenaline. The secondary outcome measures included time to adrenaline administration, ability to seek and identify relevant features of history and clinical examination and use of other medications. RESULTS: Fifty-six junior medical staff participated (90% participation rate). Only 50% of participants administered adrenaline in scenarios of definite anaphylaxis. Adrenaline was more likely to be administered if the scenario included hypotension, where the junior medical officer had previous formal resuscitation training (Advanced Paediatric Life Support) and by medical officers with more years of training. CONCLUSION: Anaphylaxis is a life-threatening presentation and requires prompt recognition and appropriate adrenaline administration. Junior medical staff may require more emphasis on recognition and prompt adrenaline administration in both undergraduate and in hospital training and education. Simulated scenarios may provide a platform to deliver this training to ultimately improve patient care.

Surveying the youth-to-senior transition landscape in Major League Soccer: a new frontier.

PURPOSE: The aim of this study was to survey Major League Soccer stakeholders' attitudes and perspectives on the youth-to-senior transition with a particular interest in the league's evolving club structures, specifically the reserve team and youth academy entities. The survey assessed various stakeholders' views on clubs' organisational aims and structure, the capabilities of club entities to prepare players for the first team, and the transition process to the first team within MLS. METHODS: A total of 80 participants working in various 'player operation' roles for MLS clubs in the United States and Canada voluntarily completed the online survey. RESULTS: The predominant aim for both reserve teams and academies in MLS is to develop players for the first team. The organisational structure and governance of reserve teams are varied across the league, but an overarching feature is their function as a development team. When players are transitioning, communication between staff may or may not be clear and effective. Finally, for players within an MLS club's talent pathway, a variety of support strategies are made available during the transition into the first team, but psychological support in particular may be limited or unavailable. CONCLUSION: Similar to European soccer, the aim of MLS reserve teams and youth academies is to develop first team players for the club. However, while players are transitioning into the first team, communication may or may not be clear and effective, and psychological support may be absent, which may impair player development initiatives.

Methods to predict the timing and status of biological maturation in male adolescent soccer players: A narrative systematic review.

The aim of this review was to summarise the methods used to predict and assess maturity status and timing in adolescent, male, academy soccer players. A systematic search was conducted on PubMed, Scopus, Web of Science, CINAHL, Medline and SPORTDiscus. Only experimental studies including male, academy players aged U9-U18 years registered with a professional soccer club were included. The methodological quality of the included studies was assessed using guidelines from the Framework of Potential Biases. Fifteen studies fulfilled our inclusion criteria. Studies were mainly conducted in European countries (n = 12). In total, 4,707 players were recruited across all 15 studies, with an age range of 8-18 years. Five studies were longitudinal, two studies were mixed-method designs and eight studies were cross-sectional. Due to high heterogeneity within the studies, a meta-analysis was not performed. Our findings provided no equivalent estimations of adult height, skeletal age, or age at PHV. Discrepancies were evident between actual and predicted adult height and age at PHV. The Bayley-Pinneau [1952], Tanner-Whitehouse 2 [1983] and Khamis-Roche [1994] methods produced estimates of adult height within 1cm of actual adult height. For age at PHV, both Moore [2015] equations produced the closest estimates to actual age at PHV, and the Fransen [2018] equation correlated highly with actual age at PHV (>90%), even when the period between chronological age and age at PHV was large. Medical imaging techniques (e.g., Magnetic Resonance Imaging, X-Ray, Dual energy X-ray Absorptiometry) demonstrated high intra/inter-rater reliability (ICC = 0.83-0.98) for skeletal maturity assessments. The poor concordance between invasive and non-invasive methods, is a warning to practitioners to not use these methods interchangeably for assessing maturational status and timing in academy soccer players. Further research with improved study designs is required to validate these results and improve our understanding of these methods when applied in this target population.

Reliability and sensitivity to change of post-match physical performance measures in elite youth soccer players.

Introduction: To effectively monitor post-match changes in physical performance, valid, reliable and practical measures which are sensitive to change are required. This study aimed to quantify test-retest reliability and sensitivity to change of a range of physical performance measures recorded during an isometric posterior chain (IPC) lower-limb muscle test and a countermovement jump (CMJ) test. Methods: Eighteen Italian Serie A academy soccer players performed three IPC repetitions per limb and five CMJ trials in 4 testing sessions. Test-retest reliability was evaluated between two testing sessions seven days apart using typical error of measurement, coefficient of variation and intraclass correlation coefficient. Sensitivity to change was assessed on two additional testing sessions performed before and immediately after a soccer match through Hedges' g effect size (g) and comparisons to typical error. Results: Absolute reliability (coefficient of variations) ranged from 1.5 to 8.8%. IPC and CMJ measures demonstrated moderate to excellent relative reliability (intraclass correlation coefficients ranged from 0.70 to 0.98). A wide range of physical performance measures showed significant alterations post-match (p < 0.05; g: small to moderate). IPC peak force and torque, CMJ reactive strength index modified, CMJ eccentric forces (mean breaking force, mean deceleration force, peak force, force at zero velocity) and CMJ mean power measures had post-match changes greater than their typical variation, demonstrating acceptable sensitivity in detecting performance changes at post-match. Discussion: IPC peak force and torque, CMJ reactive strength index modified, CMJ eccentric phase forces and CMJ mean power were found to be both reliable and sensitive to change, and thus may be appropriate for monitoring post-match neuromuscular performance in youth soccer population.

Primary cardiac arrest following sport or exertion in children presenting to an emergency department: chest compressions and early defibrillation can save lives, but is intravenous epinephrine always appropriate?

OBJECTIVES: The objective of this study was to describe the characteristics and outcome of pediatric patients presenting to an emergency department (ED) following out-of-hospital primary cardiac arrest (OHPCA), to determine if long-term survival is influenced by specific resuscitation interventions. METHODS: This was a prospective observational study of cases of OHPCA during sport or exertion in young patients presenting to an ED over a 5-year period. Cases were identified from a resuscitation database, which documented patient demographics, nature of event, emergency treatment, response times, and clinical progress. These data were analyzed to determine outcomes. RESULTS: Nine children were identified who presented following OHPCA during the study period. The mean age was 10.7 (±4.2) years. All were subsequently diagnosed with an underlying primary cardiac disorder. Six patients (66.6%) survived to make a full recovery. All patients who survived had received early chest compressions (within 5 minutes) and early defibrillation (within 10 minutes). The initial cardiac arrest rhythm in all survivors had been an electrically cardiovertable rhythm. Five (83%) of the 6 survivors did not receive epinephrine during resuscitation. CONCLUSIONS: The importance of early chest compressions and defibrillation in collapsed young athletes is highlighted in this report. These interventions can result in full long-term neurological recovery. Use of epinephrine in these patients may be dangerous. We suggest that special consideration should be given to this subgroup of patients in the development of future resuscitation guidelines.

Weight loss practices and eating behaviours among female physique athletes: Acquiring the optimal body composition for competition.

Little is known about weight loss practices and eating behaviours in female physique athletes. This study investigated the weight loss history, practices, and key influences during the pre-competition period in a large cohort of female physique athletes stratified by division and experience level. Eating attitudes and behaviours were assessed to identify whether athletes were at risk of developing an eating disorder. Using a cross-sectional research design, female physique athletes (n = 158) were recruited and completed an anonymous online self-reported survey consisting of two validated questionnaires: Rapid Weight Loss Questionnaire and Eating Attitudes Test-26. Irrespective of division or experience, female physique athletes used a combination of weight loss practices during the pre-competition phase. Gradual dieting (94%), food restriction (64%) and excessive exercise (84%), followed by body water manipulation via water loading (73%) were the most commonly used methods. Overall, 37% of female physique athletes were considered at risk of developing an eating disorder. Additionally, 42% of female physique athletes used two pathogenic weight control methods with 34% of Figure novice athletes indicating binge eating once a week or more. The coach (89%) and another athlete (73%) were identified as key influences on athletes' dieting practices and weight loss. The prevalence of athletes identified with disordered eating symptoms and engaging in pathogenic weight control methods is concerning. In future, female physique athletes should seek advice from registered nutritionists to optimise weight management practices and minimise the risk of developing an eating disorder.

The Effect of Dietary Carbohydrate and Fat Manipulation on the Metabolome and Markers of Glucose and Insulin Metabolism: A Randomised Parallel Trial.

High carbohydrate, lower fat (HCLF) diets are recommended to reduce cardiometabolic disease (CMD) but low carbohydrate high fat (LCHF) diets can be just as effective. The effect of LCHF on novel insulin resistance biomarkers and the metabolome has not been fully explored. The aim of this study was to investigate the impact of an ad libitum 8-week LCHF diet compared with a HCLF diet on CMD markers, the metabolome, and insulin resistance markers. n = 16 adults were randomly assigned to either LCHF (n = 8, <50 g CHO p/day) or HCLF diet (n = 8) for 8 weeks. At weeks 0, 4 and 8, participants provided fasted blood samples, measures of body composition, blood pressure and dietary intake. Samples were analysed for markers of cardiometabolic disease and underwent non-targeted metabolomic profiling. Both a LCHF and HCLF diet significantly (p < 0.01) improved fasting insulin, HOMA IR, rQUICKI and leptin/adiponectin ratio (p < 0.05) levels. Metabolomic profiling detected 3489 metabolites with 78 metabolites being differentially regulated, for example, an upregulation in lipid metabolites following the LCHF diet may indicate an increase in lipid transport and oxidation, improving insulin sensitivity. In conclusion, both diets may reduce type 2 diabetes risk albeit, a LCHF diet may enhance insulin sensitivity by increasing lipid oxidation.

Should a near-patient test be part of the management of pharyngitis in the pediatric emergency department?

OBJECTIVE: The study's objective was to evaluate the efficacy of a rapid streptococcal test as a single diagnostic agent in the diagnosis of streptococcal pharyngitis in patients presenting to a pediatric emergency department. METHODS: We performed a rapid streptococcal test as part of the diagnostic workup for patients presenting with clinical findings consistent with streptococcal pharyngitis. In addition to undergoing the study intervention, each patient had a standard throat swab sent to the laboratory for formal culture. A questionnaire detailing the clinical features was to be completed in each case. RESULTS: Two hundred ten near-patient tests were performed. Complete laboratory results were available in 177 cases (77%). Clinical data were available for analysis in 94 patients (53%). In our patient population, the near-patient test had a high specificity (98.6%) but a low sensitivity (71%). The clinical presentation of confirmed group A ß-hemolytic streptococcal pharyngitis is very variable. CONCLUSIONS: The QuickVue In-Line Strep A test for streptococcal pharyngitis is unreliable in our patient population. Clinical findings are unhelpful in confirming the diagnosis. Formal laboratory culture is the criterion standard for identifying the organism, but the results are not clinically significant in every case. Acute pharyngitis presenting to the pediatric emergency department can be managed in accordance with the recommendations in the Scottish Intercollegiate Guideline Network guideline.

The integral role of the clinical pharmacist in drug-assisted intubation at a newly established children's major trauma center.

This commentary outlines how the clinical pharmacist can support the safe administration of emergency medications in trauma anesthesia for seriously injured children. Promoting the professional development of the clinical pharmacist provided an opportunity to strengthen a key step in our trauma care pathway. We describe the implementation of this process in a new hospital, which was to become the designated children's trauma center for an entire country. Although the literature documents the use of pharmacists in emergency intubation, ours was a unique set of circumstances, where empowering the pharmacist in frontline clinical care provided additional quality assurance for rapid sequence induction and intubation in trauma. Medical simulation was a core part of socializing the advanced clinical practice role of pharmacy within the trauma team. It was our experience that the pharmacist helps to promote confidence and decision making among other members of the trauma team.

Research in Another un-Examined (RAE) context. A chronology of 35 years of relative age effect research in soccer: is it time to move on?

It is approximately 35 years since the publication of the first relative age effect paper in sport and despite the volume of empirical studies, book chapters, conference presentations, and column inches dedicated to this topic we appear to be no further on in eliminating or attenuating this discriminatory practice. This commentary argues that the ongoing use of univariate methods, focusing on primary or secondary analyses of birth-date data, unearthed from previously un-examined contexts is not conducive to stimulating discussion or providing empirical solutions to relative age effects. This paper concludes by suggesting a departure from the traditionally narrow view of relative age inquiry and instead consider the role of transdisciplinary research.

Maturity-associated considerations for training load, injury risk, and physical performance in youth soccer: One size does not fit all.

Biological maturation can be defined as the timing and tempo of progress to achieving a mature state. The estimation of age of peak height velocity (PHV) or percentage of final estimated adult stature attainment (%EASA) is typically used to inform the training process in young athletes. In youth soccer, maturity-related changes in anthropometric and physical fitness characteristics are diverse among individuals, particularly around PHV. During this time, players are also at an increased risk of sustaining an overuse or growth-related injury. As a result, the implementation of training interventions can be challenging. The purpose of this review was to (1) highlight and discuss many of the methods that can be used to estimate maturation in the applied setting and (2) discuss the implications of manipulating training load around PHV on physical development and injury risk. We have provided key stakeholders with a practical online tool for estimating player maturation status (Supplementary Maturity Estimation Tools). Whilst estimating maturity using predictive equations is useful in guiding the training process, practitioners should be aware of its limitations. To increase the accuracy and usefulness of data, it is also vital that sports scientists implement reliable testing protocols at predetermined time-points.