Personalised exercise rehabilitation in cancer survivorship: the percs triage and referral system study protocol.

BACKGROUND: To effectively embed exercise rehabilitation in cancer survivorship care, a co-ordinated system of acute and community exercise rehabilitation services, forming a stepped model of care, is recommended. Patients can be directed to the exercise rehabilitation service which best meets their needs through a system of assessment, triage and referral. Triage and referral systems are not yet widely applied in cancer survivorship practice and need to be evaluated in real-world contexts. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) study aims to evaluate the real-world application of an exercise rehabilitation triage and referral system in cancer survivors treated during the COVID-19 pandemic. Secondary aims are to evaluate change in physical and psychosocial outcomes, and to qualitatively evaluate the impact of the system and patient experiences, at three months after application of the triage and referral system. METHODS: This study will assess the implementation of an exercise rehabilitation triage and referral system within the context of a physiotherapy-led cancer rehabilitation clinic for cancer survivors who received cancer treatment during the COVID-19 pandemic. The PERCS triage and referral system supports decision making in exercise rehabilitation referral by recommending one of three pathways: independent exercise; fitness professional referral; or health professional referral. Up to 100 adult cancer survivors treated during the COVID-19 pandemic who have completed treatment and have no signs of active disease will be recruited. We will assess participants' physical and psychosocial wellbeing and evaluate whether medical clearance for exercise is needed. Participants will then be triaged to a referral pathway and an exercise recommendation will be collaboratively decided. Reassessment will be after 12 weeks. Primary outcomes are implementation-related, guided by the RE-AIM framework. Secondary outcomes include physical function, psychosocial wellbeing and exercise levels. Qualitative analysis of semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) will provide insights on implementation and system impact. DISCUSSION: The PERCS study will investigate the real-world application of a cancer rehabilitation triage and referral system. This will provide proof of concept evidence for this triage approach and important insights on the implementation of a triage system in a specialist cancer centre. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov, registration number: NCT05615285, date registered: 21st October 2022.

Modelling the Influence of Task Constraints on Goal Kicking Performance in Australian Rules Football.

BACKGROUND: The primary aim of this study was to determine the influence of task constraints, from an ecological perspective, on goal kicking performance in Australian football. The secondary aim was to compare the applicability of three analysis techniques; logistic regression, a rule induction approach and conditional inference trees to achieve the primary aim. In this study, an ecological perspective has been applied to explore the impact of task constraints on shots on goal in the Australian Football League, such as shot type, field location and pressure. Analytical techniques can increase the understanding of competition environments and the influence of constraints on skilled events. Differing analytical techniques can produce varying outputs styles which can impact the applicability of the technique. Logistic regression, Classification Based on Associations rules and conditional inference trees were conducted to determine constraint interaction and their influence on goal kicking, with both the accuracy and applicability of each approach assessed. RESULTS: Each analysis technique had similar accuracy, ranging between 63.5% and 65.4%. For general play shots, the type of pressure and location particularly affected the likelihood of a shot being successful. Location was also a major influence on goal kicking performance from set shots. CONCLUSIONS: When different analytical methods display similar performance on a given problem, those should be prioritised which show the highest interpretability and an ability to guide decision-making in a manner similar to what is currently observed in the organisation.

Effects of lower limb light-weight wearable resistance on running biomechanics.

Wearable resistance allows individualized loading for sport specific movements and can lead to specific strength adaptations benefiting the athlete. The objective was to determine biomechanical changes during running with lower limb light-weight wearable resistance. Fourteen participants (age: 28 ± 4 years; height: 180 ± 8 cm; body mass: 77 ± 6 kg) wore shorts and calf sleeves of a compression suit allowing attachment of light loads. Participants completed four times two mins 20-m over-ground shuttle running bouts at 3.3 m*s-1 alternated by three mins rest. The first running bout was unloaded and the other three bouts were under randomised loaded conditions (1%, 3% and 5% additional loading of the individual body mass). 3D motion cameras and force plates recorded kinematic and kinetic data at the midpoint of each 20-m shuttle. Friedman-test for repeated measures and linear mixed effect model analysis were used to determine differences between the loading conditions (α = 0.05). Increased peak vertical ground reaction force (2.7 N/kg to 2.74 N/kg), ground contact time (0.20 s to 0.21 s) and decreased step length (1.49 m to 1.45 m) were found with additional 5 % body mass loading compared to unloaded running (0.001 > p < 0.007). Marginally more knee flexion and hip extension and less plantarflexion was seen with higher loading. Differences in the assessed parameters were present between each loading condition but accompanied by subject variability. Further studies, also examining long term effects, should be conducted to further inform use of this training tool.

Methodological Considerations for Furthering the Understanding of Constraints in Applied Sports.

Commonly classified as individual, task or environmental, constraints are boundaries which shape the emergence of functional movement solutions. In applied sport, an ongoing challenge is to improve the measurement, analysis and understanding of constraints to key stakeholders. Methodological considerations for furthering these pursuits should be centred around an interdisciplinary approach. This integration of methodology and knowledge from different disciplines also encourages the sharing of encompassing principles, concepts, methods and data to generate new solutions to existing problems. This narrative review discusses how a number of rapidly developing fields are positioned to help guide, support and progress an understanding of sport through constraints. It specifically focuses on examples from the fields of technology, analytics and perceptual science. It discusses how technology is generating large quantities of data which can improve our understanding of how constraints shape the movement solutions of performers in training and competition environments. Analytics can facilitate new insights from numerous and complex data through enhanced non-linear and multivariate analysis techniques. The role of the perceptual sciences is discussed with respect to generating outputs from analytics that are more interpretable for the end-user. Together, these three fields of technology, analytics and perceptual science may enable a more comprehensive understanding of constraints in sports performance.

Applications of a working framework for the measurement of representative learning design in Australian football.

Representative learning design proposes that a training task should represent informational constraints present within a competitive environment. To assess the level of representativeness of a training task, the frequency and interaction of constraints should be measured. This study compared constraint interactions and their frequencies in training (match simulations and small sided games) with competition environments in elite Australian football. The extent to which constraints influenced kick and handball effectiveness between competition matches, match simulations and small sided games was determined. The constraints of pressure and time in possession were assessed, alongside disposal effectiveness, through an association rule algorithm. These rules were then expanded to determine whether a disposal was influenced by the preceding disposal. Disposal type differed between training and competition environments, with match simulations yielding greater representativeness compared to small sided games. The subsequent disposal was generally more effective in small sided games compared to the match simulations and competition matches. These findings offer insight into the measurement of representative learning designs through the non-linear modelling of constraint interactions. The analytical techniques utilised may assist other practitioners with the design and monitoring of training tasks intended to facilitate skill transfer from preparation to competition.

Prevalence of interactions and influence of performance constraints on kick outcomes across Australian Football tiers: Implications for representative practice designs.

Representative learning design is a key feature of the theory of ecological dynamics, conceptualising how task constraints can be manipulated in training designs to help athletes self-regulate during their interactions with information-rich performance environments. Implementation of analytical methodologies can support representative designs of practice environments by practitioners recording how interacting constraints influence events, that emerge under performance conditions. To determine key task constraints on kicking skill performance, the extent to which interactions of constraints differ in prevalence and influence on kicking skills was investigated across competition tiers in Australian Football (AF). A data sample of kicks (n = 29,153) was collected during junior, state-level and national league matches. Key task constraints were recorded for each kick, with performance outcome recorded as effective or ineffective. Rules were based on frequency and strength of associations between constraints and kick outcomes, generated using the Apriori algorithm. Univariate analysis revealed that low kicking effectiveness was associated with physical pressure (37%), whereas high efficiency emerged when kicking to an open target (70%). Between-competition comparisons showed differences in constraint interactions through seven unique rules and differences in confidence levels in shared rules. Results showed how understanding of key constraints interactions, and prevalence during competitive performance, can be used to inform representative learning designs in athlete training programmes. Findings can be used to specify how the competitive performance environment differs between competition tiers, supporting the specification of information in training designs, representative of different performance levels.

The relationship between workplace psychosocial environment and retirement intentions and actual retirement: a systematic review.

Psychosocial work characteristics are potential determinants of retirement intentions and actual retirement. A systematic review was conducted of the influence of psychosocial work characteristics on retirement intentions and actual retirement among the general population. This did not include people who were known to be ill or receiving disability pension. Relevant papers were identified by a search of PubMed, PsycINFO and Web of Science databases to December 2016. We included longitudinal and cross-sectional papers that assessed psychosocial work characteristics in relation to retirement intentions or actual retirement. Papers were filtered by title and abstract before data extraction was performed on full texts using a predetermined extraction sheet. Forty-six papers contained relevant evidence. High job satisfaction and high job control were associated with later retirement intentions and actual retirement. No consistent evidence was found for an association of job demands with retirement intentions or actual retirement. We conclude that to extend working lives policies should increase the job control available to older employees.

Ward round template: enhancing patient safety on ward rounds.

INTRODUCTION AND AIMS: Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets. METHOD: The quality improvement technique of plan-do-study-act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template. SUMMARY OF RESULTS: Documentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%. CONCLUSIONS: Following introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

Enhanced interferon regulatory factor 3 binding to the interleukin-23p19 promoter correlates with enhanced interleukin-23 expression in systemic lupus erythematosus.

OBJECTIVE: To examine the role of interferon regulatory factor 3 (IRF-3) in the regulation of interleukin-23 (IL-23) production in patients with systemic lupus erythematosus (SLE). METHODS: Bone marrow-derived macrophages were isolated from both wild-type and IRF3(-/-) C57BL/6 mice. These cells were stimulated with the Toll-like receptor 3 (TLR-3) agonist poly(I-C), and IL-23p19 cytokine levels were analyzed by enzyme-linked immunosorbent assay. IRF-3 binding to the IL-23p19 gene promoter region in monocytes from patients with SLE and healthy control subjects was analyzed by chromatin immunoprecipitation (ChIP) assay. Luciferase reporter gene assays were performed to identify key drivers of IL-23p19 promoter activity. TANK-binding kinase 1 (TBK-1) protein levels were determined by Western blotting. RESULTS: ChIP assays demonstrated that IRF-3 was stably bound to the human IL-23p19 promoter in monocytes; this association increased following TLR-3 stimulation. Patients with SLE demonstrated increased levels of IRF-3 bound to the IL-23p19 promoter compared with control subjects, which correlated with enhanced IL-23p19 production in monocytes from patients with SLE. Investigations of the TLR-3-driven responses in monocytes from patients with SLE revealed that TBK-1, which is critical for regulating IRF-3 activity, was hyperactivated in both resting and TLR-3-stimulated cells. CONCLUSION: Our results demonstrate for the first time that patients with SLE display enhanced IL-23p19 expression as a result of hyperactivation of TBK-1, resulting in increased binding of IRF-3 to the promoter. These findings provide novel insights into the molecular pathogenesis of SLE and the potential role for TLR-3 in driving this response.

Intracavity parametric generation of nanosecond terahertz radiation using quasi-phase-matching.

We report the use of quasi-phase-matching techniques based on periodically-poled MgO:LiNbO(3) for the generation of nanosecond duration pulses of terahertz radiation in intracavity optical parametric oscillators. Multiple idler-waves are generated with temporal studies indicating that the initiating process is the expected parametric down-conversion, but followed by cascaded difference frequency generation. A number of grating geometries have been explored, revealing the presence of dual solutions for the quasi-phase-matching process in the general case. Choice of grating parameters so as to minimize oscillation threshold while simultaneously ensuring effective extraction of the THz radiation is considered.

Time-resolved fluorescence anisotropy studies show domain-specific interactions of calmodulin with IQ target sequences of myosin V.

Single cysteine mutants of calmodulin, Cam(S38C) and Cam(N111C), have been specifically labelled with Alexa488 maleimide to study the effects of calcium on the structural dynamics of calmodulin complexed with IQ3, IQ4 and IQ34 target peptide motifs of mouse unconventional myosin-V. Using phase fluorometry, the time-resolved anisotropy shows well-separated global and segmental correlation times. The calcium-sensitive global motion of either calmodulin domain can be independently monitored in domain-specific interactions of either apo- or Ca(4).calmodulin with IQ3 or IQ4 peptides. C-domain interactions predominate, and apo-N-domain interactions are unexpectedly weak. The 1:1 complex of Ca(4).calmodulin with IQ34 behaves as a compact globular species. The results demonstrate novel dynamic aspects of calmodulin-IQ interactions relating to the calcium regulation of motility of unconventional myosin.