Point-of-care HCV RNA testing improves hepatitis C testing rates and allows rapid treatment initiation among people who inject drugs attending a medically supervised injecting facility.

BACKGROUND: To achieve hepatitis C virus (HCV) elimination targets, simplified care engaging people who inject drugs is required. We evaluated whether fingerstick HCV RNA point-of-care testing (PoCT) increased the proportion of clients attending a supervised injecting facility who were tested for hepatitis C. METHODS: Prospective single-arm study with recruitment between 9 November 2020 and 28 January 2021 and follow-up to 31 July 2021. Clients attending the supervised injecting facility were offered HCV RNA testing using the Xpert® HCV Viral Load Fingerstick (Cepheid, Sunnyvale, CA) PoCT. Participants with a positive HCV RNA test were prescribed direct acting antiviral (DAA) therapy. The primary endpoint was the proportion of clients who engaged in HCV RNA PoCT, compared to a historical comparator group when venepuncture-based hepatitis C testing was standard of care. RESULTS: Among 1618 clients who attended the supervised injecting facility during the study period, 228 (14%) engaged in PoCT. This was significantly higher than that observed in the historical comparator group (61/1,775, 3%; p < 0.001). Sixty-five (28%) participants were HCV RNA positive, with 40/65 (62%) receiving their result on the same day as testing. Sixty-one (94%) HCV RNA positive participants were commenced on DAA therapy; 14/61 (23%) started treatment on the same day as diagnosis. There was no difference in the proportion of HCV RNA positive participants commenced on treatment with DAA therapy when compared to the historical comparator group (61/65, 94% vs 22/26, 85%; p = 0.153). However, the median time to treatment initiation was significantly shorter in the PoCT cohort (2 days (IQR 1-20) vs 41 days (IQR 22-76), p < 0.001). Among participants who commenced treatment and had complete follow-up data available, 27/36 (75%) achieved hepatitis C cure. CONCLUSIONS: HCV RNA PoCT led to a significantly higher proportion of clients attending a supervised injecting facility engaging in hepatitis C testing, whilst also reducing the time to treatment initiation.

The onset and severity of acute opioid toxicity in heroin overdose cases: a retrospective cohort study at a supervised injecting facility in Melbourne, Australia.

AIM: To differentiate the severity of acute opioid toxicity and describe both the clinical and physiological features associated with heroin overdose in a cohort of witnessed overdose cases. METHODS: Witnessed heroin overdose cases over a 12-month period (30 June 2018 - 30 June 2019) at the Medically Supervised Injecting Room (MSIR) in Melbourne, Australia were examined. The severity of acute opioid toxicity was classified according to the level of clinical intervention required to manage the overdose cases where an escalating level of care was provided. Heroin overdose cases were classified into one of three graded severity categories and a fourth complicated heroin overdose category. RESULTS: A total of 1218 heroin overdose cases were identified from 60,693 supervised injecting visits over the study period. On the spectrum of toxicity, 78% (n = 955) of overdose cases were classified as Grade 1 severity, 7% (n = 83) as Grade 2 severity, and 13% (n = 161) as Grade 3 acute opioid toxicity severity cases, as well as 2% (n = 19) classified as complicated heroin overdose cases. The median onset time for heroin overdose cases was 17 min (IQR 11-28 min) from the time the individual was ready to prepare and inject heroin until clinical intervention was initiated. CONCLUSION: We demonstrated that heroin overdose is a dynamic illness and cases differ in the severity of acute opioid toxicity. The risk of airway occlusion including positional asphyxia was an early and consistent feature across all levels of toxicity, while exaggerated respiratory depression together with exaggerated depression of consciousness was increasingly observed with greater levels of toxicity. We also demonstrated the importance of early intervention in overdose cases, where in a large cohort of heroin overdose cases there were no fatal outcomes, a very low hospitalisation rate and most cases were able to be managed to clinical resolution on-site.

Trace residue identification, characterization, and longitudinal monitoring of the novel synthetic opioid ß-U10, from discarded drug paraphernalia.

Empirical data regarding dynamic alterations in illicit drug supply markets in response to the COVID-19 pandemic, including the potential for introduction of novel drug substances and/or increased poly-drug combination use at the "street" level, that is, directly proximal to the point of consumption, are currently lacking. Here, a high-throughput strategy employing ambient ionization-mass spectrometry is described for the trace residue identification, characterization, and longitudinal monitoring of illicit drug substances found within >6,600 discarded drug paraphernalia (DDP) samples collected during a pilot study of an early warning system for illicit drug use in Melbourne, Australia from August 2020 to February 2021, while significant COVID-19 lockdown conditions were imposed. The utility of this approach is demonstrated for the de novo identification and structural characterization of ß-U10, a previously unreported naphthamide analog within the "U-series" of synthetic opioid drugs, including differentiation from its α-U10 isomer without need for sample preparation or chromatographic separation prior to analysis. Notably, ß-U10 was observed with 23 other drug substances, most commonly in temporally distinct clusters with heroin, etizolam, and diphenhydramine, and in a total of 182 different poly-drug combinations. Longitudinal monitoring of the number and weekly "average signal intensity" (ASI) values of identified substances, developed here as a semi-quantitative proxy indicator of changes in availability, relative purity and compositions of street level drug samples, revealed that increases in the number of identifications and ASI for ß-U10 and etizolam coincided with a 50% decrease in the number of positive detections and an order of magnitude decrease in the ASI for heroin.

Acute Response to Capsiate Supplementation at Rest and during Exercise on Energy Intake, Appetite, Metabolism, and Autonomic Function: A Randomized Trial.

OBJECTIVE: The purpose of the present study was to examine the effect of capsiate supplementation on energy intake, self-reported appetite-related sensations, energy expenditure, fat oxidation, and autonomic parameters with and without an exercise intervention. METHODS: Thirteen healthy men completed four randomized trials: two trials for the control condition (without exercise), one with capsiate supplementation (CTRLcap) and one with a placebo (CTRLpla), and two trials for the exercise condition, one with capsiate supplementation (EXcap) and one with placebo (EXpla). Exercise sessions were performed 150 min after the consumption of a standardized breakfast, and supplementation 115 min after consumption of breakfast. An ad libitum buffet was offered 200 min following the completion of the standardized breakfast, and energy intake (EI) and relative energy intake (REI) (relative energy intake = energy intake - energy expenditure related to exercise) were evaluated. RESULTS: There were no significant effects on EI, self-reported appetite sensations, fat oxidation, and energy expenditure. REI was reduced in conditions involving EX when compared to CTRL. A low-frequency to high-frequency ratio for heart rate variability was higher in CTRLcap (1.6 ± 1.1) vs. CTRLpla (1.2 ± 0.9) (p = 0.025; d = 0.39). CONCLUSION: Acute capsiate supplementation combined with aerobic exercise has limited effects on the examined variables (EI, REI, fat oxidation, energy expenditure, and autonomic parameters), while changes in the autonomic nervous system function in the absence of exercise may have occurred without influencing other variables. CLINICAL TRIAL REGISTRATION: ensaiosclinicos.gov.br number, RBR-5pckyr https://ensaiosclinicos.gov.br/rg/RBR-5pckyr.

Early Warning System for Illicit Drug Use at Large Public Events: Trace Residue Analysis of Discarded Drug Packaging Samples.

Inspired by Locard's exchange principle, which states "every contact leaves a trace", a trace residue sampling strategy has been developed for the analysis of discarded drug packaging samples (DPS), as part of an early warning system for illicit drug use at large public events including music/dance festivals. Using direct analysis in real time/mass spectrometry and tandem mass spectrometry, rapid and high-throughput identification and characterization of a wide range of illicit drugs and adulterant substances was achieved, including in complex polydrug mixtures and at low relative ion abundances. A total of 1362 DPS were analyzed either off-site using laboratory-based instrumentation or on-site and in close to real time using a transportable mass spectrometer housed within a mobile analytical laboratory, with each analysis requiring less than 1 min per sample. Of the DPS analyzed, 92.2% yielded positive results for at least one of 15 different drugs and/or adulterants, including cocaine, MDMA, and ketamine, as well as numerous novel psychoactive substances (NPS). Also, 52.6% of positive DPS were found to contain polydrug mixtures, and a total of 42 different drug and polydrug combinations were observed throughout the study. For analyses performed on-site, reports to key stakeholders including event organizers, first aid and medical personnel, and peer-based harm reduction workers could be provided in as little as 5 min after sample collection. Following risk assessment of the potential harms associated with their use, drug advisories or alerts were then disseminated to event staff and patrons and subsequently to the general public when substances with particularly toxic properties were identified.

Efficacy of Rest Redistribution During Squats: Considerations for Strength and Sex.

ABSTRACT: Boffey, D, Clark, NW, and Fukuda, DH. Efficacy of rest redistribution during squats: Considerations for strength and sex. J Strength Cond Res 35(3): 586-595, 2021-This study examined the kinematic, perceptual, and heart rate responses to rest redistribution (RR) and traditional sets (TS) during the barbell back squat for men and women possessing a wide range of strength levels. Forty-five resistance-trained subjects (30 men and 15 women) performed 40 repetitions of the barbell squat with 65% 1RM load with TS (4 × 10 repetitions, 3-minute rest) or RR (10 × 4 repetitions, 1-minute rest), in a randomized order on days separated by ≥72 hours. The significance was set at p ≤ 0.05 for all statistical analyses. The mean velocity (MV) maintenance was significantly higher for RR compared with TS (87.70 ± 4.50% vs. 84.07 ± 4.48%, respectively; p < 0.01, d = 0.35). Rating of perceived exertion (active muscles) was significantly lower for RR compared with TS (5.38 ± 1.42 vs. 6.08 ± 1.43, respectively; p = 0.02, d = -0.35). Rating of perceived exertion (overall) was also significantly lower for RR compared with TS (5.60 ± 1.40 vs. 6.48 ± 1.49, respectively; p = 0.02, d = -0.37). The relative strength ratio (relative strength ratio; squat 1RM: body mass) was significantly correlated with the difference in MV maintenance between RR and TS (r = -0.34, p = 0.02). No sex-based differences (p > 0.05) were found for any dependent variables. Rest redistribution produced significantly higher mean HR (143.25 ± 21.11 vs. 135.05 ± 20.74, p < 0.01) and minimum HR (102.77 ± 19.58 vs. 95.97 ± 22.17, p < 0.01). Subjects were better able to maintain velocity with RR compared with TS, while experiencing less perceived effort. Rest redistribution can be recommended for both men and women, but very strong individuals may not improve their velocity maintenance with RR to the same extent as less strong individuals.

COVID-19 and Substance Use Disorders: Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine Practice and Policy Interest Group Position Paper.

Coronavirus Disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations. People Who Use Drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These conditions put them at a higher risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious diseases, and disaster psychiatry explore the possible raised concerns in this issue and provide recommendations to manage the comorbidity of COVID-19 and Substance Use Disorder (SUD).

Heart Rate Variability Behavior during Exercise and Short-Term Recovery Following Energy Drink Consumption in Men and Women.

This study examined the cardiac autonomic responses, as measured by heart rate variability (HRV), during cycling exercise and short-term rest after energy drink consumption. Seventeen participants (seven males and 10 females; age: 22.8 ± 3.5 years; BMI: 24.3 ± 3.3 kg/m2) completed this double-blind, placebo-controlled, counterbalanced crossover design study. Participants received an energy drink formula containing 140 mg of caffeine and a placebo in a randomized order before completing a 10-min steady-state warm up (WUP) and a graded exercise test to exhaustion (GXT) followed by a 15-min short-term rest (STR) period. Heartbeat intervals were recorded using a heart rate monitor. Data were divided into WUP, GXT, and STR phases, and HRV parameters were averaged within each phase. Additionally, root mean square of the standard deviation of R-R intervals (RMSSD) during GXT was analyzed to determine the HRV threshold. Separate two-way (sex (male vs. female) x drink (energy drink vs. placebo)) repeated measures ANOVA were utilized. Significant increases in high frequency (HF) and RMSSD were shown during WUP after energy drink consumption, while interactions between drink and sex were observed for HRV threshold parameters (initial RMSSD and rate of RMSSD decline). No significant differences were noted during STR. Energy drink consumption may influence cardiac autonomic responses during low-intensity exercise, and sex-based differences in response to graded exercise to exhaustion may exist.

Dynamic post-activation potentiation protocol improves rowing performance in experienced female rowers.

Post-activation potentiation likely acutely improves power-based performance; however, few studies have demonstrated improved endurance performance. Forty collegiate female rowers performed isometric potentiating (ISO), dynamic potentiating (DYN) and control (CON) warm-up protocols on a rowing ergometer, followed by a three-minute all-out test to evaluate their total distance, peak power, mean power, critical power, anaerobic working capacity (W') and stroke rate. Fifteen-second splits were also analysed. ISO consisted of 5 × 5-second static muscle actions with the ergometer handle rendered immovable with a nylon strap, while DYN consisted of 2 × 10-second all-out rowing bouts, separated by a 2-minute rest interval. The participants were divided into high and low experience groups by median experience level (3.75 years) for statistical analysis. Significant differences (DYN > CON; p < 0.05) were found for distance (+5.6 m), mean power (+5.9 W) and W' (+1561.6 J) for more experienced rowers (n = 19) and no differences for less experienced rowers (n = 18). Mean power in DYN was significantly greater than CON and ISO in the 15-30, 30-45, 45-60 and 60-75 second intervals independent of experience level. These results suggest that DYN may benefit experienced female rowers and that these strategies might benefit a greater power output over shorter distances regardless of experience.

The acute effects of thermogenic fitness drink formulas containing 140 mg and 100 mg of caffeine on energy expenditure and fat metabolism at rest and during exercise.

BACKGROUND: Thermogenic fitness drink formulas (TFD) have been shown to increase energy expenditure and markers of lipid metabolism. The purpose of the current study was to compare TFD formulas containing different caffeine concentrations versus a placebo drink on energy expenditure and lipid metabolism at rest and during exercise. METHODS: Thirty-two recreationally active participants (22.9 ± 0.7 y, 167.1 ± 1.4 cm, 68.8 ± 2.0 kg, 24.0 ± 1.2% fat) who were regular caffeine consumers, participated in this randomized, double-blind, crossover design study. Participants reported to the laboratory on three occasions, each of which required consumption of either a TFD containing 140 mg or 100 mg of caffeine or a placebo. Baseline measurements of resting energy expenditure (REE) and resting fat oxidation (RFO) were assessed using indirect calorimetry as well as measurements of serum glycerol concentration. Measurements were repeated at 30, 60, 90 min post-ingestion. Following resting measures, participants completed a graded exercise test to determine maximal oxygen uptake (V̇O2max), maximal fat oxidation (MFO) and the exercise intensity that elicits MFO (Fatmax), and total energy expenditure (EE). RESULTS: A significant interaction was shown for REE (p < 0.01) and RFO (p < 0.01). Area under the curve analysis showed an increased REE for the 140 mg compared to the 100 mg formula (p = 0.02) and placebo (p < 0.01) and an increased REE for the 100 mg formula compared to placebo (p = 0.02). RFO significantly decreased for caffeinated formulas at 30 min post ingestion compared to placebo and baseline (p < 0.01) and significantly increased for the 140 mg formula at 60 min post-ingestion (p = 0.03). A main effect was shown for serum glycerol concentrations over time (p < 0.01). No significant differences were shown for V̇O2max (p = 0.12), Fatmax (p = 0.22), and MFO (p = 0.05), and EE (p = 0.08) across drinks. CONCLUSIONS: Our results suggest that TFD formulas containing 100 and 140 mg of caffeine are effective in increasing REE and that a 40 mg of caffeine difference between the tested formulas may impact REE and RFO in healthy individuals within 60 min of ingestion.

Alterations in energy system contribution following upper body sprint interval training.

PURPOSE: The primary purpose of this study was to examine the influence of different work-to-rest ratios on relative energy system utilization during short-term upper-body sprint interval training (SIT) protocols. METHODS: Forty-two recreationally trained men were randomized into one of three training groups [10 s work bouts with 2 min of rest (10:2, n = 11) or 4 min of rest (10:4, n = 11), or 30 s work bouts with 4 min of rest (30:4, n = 10)] or a control group (CON, n = 10). Participants underwent six training sessions over 2 weeks with 4-6 'all-out' sprints. Participants completed an upper body Wingate test (30 s 'all-out' using 0.05 kg kg-1 of the participant's body mass) pre- and post-intervention from which oxygen consumption and blood lactate were used to estimate oxidative, glycolytic, and adenosine triphosphate-phosphocreatine (ATP-PCr) energy system provisions. An analysis of covariance was performed on all testing measurements collected at post with the associated pre-values used as covariates. RESULTS: Relative energy contribution (p = 0.026) and energy expenditure (p = 0.019) of the ATP-PCr energy system were greater in 10:4 (49.9%; 62.1 kJ) compared to CON (43.1%; 47.2 kJ) post training. No significant differences were found between groups in glycolytic or oxidative energy contribution over a 30 s upper body Wingate test. CONCLUSION: SIT protocols with smaller work-to-rest ratios may enhance ATP-PCr utilization in a 30 s upper body Wingate over a 2-week intervention.

Influence of Acute and Chronic High-Intensity Intermittent Aerobic Plus Strength Exercise on BDNF, Lipid and Autonomic Parameters.

The purpose of the present study is two-fold. First, we evaluated whether 8-weeks of combined training (high-intensity intermittent plus strength training) may change brain derived neurotropic factor (BDNF) and lipid parameters (triacylglycerol, HDL-c and non-HDL) in a fasted state. Second, we investigated the effect of an acute session of high-intensity intermittent exercise followed by strength training on systemic BDNF and lipid parameters pre- and post 8-weeks of training. Twenty-one healthy and physically active men were divided into two groups: high-intensity intermittent exercise combined with strength training (HSG; n = 11) and control (CG; n = 10). The HSG exercised for one minute at 100% of speedVO2max (sVO2max) interspersed with one minute of passive recovery followed by strength training (8 exercises with 8-12 repetition maximum loads) for 8-weeks. Heart rate variability, blood pressure, lipid profile, and BDNF concentrations were measured in the fasted state pre- and post-exercise and before and after the 8-week training period. After 8-weeks of exercise training, there was an increase in spectral high frequency component (ms2) and RR interval (p < 0.05), a decreased spectral low frequency component (nu) and heart rate values (p < 0.05), an increase in HDL-c (p < 0.001), and lower BDNF concentrations (p < 0.001). These results suggest that 8-weeks of high-intensity intermittent exercise combined with strength exercise is an effective protective cardio-metabolic strategy capable of increasing HDL-c and BDNF concentrations after an acute exercise session. In the long-term, the modulation on BDNF and HDL-c concentrations may be a determining factor for protection against neurological and cardiovascular diseases.

Examining work-to-rest ratios to optimize upper body sprint interval training.

The objective was to compare the metabolic influence of varying work-to-rest ratios during upper body sprint interval training (SIT). Forty-two recreationally-trained men were randomized into a training group [10 s work - 2 min of rest (10:2) or 4 min of rest (10:4), or 30 s work - 4 min of rest (30:4)] or a control group (CON). Participants underwent six training sessions over two weeks. Assessments consisted of a graded exercise test [maximal oxygen consumption (VO2peak) and peak power output (PPO)], four constant-work rate trials [critical power, anaerobic working capacity, and electromyographic fatigue threshold], and an upper body Wingate test (mean/peak power and total work). Post-training absolute and relative VO2peak was greater than pre-training for 30:4 (p = .005 and p = .009, respectively), but lower for CON (p = .001 and p = .006, respectively). Post-training PPO was greater in 30:4 (p < .001). No differences were observed during the constant-work rate trials or Wingate test. Traditional SIT appears to have enhanced VO2peak in the upper body over a short-term two-week intervention.

Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis.

BACKGROUND: Clinical guidelines recommend psychosocial interventions for cocaine and/or amphetamine addiction as first-line treatment, but it is still unclear which intervention, if any, should be offered first. We aimed to estimate the comparative effectiveness of all available psychosocial interventions (alone or in combination) for the short- and long-term treatment of people with cocaine and/or amphetamine addiction. METHODS AND FINDINGS: We searched published and unpublished randomised controlled trials (RCTs) comparing any structured psychosocial intervention against an active control or treatment as usual (TAU) for the treatment of cocaine and/or amphetamine addiction in adults. Primary outcome measures were efficacy (proportion of patients in abstinence, assessed by urinalysis) and acceptability (proportion of patients who dropped out due to any cause) at the end of treatment, but we also measured the acute (12 weeks) and long-term (longest duration of study follow-up) effects of the interventions and the longest duration of abstinence. Odds ratios (ORs) and standardised mean differences were estimated using pairwise and network meta-analysis with random effects. The risk of bias of the included studies was assessed with the Cochrane tool, and the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We followed the PRISMA for Network Meta-Analyses (PRISMA-NMA) guidelines, and the protocol was registered in PROSPERO (CRD 42017042900). We included 50 RCTs evaluating 12 psychosocial interventions or TAU in 6,942 participants. The strength of evidence ranged from high to very low. Compared to TAU, contingency management (CM) plus community reinforcement approach was the only intervention that increased the number of abstinent patients at the end of treatment (OR 2.84, 95% CI 1.24-6.51, P = 0.013), and also at 12 weeks (OR 7.60, 95% CI 2.03-28.37, P = 0.002) and at longest follow-up (OR 3.08, 95% CI 1.33-7.17, P = 0.008). At the end of treatment, CM plus community reinforcement approach had the highest number of statistically significant results in head-to-head comparisons, being more efficacious than cognitive behavioural therapy (CBT) (OR 2.44, 95% CI 1.02-5.88, P = 0.045), non-contingent rewards (OR 3.31, 95% CI 1.32-8.28, P = 0.010), and 12-step programme plus non-contingent rewards (OR 4.07, 95% CI 1.13-14.69, P = 0.031). CM plus community reinforcement approach was also associated with fewer dropouts than TAU, both at 12 weeks and the end of treatment (OR 3.92, P < 0.001, and 3.63, P < 0.001, respectively). At the longest follow-up, community reinforcement approach was more effective than non-contingent rewards, supportive-expressive psychodynamic therapy, TAU, and 12-step programme (OR ranging between 2.71, P = 0.026, and 4.58, P = 0.001), but the combination of community reinforcement approach with CM was superior also to CBT alone, CM alone, CM plus CBT, and 12-step programme plus non-contingent rewards (ORs between 2.50, P = 0.039, and 5.22, P < 0.001). The main limitations of our study were the quality of included studies and the lack of blinding, which may have increased the risk of performance bias. However, our analyses were based on objective outcomes, which are less likely to be biased. CONCLUSIONS: To our knowledge, this network meta-analysis is the most comprehensive synthesis of data for psychosocial interventions in individuals with cocaine and/or amphetamine addiction. Our findings provide the best evidence base currently available to guide decision-making about psychosocial interventions for individuals with cocaine and/or amphetamine addiction and should inform patients, clinicians, and policy-makers.

Effect of a Flying Versus Stationary Start on Wingate Test Outcomes Using an Electromagnetically-Braked Cycle Ergometer in Advanced Resistance-Trained Males.

The purpose of this study was to compare power outputs of the flying start to the stationary start method on an electromagnetically-braked cycle ergometer. Twenty advanced resistance-trained men (age 24.6 ± 4.5 years; 25.4 ± 2.5 kg/m2) volunteered to participate in this study. A counter-balanced, repeated-measures design was utilized to randomly assign participants to either the flying start or the stationary start for their first Wingate test. Paired t tests were used to evaluate mean differences between start methods. Peak power (PP), mean power (MP), total work (TW), peak cadence (PC), mean cadence (MC), and time to reach peak power (TPP) were recorded. Start method revealed significant differences for PP (p<0.01; flying start = 1,111 ± 42 W vs. stationary start = 854 ± 41 W) and PC attainment (p<0.01; flying start = 167 ± 7 RPM vs. stationary start = 128 ± 5 RPM). Start method did not significantly affect MP (p=0.73; flying start 673 ± 30 W vs. stationary start 657 ± 34 W) or MC (p=0.61; flying start 102 ± 5 RPM vs. 99 ± 4 RPM). The flying start method allowed for not only a greater PP but also a faster TPP (0.24 ± 0.02 seconds). In contrast, TPP was not attained until approximately one-third of the stationary start test (10.3 ± 0.4 seconds). This study showed that the traditional flying start allowed higher PP and PC outputs when compared to the alternative stationary start method in a sample of advanced resistance-trained male participants.

Influence of Velotron chainring size on Wingate anaerobic test.

OBJECTIVES: This study compared an 85-tooth versus the standard 62-tooth chainring for power outputs during a Wingate test using a Velotron electromagnetically-braked cycle ergometer. DESIGN: All participants completed trials using both chainring sizes in a repeated-measures cross-over design. METHODS: Resistance-trained male participants (n=20, 24.6±4.5years) performed two Wingate tests separated by at least 48h. Peak power (PP), mean power (MP), fatigue index (FI), peak cadence, mean cadence, and total work (TW) were recorded. RESULTS: Peak power was not significantly different (p=0.10) between trials (62-tooth=1111±187W vs. 85-tooth=1188±103W). However, MP, mean cadence, and TW were significantly greater (p<0.01) for the 85-tooth trial (869±114W, 131±16rpm, and 26,063±3418J) compared to the 62-tooth test (673±136W, 102±24rpm, and 20,199±4066J). Fatigue index was reduced during the 85-tooth trial (49.9±9.1% vs. 61.6±8.8%; p<0.01). Agreement was poor with most ICCs≈0.19 and large SEMs. CONCLUSIONS: The two options for chainrings on Velotron cycle ergometers should not be interchangeably used with the Wingate test software; the 62-tooth ring is recommended for most applications. Individuals who can attain peak cadence >180rpm have less variability and tend to achieve higher power outputs on the 62-tooth ring. We suspect that the manufacturer's software limits peak cadence to 182rpm when using the 85-tooth chainring.

Effects of ambient particulate matter on aerobic exercise performance.

BACKGROUND/OBJECTIVE: Wintertime thermal inversions in narrow mountain valleys create a ceiling effect, increasing concentration of small particulate matter (PM2.5). Despite potential health risks, many people continue to exercise outdoors in thermal inversions. This study measured the effects of ambient PM2.5 exposure associated with a typical thermal inversion on exercise performance, pulmonary function, and biological markers of inflammation. METHODS: Healthy, active adults (5 males, 11 females) performed two cycle ergometer time trials outdoors in a counterbalanced design: 1) low ambient PM2.5 concentrations (<12 µg/m3), and 2) an air quality index (AQI) ranking of "yellow." Variables of interest were exercise performance, exhaled nitric oxide (eNO), c-reactive protein (CRP), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1). RESULTS: Despite a significant difference in mean PM2.5 concentration of 9.3 ±â€¯3.0 µg/m3 between trials (p < .001), there was no significant difference (p = .424) in the distance covered during low PM2.5 conditions (9.9 ±â€¯1.7 km) compared to high PM2.5 conditions (10.1 ±â€¯1.5 km). There were no clinically significant differences across time or between trials for eNO, CRP, FVC, or FEV1. Additionally, there were no dose-response relationships (p > .05) for PM2.5 concentration and the measured variables. CONCLUSION: An acute bout of vigorous exercise during an AQI of "yellow" did not diminish exercise performance in healthy adults, nor did it have a negative effect on pulmonary function or biological health markers. These variables might not be sensitive to small changes from acute, mild PM2.5 exposure.

Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO).

Very little evidence has been reported in literature regarding the misuse of substances in rural areas. Despite the common perception of rural communities as a protective and risk-mitigating environment, the scientific literature demonstrated the existence of many risk factors in rural communities. The Drug Prevention and Health Branch (DHB) of the United Nations Office on Drugs and Crime (UNODC), and the World Health Organization (WHO), in June 2016, organized a meeting of experts in treatment and prevention of SUDs in rural settings. The content presented during the meeting and the related discussion have provided materials for the preparation of an outline document, which is the basis to create a technical tool on SUDs prevention and treatment in rural settings. The UNODC framework for interventions in rural settings is a technical tool aimed to assist policy makers and managers at the national level. This paper is a report on UNODC/WHO efforts to improve the clinical conditions of people affected by SUDs and living in rural areas. The purpose of this article is to draw attention on a severe clinical and social problem in a reality forgotten by everyone.

Interventions for the management of substance use disorders: an overview.

For the past 50 years, there has been a systematic effort to expand and improve treatment services for individuals with substance use disorders by developing an evidence base to guide practice. This policy brief aims to review the available interventions for the management of substance use disorders, examine the evidence base for these interventions, including the WHO Mental Health Gap Action Programme intervention guide, and make recommendations related to the treatment of substance use disorders. In the development of this policy brief, numerous documents were reviewed. The WHO Mental Health Gap Action Programme intervention guide offers the most well synthesized summary of interventions that have evidence of support, clinical acceptance, extensive implementation and expert consensus. The recommendations within this policy brief incorporate the core recommendations on substance use disorder elements included in the mhGAP intervention guide.

Validity and Reliability of A-Mode Ultrasound for Body Composition Assessment of NCAA Division I Athletes.

This study evaluated the validity and reliability of the BodyMetrix™ BX2000 A-mode ultrasound for estimating percent body fat (%BF) in athletes by comparing it to skinfolds and the BOD POD. Forty-five (22 males, 23 females) National Collegiate Athletic Association (NCAA) Division-I athletes volunteered for this study. Subjects were measured once in the BOD POD then twice by two technicians for skinfolds and ultrasound. A one-way repeated-measures ANOVA revealed significant differences between body composition methods (F = 13.24, p < 0.01, η² = 0.24). This difference was further explained by a sex-specific effect such that the mean difference between ultrasound and BOD POD was large for females (~ 5% BF) but small for males (~ 1.5% BF). Linear regression using the %BF estimate from ultrasound to predict %BF from BOD POD resulted in an R2 = 0.849, SEE = 2.6% BF and a TE = 4.4% BF. The inter-rater intraclass correlation (ICC) for skinfold was 0.966 with a large 95% confidence interval (CI) of 0.328 to 0.991. The inter-rater ICC for ultrasound was 0.987 with a much smaller 95% CI of 0.976 to 0.993. Both skinfolds and ultrasound had test-retest ICCs ≥ 0.996. The BX2000 ultrasound device had excellent test-retest reliability, and its inter-rater reliability was superior to the skinfold method. The validity of this method is questionable, particularly for female athletes. However, due to its excellent reliability, coaches and trainers should consider this portable and easy to use A-mode ultrasound to assess body composition changes in athletes.