Triple-clad W-type fiber mitigates multipath artifacts in multimodal optical coherence tomography.

Multimodal endoscopic optical coherence tomography (OCT) can be implemented with double-clad fiber by using the presumed single-mode core for OCT and the higher numerical aperture cladding for a secondary modality. However, the quality of OCT in double-clad fiber (DCF) based systems is compromised by the introduction of multipath artifacts that are nt present in single-mode fiber OCT systems. Herein, the mechanisms for multipath artifacts in DCF are linked to its modal contents using a commercial software package and experimental measurement. A triple-clad W-type fiber is proposed as a method for achieving multimodal imaging with single-mode quality OCT in an endoscopic system. Simulations of the modal contents of a W-type fiber are compared to DCF and single-mode fiber. Finally, a W-Type fiber rotary catheter is used in a DCF-based endoscopic OCT and autofluorescence imaging (AFI) system to demonstrate multipath artifact free OCT and AFI of a human fingertip.

Multipath artifacts enable angular contrast in multimodal endoscopic optical coherence tomography.

Multipath artifacts are inherent to double-clad fiber based optical coherence tomography (OCT), appearing as ghost images blurred in the A-line direction. They result from the excitation of higher-order inner-cladding modes in the OCT sample arm which cross-couple into the fundamental mode at discontinuities and thus are detected in single-mode fiber-based interferometers. Historically, multipath artifacts have been regarded as a drawback in single fiber endoscopic multimodal OCT systems as they degrade OCT quality. In this work, we reveal that multipath artifacts can be projected into high-quality two-dimensional en face images which encode high angle backscattering features. Using a combination of experiment and simulation, we characterize the coupling of Mie-range scatterers into the fundamental image (LP01 mode) and higher-order image (multipath artifact). This is validated experimentally through imaging of microspheres with an endoscopic multimodal OCT system. The angular dependence of the fundamental image and higher order image generated by the multipath artifact lays the basis for multipath contrast, a ratiometric measurement of differential coupling which provides information regarding the angular diversity of a sample. Multipath contrast images can be generated from OCT data where multipath artifacts are present, meaning that a wealth of clinical data can be retrospectively examined.

Association of Baseline Patient-reported Health-related Quality of Life Metrics with Outcome in Localised Prostate Cancer.

AIMS: Although health-related quality of life (HR-QoL) outcomes are pivotal in oncology, the prognostic significance of patient-reported HR-QoL metrics is largely undefined in localised prostate cancer. We report the association of baseline HR-QoL metrics with overall survival and toxicity in localised prostate cancer. MATERIALS AND METHODS: This was a secondary analysis of a phase III randomised controlled study conducted in a single-payer health system. Patients with Gleason score ≤7, clinical stage T1b-T3a and prostate-specific antigen <30 ng/ml were randomised to neoadjuvant and concurrent androgen deprivation therapy (ADT) for 6 months starting 4 months before prostate radiotherapy or concurrent and adjuvant ADT for 6 months starting simultaneously with prostate radiotherapy. HR-QoL scores were estimated using the European Organisation for Research and Treatment of Cancer QoL questionnaire. A multistate Markov model was used to determine the association of baseline HR-QoL metrics with overall survival and a multilevel multivariable Cox regression was used to determine the association with the incidence of delayed-onset grade ≥3 radiotherapy-related toxicities. To adjust for multiple analyses, P < 0.025 was considered as statistically significant. RESULTS: Overall, 393 patients with baseline HR-QoL data were included in this analysis: 194 in the neoadjuvant arm and 199 in the adjuvant arm. Baseline financial difficulty (hazard ratio 1.020, 95% confidence interval 1.010-1.030, P = 0.02) and dyspnoea (hazard ratio 1.020, 95% confidence interval 1.003-1.030, P = 0.01) were associated with inferior overall survival. Baseline dyspnoea was associated with a higher incidence of grade ≥3 toxicity (hazard ratio 1.020, 95% confidence interval 1.010-1.030, P = 0.023). CONCLUSION: In a cohort of localised prostate cancer patients treated with radiotherapy and short-term ADT, a 10-point higher baseline financial difficulty or dyspnoea was associated with a 20% increased risk of death. With each 10-point increase in baseline dyspnoea, we noted a 20% increase in the associated risk of grade ≥3 delayed-onset radiotherapy-related toxicity.

The effect of the menstrual cycle and hyperglycaemia on hormonal and metabolic responses during exercise.

PURPOSE: Variations in substrate metabolism have been identified in women during continuous steady-state aerobic exercise performed at the same relative intensity throughout discrete phases of the menstrual cycle, although some evidence exists that this is abolished when carbohydrate is ingested. This investigation examined the effects of a supraphysiologic exogenous glucose infusion protocol, administered during two phases of the menstrual cycle (follicular and luteal) in eumenorrheic women to identify differences between metabolic, hormonal and substrate oxidative responses. METHODS: During the experimental conditions, blood glucose was infused intravenously at rates to "clamp" blood glucose at 10 mM in seven healthy females (age 20 ± 1 y, mass 55.0 ± 4.1 kg, [Formula: see text] 40.0 ± 1.8 ml/kg/min). Following 30 min of seated rest, participants exercised on a cycle ergometer for 90 min at 60% [Formula: see text]. During the rest period and throughout exercise, blood metabolites and hormones were collected at regular intervals, in addition to expired air for the measurement of substrate oxidation. RESULTS: Significant differences between ovarian hormones and menstrual phase were identified, with estrogen significantly higher during the luteal phase compared to the follicular phase (213.28 ± 30.70 pmol/l vs 103.86 ± 13.85 pmol/l; p = 0.016), and for progesterone (14.23 ± 4.88 vs 2.11 ± 0.36 nmol/l; p = 0.042). However, no further significance was identified in any of the hormonal, metabolite or substrate utilisation patterns between phases. CONCLUSION: These data demonstrate that the infusion of a supraphysiological glucose dose curtails any likely metabolic influence employed by the fluctuation of ovarian hormones in eumenorrheic women during moderate exercise.

Ethical aspects in the use of radiation in medicine: update from ICRP Task Group 109.

Whereas scientific evidence is the basis for recommendations and guidance on radiological protection, professional ethics is critically important and should always guide professional behaviour. The International Commission on Radiological Protection (ICRP) established Task Group 109 to advise medical professionals, patients, families, carers, the public, and authorities about the ethical aspects of radiological protection of patients in the diagnostic and therapeutic use of radiation in medicine. Occupational exposures and research-related exposures are not within the scope of this task group. Task Group 109 will produce a report that will be available to the different interested parties for consultation before publication. Presently, the report is at the stage of a working document that has benefitted from an international workshop organised on the topic by the World Health Organization. It presents the history of ethics in medicine in ICRP, and explains why this subject is important, and the benefits it can bring to the standard biomedical ethics. As risk is an essential part in decision-making and communication, a summary is included on what is known about the dose-effect relationship, with emphasis on the associated uncertainties. Once this theoretical framework has been presented, the report becomes resolutely more practical. First, it proposes an evaluation method to analyse specific situations from an ethical point of view. This method allows stakeholders to review a set of six ethical values and provides hints on how they could be balanced. Next, various situations (e.g. pregnancy, elderly, paediatric, end of life) are considered in two steps: first within a realistic, ethically challenging scenario on which the evaluation method is applied; and second within a more general context. Scenarios are presented and discussed with attention to specific patient circumstances, and on how and which reflections on ethical values can be of help in the decision-making process. Finally, two important related aspects are considered: how should we communicate with patients, family, and other stakeholders; and how should we incorporate ethics into the education and training of medical professionals?

Eli Lilly and Company Insulins - A Century of Innovation.

Eli Lilly and Company has played a pivotal role in the development of insulin products since its discovery in 1921. Through their dedication to pharmaceutical innovation, Josiah K. Lilly Sr. and George HA Clowes, in close collaborations with the University of Toronto, made insulin commercially available in 1923. Other innovations include the development and commercialization of the first biosynthetic human insulin, a rapid-acting insulin analog and analog mixtures. Lilly has advanced the field of knowledge with significant efforts toward developing a hepatic preferential basal insulin. Other important insulin projects include the first concentrated rapid-acting insulin analog, clinical studies supporting the use of highly concentrated human insulin, and an advanced clinical development program for an ultra-rapid insulin analog. Lilly's commitment to people affected with diabetes remains strong and will continue into the future through collaborative research, innovative product development and investing in advanced technologies.

The generation of consensus guidelines for carrying out process evaluations in rehabilitation research.

BACKGROUND: Although in recent years there has been a strong increase in published research on theories (e.g. realist evaluation, normalization process theory) driving and guiding process evaluations of complex interventions, there is limited guidance to help rehabilitation researchers design and carry out process evaluations. This can lead to the risk of process evaluations being unsystematic. This paper reports on the development of new consensus guidelines that address the specific challenges of conducting process evaluations alongside clinical trials of rehabilitation interventions. METHODS: A formal consensus process was carried out based on a modified nominal group technique, which comprised two phases. Phase I was informed by the findings of a systematic review, and included a nominal group meeting with an expert panel of participants to rate and discuss the proposed statements. Phase II was an in depth semi-structured telephone interviews with expert panel participants in order to further discuss the structure and contents of the revised guidelines. Frequency of rating responses to each statement was calculated and thematic analysis was carried out on all qualitative data. RESULTS: The guidelines for carrying out process evaluations within complex intervention rehabilitation research were produced by combining findings from Phase I and Phase II. The consensus guidelines include recommendations that are grouped in seven sections. These sections are theoretical work, design and methods, context, recruitment and retention, intervention staff, delivery of the intervention and results. These sections represent different aspects or stages of the evaluation process. CONCLUSION: The consensus guidelines here presented can play a role at assisting rehabilitation researchers at the time of designing and conducting process evaluations alongside trials of complex interventions. The guidelines break new ground in terms of concepts and theory and works towards a consensus in regards to how rehabilitation researchers should go about carrying out process evaluations and how this evaluation should be linked into the proposed trials. These guidelines may be used, adapted and tested by rehabilitation researchers depending on the research stage or study design (e.g. feasibility trial, pilot trial, etc.).

Re-evaluation of mouse tissue factor pathway inhibitor and comparison of mouse and human tissue factor pathway inhibitor physiology.

Essentials Mouse models are often used to define roles of tissue factor pathway inhibitor (TFPI) in man. TFPI isoform-specific KOs reveal unexpected differences between mouse and human TFPI physiology. Mouse plasma contains 20 times more TFPI than man, derived from TFPIγ, a form not found in man. TFPIγ null mice, expressing only TFPI isoforms α and ß, may better reflect the human situation. SUMMARY: Background Mouse models can provide insight into the pathophysiology of human thrombosis and hemostasis. Tissue factor pathway inhibitor (TFPI) regulates coagulation through protein S (PS)-enhanced factor (F) Xa inhibition and FXa-dependent inhibition of FVIIa/tissue factor (TF) activity. TFPI is expressed as isoforms α and ß in man, and α, ß and γ in the mouse. Objective Assess the reliability of extending TFPI-related studies in mice to humans. Method Compare mouse and human TFPI physiology using a variety of methods. Results Mouse TFPI and human TFPI are similar in regard to: (i) the mechanisms for FVIIa/TF and FXa inhibition; (ii) TFPIα is a soluble form and TFPIß is glycosyl phosphatidyl inositol (GPI) membrane anchored; (iii) the predominant circulating form of TFPI in plasma is lipoprotein-associated; (iv) low levels of TFPIα circulate in plasma and increase following heparin treatment; and (v) TFPIα is the isoform in platelets. They differ in that: (i) mouse TFPI circulates at a ~20-fold higher concentration; (ii) mouse lines with isolated isoform deletions show this circulating mouse TFPI is derived from TFPIγ; (iii) sequences homologous to the mouse TFPIγ exon are present in many species, including man, but in primates are unfavorable for splicing; and (iv) tandem mass spectrometry (MS/MS) detects sequences for TFPI isoforms α and ß in human plasma and α and γ in mouse plasma. Conclusion To dissect the pathophysiological roles of human TFPIα and TFPIß, studies in TFPIγ null mice, expressing only α and ß, only α or only ß should better reflect the human situation.

Implementation and trial evidence: a plea for fore-thought.

In a world where evidence-based practice is see as the foundation of modern healthcare, this paper asks when and how should we be accounting for the input of patients, the public, dental professionals, commissioners and policy-makers in the evidence generation process?

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions.

OBJECTIVES: This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services. DESIGN: Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) 'testing out' the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations. PARTICIPANTS: Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process. RESULTS: Eight context-mechanism-outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about 'what works' to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations. CONCLUSIONS: It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the employing organisations within which workforce development operates. Workforce development interventions need to balance the technical, professional and emotional aspects of care. TRIAL REGISTRATION NUMBER: CRD42013006283.

A decade of burn unit experience with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical pathological diagnosis and risk factor awareness.

Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) is a rare and often fatal spectrum of mucocutaneous diseases usually attributable to severe adverse drug reactions. Burn units are referral centers for patients at the most extreme end of the disease continuum. Our burn center admits a much higher percentage of TEN (>30% BSA) cases than reported in most prior reviews. The purpose of this study was to analyze the diagnostic and prognostic value of variables collected on referred SJS/TEN patients. We retrospectively analyzed 94 patients admitted to our unit with a presumptive SJS/TEN diagnosis made in most cases by the referring center. Most of the diagnoses were clinical. Fifty of the 94 patients underwent biopsy when the clinical diagnosis was questionable. Of the 50 patients who underwent biopsy, 18 (36%) received an alternative diagnosis. Analysis was therefore limited to 76 patients, i.e. 44 patients felt to have firm clinical diagnoses plus 32 patients with diagnoses confirmed by biopsy. Mean age was 54.3 years (17-93) and overall gender ratio was 43 F vs. 33 M (56.6% vs. 43.4%). Mean LOS was 15.2 days (1-48) and overall mortality was 23.7% (18/76). Univariate analysis revealed percent body surface area (%BSA) did not show statistically significant association with mortality. Histopathological correlation for diagnosis is not standardized across institutions worldwide. Due to challenges in the diagnosis of SJS/TEN and the high incidence of error in clinical diagnosis, it is recommended that all patients with presumed SJS/TEN receive skin biopsies with H&E and direct immunofluorescence. We propose a diagnostic approach in order to address this need. Lack of association between %BSA and mortality suggests that all biopsy-proven SJS/TEN cases belong in specialty centers due to the unstable nature of the disease and risk for rapid progression.

An analysis of Pseudomonas genomic diversity in take-all infected wheat fields reveals the lasting impact of wheat cultivars on the soil microbiota.

Manipulation of the soil microbiota associated with crop plants has huge promise for the control of crop pathogens. However, to fully realize this potential we need a better understanding of the relationship between the soil environment and the genes and phenotypes that enable microbes to colonize plants and contribute to biocontrol. A recent 2 years of investigation into the effect of wheat variety on second year crop yield in the context of take-all fungal infection presented the opportunity to examine soil microbiomes under closely defined field conditions. Amplicon sequencing of second year soil samples showed that Pseudomonas spp. were particularly affected by the wheat cultivar grown in year one. Consequently, 318 rhizosphere-associated Pseudomonas fluorescens strains were isolated and characterized across a variety of genetic and phenotypic traits. Again, the wheat variety grown in the first year of the study was shown to exert considerable selective pressure on both the extent and nature of Pseudomonas genomic diversity. Furthermore, multiple significant correlations were identified within the phenotypic/genetic structure of the Pseudomonas population, and between individual genotypes and the external wheat field environment. The approach outlined here has considerable future potential for our understanding of plant-microbe interactions, and for the broader analysis of complex microbial communities.

Spatio-temporal modeling of the African swine fever epidemic in the Russian Federation, 2007-2012.

In 2007 African swine fever (ASF) entered Georgia and in the same year the disease entered the Russian Federation. From 2007 to 2012 ASF spread throughout the southern region of the Russian Federation. At the same time several cases of ASF were detected in the central and northern regions of the Russian Federation, forming a northern cluster of outbreaks in 2011. This northern cluster is of concern because of its proximity to mainland Europe. The aim of this study was to use details of recorded ASF outbreaks and human and swine population details to estimate the spatial distribution of ASF risk in the southern region of the European part of the Russian Federation. Our model of ASF risk was comprised of two components. The first was an estimate of ASF suitability scores calculated using maximum entropy methods. The second was an estimate of ASF risk as a function of Euclidean distance from index cases. An exponential distribution fitted to a frequency histogram of the Euclidean distance between consecutive ASF cases had a mean value of 156 km, a distance greater than the surveillance zone radius of 100-150 km stated in the ASF control regulations for the Russian Federation. We show that the spatial and temporal risk of ASF expansion is related to the suitability of the area of potential expansion, which is in turn a function of socio-economic and geographic variables. We propose that the methodology presented in this paper provides a useful tool to optimize surveillance for ASF in affected areas.

Intervention Now To Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, qualitative and realist synthesis of implementation factors and user engagement.

BACKGROUND: The UK has the highest rate of teenage pregnancies in Western Europe, a fifth are repeat pregnancies. Unintended conceptions can result in emotional, psychological and educational harm to teenage girls, often with enduring implications for their life chances. Babies of teenage mothers have increased mortality in their first year and increased risk of poverty, educational underachievement and unemployment later in life, with associated societal costs. METHODS AND ANALYSIS: We will conduct a streamed, mixed-methods systematic review to find and evaluate interventions designed to reduce repeat unintended teen pregnancies. OUR AIMS ARE TO IDENTIFY:  Who is at greater risk of repeat unintended pregnancies? Which interventions are effective, cost-effective, how they work, in what setting and for whom? What are the barriers and facilitators to intervention uptake? Traditional electronic database searches will be augmented by targeted searches for evidence 'clusters' and guided by an advisory group of experts and stakeholders. To address the topic's inherent complexities, we will use a highly structured, innovative and iterative approach combining methodological techniques tailored to each stream of evidence. Quantitative data will be synthesised with reference to Cochrane guidelines for public health interventions. Qualitative evidence addressing facilitators and barriers to the uptake of interventions, experience and acceptability of interventions will be synthesised thematically. We will apply the principles of realist synthesis to uncover theories and mechanisms underpinning interventions. We will conduct an integration and overarching narrative of findings authenticated by client group feedback. ETHICS AND DISSEMINATION: We will publish the complete review in 'Health Technology Assessment' and sections in specialist peer-reviewed journals. We will present at national and international conferences in the fields of public health, reproductive medicine and review methodology. Findings will be fed back to service users and practitioners via workshops run by the partner collaborators. TRAIL REGISTRATION NUMBER: PROSPERO CRD42012003168. COCHRANE REGISTRATION NUMBER: i=fertility/0068.

Criteria and suspension levels in diagnostic radiology.

The EC (European Council) Directive on radiation protection of patients requires that criteria for acceptability of equipment in diagnostic radiology, nuclear medicine and radiotherapy be established throughout the member states. This study reviews the background to this requirement and to its implementation in practice. It notes and considers parallel requirements in the EC medical devices directive and International Electrotechnical Commission standards that it is also important to consider and that both sets of requirements should ideally be harmonised due to the global nature of the equipment industry. The study further reviews the types of criteria that can be well applied for the above purposes, and defines qualitative criteria and suspension levels suitable for application. Both are defined and relationships with other acceptance processes are considered (including acceptance testing at the time of purchase, commissioning and the issue of second-hand equipment). Suspension levels are divided into four types, A, B, C and D, depending on the quality of evidence and consensus they are based on. Exceptional situations involving, for example, new or rapidly evolving technology are also considered. The publication and paper focuses on the role of the holder of the equipment and related staff, particularly the medical physics expert and the practitioner. Advice on how the criteria should be created and implemented is provided for these groups and how this might be coordinated with the supplier. Additional advice on the role of the regulator is provided.

Practical application of suspension criteria scenarios in general radiography, computed radiography,digital radiography and fluoroscopy.

Radiological equipment must be assessed against criteria for acceptability to ensure that it meets the minimum standards for patient safety. This assessment is typically led by a medical physicist with input from radiology staff and the equipment supplier. Equipment that does not meet the criteria requires action and may be suspended from clinical use. European Commission report RP 91 will be revised and replaced as RP 162. It has been drawn up to aid medical physicists with the assessment process and provide guidance on suspension levels. This paper details several cases where the criteria in the proposed RP 162 were applied in general radiography, computed radiography, digital radiography and fluoroscopy. The factors considered by the medical physicist and the outcome of each case are presented. The proposed RP 162 report improves on its predecessor and provides a robust set of criteria for ensuring that patient safety within the EU medical exposures framework is optimised.

Development of acceptability criteria in mammography.

Quality assurance protocols and standards of performance for X-ray mammography equipment are probably the most developed of any in the area of diagnostic radiology, due to the exacting demands on image quality required in population-based breast cancer screening programmes. Both qualitative and quantitative acceptability criteria have been published for X-ray mammography by considering the image quality needed clinically in screening programmes. Consequently, the task of developing a consensus for acceptability criteria appears to be relatively easy at first glance. However, there are two contentious issues that must be considered; the first is whether standards based on breast cancer screening can be transposed to equipment used for women referred for imaging with breast symptoms. The second relates to the use of image-quality assessment based upon the observation of details in test phantoms. In respect of the former, there was general agreement that only one set of acceptability criteria should apply to mammographic X-ray equipment. With regard to image-quality assessment, the weakness of the observer-based methods was recognised and a consensus position developed. This paper describes the development of a consensus on acceptability criteria and proposes both qualitative and quantitative criteria for use on all mammographic equipment. Some test approaches and criteria for image displays, in particular, were omitted from the document as concerns about their robustness emerged during the consultation phases of the revision. Clearly, further scientific work is needed in these areas.

The revision of RP 91 on criteria for acceptability of radiological (including radiotherapy) and nuclear medicine installations.

In 1997 the European Commission published Radiation Protection 91: 'Criteria for acceptability of radiological (including radiotherapy) and nuclear medicine installations'. This document specified the minimum criteria for acceptability. It has been used to this effect in legislation, codes of practice and by individual professionals. In a single document, it defined a level of performance at which remedial action was required. The document specified a series of parameters which characterised equipment performance and acceptable levels of performance. In its time it proved to be a useful document which was applied in member states to various degrees. Since the publication of Report 91 in 1997, a series of weaknesses emerged over time. Development of new radiological systems and technologies, as well as improvements in traditional technologies, has created circumstances where the acceptability criteria were in need of review. These weaknesses were recognised by the European Commission and a tender for its revision was issued. The criteria were developed by a team drawn from a broad range of backgrounds including hospitals, industry, government bodies, regulators and standardisation organisations. Representatives were mainly from Europe, but individuals from the American Association of Physicists in Medicine and International Atomic Energy Agency were included in the drafting process. This study describes the process employed in developing the revised document and the consultation process involved. One of the major difficulties the revision team encountered was related to an understanding of the actual meaning of the EC Directive. The view taken by the revision team was that Article 8, paragraph 3 places responsibilities on both the holders of radiological equipment and competent authorities. The acceptability criteria have been produced consistent with the European Commission's Medical Exposures Directive, which requires that patient exposures are optimised and justified.

Yoga for reducing perceived stress and back pain at work.

BACKGROUND: Stress and back pain are two key factors leading to sickness absence at work. Recent research indicates that yoga can be effective for reducing perceived stress, alleviating back pain, and improving psychological well-being. AIMS: To determine the effectiveness of a yoga-based intervention for reducing perceived stress and back pain at work. METHODS: Participants were recruited from a British local government authority and randomized into a yoga group who received one 50 min Dru Yoga session each week for 8 weeks and a 20 min DVD for home practice and a control group who received no intervention. Baseline and end-programme measurements of self-reported stress, back pain and psychological well-being were assessed with the Perceived Stress Scale, Roland Morris Disability Questionnaire and the Positive and Negative Affect Scale. RESULTS: There were 37 participants in each group. Analysis of variance and multiple linear regression showed that in comparison to the control group, the yoga group reported significant reductions in perceived stress and back pain, and a substantial improvement in psychological well-being. When compared with the control group at the end of the programme, the yoga group scores were significantly lower for perceived stress, back pain, sadness and hostility, and substantially higher for feeling self-assured, attentive and serene. CONCLUSIONS: The results indicate that a workplace yoga intervention can reduce perceived stress and back pain and improve psychological well-being. Larger randomized controlled trials are needed to determine the broader efficacy of yoga for improving workplace productivity and reducing sickness absence.

The physiological effects of low-intensity neuromuscular electrical stimulation (NMES) on short-term recovery from supra-maximal exercise bouts in male triathletes.

This study investigated the acute effects of NMES on blood lactate (BLa) and performance parameters in trained male triathletes. On three separate days, 13 trained male triathletes performed six 30 s Wingate tests (30 WanT) on a cycle ergometer. Each session consisted of performing 3 × 30 WanT (bouts 1-3) followed by a randomly assigned 30 min recovery intervention of either: (i) passive (seated), (ii) active (cycling at 30% VO(2 max)) or (iii) NMES (1 Hz/500 µs-ON:OFF 2:6 s). The 3 × 30 WanT bouts were then repeated (bouts 4-6) and compared to bouts 1-3 for peak power (PP), mean power (MP) and fatigue index (FI). BLa and heart rate (HR) were recorded at designated time points throughout. Data were analyzed using repeated measures ANOVA with Tukey's honestly significant difference post hoc test. BLa decreased significantly faster during the active recovery intervention (P < 0.001), however, there were no significant differences between interventions for PP (P = 0.217), MP (P = 0.477) and FI (P = 0.234) when the post intervention bouts (4-6) where compared to the pre intervention bouts (1-3). NMES during recovery was not more effective than active or passive recovery for improving subsequent performance. Despite BLa clearing at a significantly faster rate for the active recovery intervention, PP, MP or FI did not improve significantly compared to NMES and passive. In conclusion, NMES does not appear to be more effective than traditional methods for enhancing short-term recovery from supra-maximal exercise bouts in trained male triathletes.