COVID-19 and Influenza Vaccination Campaign in a Research and University Hospital in Milan, Italy.

BACKGROUND: Healthcare workers (HCWs) are a historical key target of influenza vaccination programs. For the 2021-2022 season, WHO considered the coadministration of a flu and a COVID-19 vaccine as acceptable and recommended it to allow for higher uptake of both vaccines. The aim of this study was to investigate demographic and occupational features of vaccinated HCWs, reasons behind flu vaccine acceptance and a possible effect of the coadministration of a COVID-19 vaccine, in order to potentially draw general conclusions on HCWs' attitude towards flu vaccination and inform further strategies for consistent improvement of vaccine acceptance. METHODS: a promotional and educational campaign, a gaming strategy, and vaccination delivery through both a large central hub and on-site ambulatories, were the implemented strategies. In the central hub, the flu/COVID-19 vaccine coadministration was offered. Statistical descriptive analysis, multiple correspondence analysis (MCA) and logistic regression models were performed. RESULTS: 2381 HCWs received the flu vaccine, prompting a vaccination coverage rate (VCR) of 52.0% versus 43.1% in the 2020-2021 campaign. Furthermore, 50.6% vaccinated HCWs belonged to the 18-39 years-old age group. The most expressed reasons for vaccine uptake were "Vaccination is the most effective strategy of prevention" (n = 1928, 81.0%), "As HCW it's my duty to get vaccinated to protect my patients" (n = 766, 32.2%), and the group of COVID-19-related reasons (n = 586, 24.6%). In addition, 23.3% HCWs received the flu vaccine in the current campaign but not in the previous one (newly vaccinated) and the flu/COVID-19 vaccine coadministration was more frequent in this group. A total of 51.0% HCWs were hesitant towards the coadministration, while residents and nurses showed the highest propensity to receive it. CONCLUSIONS: in the second year of the COVID-19 pandemic, the Fondazione's influenza VCR continued to increase, with the greatest participation among HCWs aged 18-39 years. A potential propelling role of the COVID-19 vaccine coadministration was highlighted.

A Computational Study on Temperature Variations in MRgFUS Treatments Using PRF Thermometry Techniques and Optical Probes.

Structural and metabolic imaging are fundamental for diagnosis, treatment and follow-up in oncology. Beyond the well-established diagnostic imaging applications, ultrasounds are currently emerging in the clinical practice as a noninvasive technology for therapy. Indeed, the sound waves can be used to increase the temperature inside the target solid tumors, leading to apoptosis or necrosis of neoplastic tissues. The Magnetic resonance-guided focused ultrasound surgery (MRgFUS) technology represents a valid application of this ultrasound property, mainly used in oncology and neurology. In this paper; patient safety during MRgFUS treatments was investigated by a series of experiments in a tissue-mimicking phantom and performing ex vivo skin samples, to promptly identify unwanted temperature rises. The acquired MR images, used to evaluate the temperature in the treated areas, were analyzed to compare classical proton resonance frequency (PRF) shift techniques and referenceless thermometry methods to accurately assess the temperature variations. We exploited radial basis function (RBF) neural networks for referenceless thermometry and compared the results against interferometric optical fiber measurements. The experimental measurements were obtained using a set of interferometric optical fibers aimed at quantifying temperature variations directly in the sonication areas. The temperature increases during the treatment were not accurately detected by MRI-based referenceless thermometry methods, and more sensitive measurement systems, such as optical fibers, would be required. In-depth studies about these aspects are needed to monitor temperature and improve safety during MRgFUS treatments.

Occupational Disorders, Daily Workload, and Fitness Levels Among Fitness and Swimming Instructors.

Few data have been published on occupational disorders among sports instructors, especially regarding those who are expected to continuously practice while teaching. As the number of sports instructors increases, new specific information about their possible injuries, daily workload, and fitness levels is needed. The aim of this study was to assess occupational disorders, cardiorespiratory fitness, and daily workload of fitness (FI) and swimming instructors (SI). An online survey addressing occupational disorders was conducted among 435 instructors (256 FI and 179 SI). In one subgroup (57 FI and 42 SI), cardiorespiratory fitness levels were evaluated using maximal oxygen consumption ( V∙ O2max) as an indicator. Daily workload was assessed by monitoring the heart rate and perception of exertion (using the Borg scale). Of the two groups, FI exhibited a higher 2-year prevalence of musculoskeletal injuries and SI experienced more upper respiratory tract infections. V∙ O2max ranged from 47.0 to 51.9 ml·kg-1·min-1 and was similar for both FI and SI. Regarding the daily workload, female SI had significantly higher mean heart rate and mean heart rate to maximal heart rate ratio compared to female FI, but no significant differences between male FI and SI were found. No significant differences were observed between the perceived exertion of FI and SI. Preventive strategies for the reduction of occupational disorders in FI and SI are needed.

Effects of Ball Drills and Repeated-Sprint-Ability Training in Basketball Players.

Purpose: To investigate the effects of ball drills and repeated-sprint-ability training during the regular season in basketball players. Methods: A total of 30 players were randomized into 3 groups: ball-drills training (BDT, n = 12, 4 × 4 min, 3 vs 3 with 3-min passive recovery), repeated-sprint-ability training (RSAT, n = 9, 3 × 6 × 20-m shuttle running with 20-s and 4-min recovery), and general basketball training (n = 9, basketball technical/tactical exercises), as control group. Players were tested before and after 8 wk of training using the following tests: V˙O2max , squat jump, countermovement jump, Yo-Yo Intermittent Recovery Test Level 1 (YIRT1), agility T test, line-drill test, 5-/10-/20-m sprints, and blood lactate concentration. A custom-developed survey was used to analyze players' technical skills. Results: After training, significant improvements were seen in YIRT1 (BDT P = .014, effect size [ES] ± 90% CI = 0.8 ± 0.3; RSAT P = .022, ES ± 90% CI = 0.7 ± 0.3), the agility T test (BDT P = .018, ES ± 90% CI = 0.7 ± 0.5; RSAT P = .037, ES ± 90% CI = 0.7 ± 0.5), and the line-drill test (BDT P = .010, ES ± 90% CI = 0.3 ± 0.1; RSAT P < .0001, ES ± 90% CI = 0.4 ± 0.1). In the RSAT group, only 10-m sprint speeds (P = .039, ES ± 90% CI = 0.3 ± 0.2) and blood lactate concentration (P = .004, ES ± 90% CI = 0.8 ± 1.1) were improved. Finally, technical skills were increased in BDT regarding dribbling (P = .038, ES ± 90% CI = 0.8 ± 0.6), shooting (P = .036, ES ± 90% CI = 0.8 ± 0.8), passing (P = .034, ES ± 90% CI = 0.9 ± 0.3), rebounding (P = .023, ES ± 90% CI = 1.1 ± 0.3), defense (P = .042, ES ± 90% CI = 0.5 ± 0.5), and offense (P = .044, ES ± 90% CI = 0.4 ± 0.4) skills. Conclusions: BDT and RSAT are both effective in improving the physical performance of basketball players. BDT had also a positive impact on technical skills. Basketball strength and conditioning professionals should include BDT as a routine tool to improve technical skills and physical performance simultaneously throughout the regular training season.

Cardio-respiratory autonomic responses to nociceptive stimuli in patients with disorders of consciousness.

The autonomic response to pain might discriminate among consciousness disorders. Therefore, aim of this study was to describe differences between minimally conscious state (MCS) and unresponsive wakefulness syndrome (UWS) patients in their autonomic response to a nociceptive stimulus. ECG, respiration, finger blood pressure (BP) and total peripheral resistances (TPR) were continuously recorded before, during and after a standardized noxious stimulus in 20 adult brain-injured patients, 14 in UWS and 6 in MCS. Occurrence of fast autonomic responses synchronous with the stimulus was detected by visual inspection of the tracings; short-term (<20 s) and long-term (between 20s and 50 s from the stimulus) responses were evaluated by beat-by-beat quantitative analysis. The noxious stimulus elicited fast responses in both groups, but only MCS patients showed a significant short-term response in TPR and long-term response in HR. Thus, short- and long-term cardiovascular responses to pain might integrate neuro-behavioural assessments to discriminate between MCS and UWS.

Effect of repeated-sprints on the reliability of short-term parasympathetic reactivation.

This study determined the reliability of post-exercise heart rate recovery (HRR) and vagal-related HR variability (HRV) after repeated-sprints (RSs), and contrasted it with the smallest worthwhile change (SWC) of these indices. Fourteen healthy male participants performed on four occasions, separated by 7 days, five 30-m sprints interspersed by 25-s of recovery. Post-exercise HR during 10 min of seated rest was measured. HRR during the first 60-s of recovery was computed (HRR60s). HRV indices were calculated in time and frequency domains during the last 5-min of the recovery. Absolute and relative reliability were assessed by typical error of measurement expressed as coefficient of variation (CV) and intraclass correlation coefficients (ICCs), respectively. Sensitivity was assessed comparing SWC to the typical error of measurement. CV ranged from 3.6% to 13.5% and from 6.3% to 109.2% for the HRR and HRV indices, respectively. ICCs were from 0.78 to 0.96 and from 0.76 to 0.92, respectively. HRR and HRV indices showed large discrepancies reliability. HRR60s and the square root of the mean sum of the squared differences between R-R intervals presented the highest levels of both absolute and relative reliability. However, SWC was lower than the typical error of measurement, indicating insufficient sensitivity to confidently detect small, but meaningful, changes in HRR and HRV indices.

Acute Modification of Cardiac Autonomic Function of High-Intensity Interval Training in Collegiate Male Soccer Players with Different Chronotype: A Cross-Over Study.

The purpose of this study was to evaluate if the time of the day (8.00 a.m. vs 8.00 p.m.) and chronotype could influence autonomic cardiac control in soccer players in relation to an acute session of high-intensity interval training. The morningness-eveningness questionnaire was administered to recruit Morning-type and Evening-type collegiate male soccer players. Therefore, 24 players (12 Morning-types and 12 Evening-types) were randomly assigned, to either morning (n = 12; age 23 ± 3 years; height 1.75 ± 0.07 m; body mass 73 ± 10 kg; weekly training volume 8 2 hours), or evening (n = 12; age 21 ± 3 years; height 1.76 ± 0.05 m; body mass 75 ± 11 kg; weekly training volume 8 ± 3 hours) training. Heart Rate Variability vagal and sympatho/vagal indices were calculated in time, frequency and complexity domains at rest, before, after 12 and 24 hours of high-intensity interval training. Before evening training session, a higher resting heart rate was observed which was determined by a marked parasympathetic withdrawal with a sympathetic predominance. Moreover, Evening-type subjects during morning training session, present a significant higher heart rate that corresponded to significant higher vagal indices with a significant lower parasympathetic tone that returned to the rest values after 24 hours of the cessation of high-intensity interval training exercise. On the contrary, Morning-type subjects did not reveal any significant differences with Evening-Type subjects during evening high-intensity interval training session. Stress response of high-intensity interval training is influenced by both the time of the day and by the chronotype. Understanding the Heart Rate Variability response to high-intensity interval training can be an additional important procedure for evaluating of cardiovascular recovery in soccer players. Moreover, these results suggest that an athlete's chronotype should be taken into account when scheduling a high-intensity interval training exercise.

Postexercise autonomic function after repeated-sprints training.

PURPOSE: We examined the effects of an 8-week repeated-sprint (RS) training protocol on postexercise parasympathetic reactivation (PNSr) in healthy adults. METHODS: Eighteen male adults (24.3 ± 3.7 years) were assigned to either of two groups. One group (n = 9) performed RS training (EXP, 3 times week(-1), 18 maximal all-out 15-m sprints interspersed with 17 s of passive recovery); the other served as the control group (CON, n = 9). Performance before, during, and after was assessed by measuring RS ability time (S dec) and total sprint time. The subjects were then seated for 10 min immediately after each trial and postexercise HR recovery (HRR), and vagal-related HR variability (HRV) indices were measured. RESULTS: All subjects demonstrated a decrease in S dec. However, only EXP showed a decrease in total sprint time (-10.5 % of baseline value). Using a qualitative statistical analysis method, we found a likely to almost certain positive effect of RS training on HR. The mean of each HRR and HRV index indicated a greater change in PNSr in EXP than in CON (e.g. with a 78/22/1 % chance to demonstrate a positive/trivial/negative effect on HRR60s after RS training; 74/21/5 % on LN rMSSD5-10min). Large correlations were noted between the changes in S dec [r = 0.59, 90 % CI (0.43)], total sprint time [r = -0.61 (0.42)] and HRR60s. CONCLUSION: RS training seems to be an effective method to improve postexercise PNSr in healthy adults. Also, HRR60s appears to be a method for evaluating positive adaption to RS training.

Autonomic modulations of heart rate variability and performances in short-distance elite swimmers.

PURPOSE: Endurance exercise is associated with high cardiac vagal tone, but how the cardiac autonomic control correlates with shorter anaerobic performances is unknown. Therefore, the aim of this study was to evaluate how autonomic modulations of heart rate (HR) variability (V) correlate with performances of short- (<1 min) and very short (<30 s) duration in elite athletes. METHOD: Thirteen male swimmers, national-level crawl specialists in short (100-m) and very short (50-m) distances, were enrolled. HR was recorded during 15-min supine rest: (1) in the morning after wake up, (2) in the afternoon before sprint-oriented training sessions, (3) few minutes after training (first recovery phase after swimming cooldown). Heart rate variability (HRV) vagal and sympatho/vagal indices were calculated in time, frequency and complexity domains. Correlations of best seasonal times on 100- or 50-m distances with HRV indices and the velocity at blood lactate accumulation onset (V OBLA) were calculated. RESULTS AND CONCLUSION: Vagal indices were highest in the morning where they positively correlated with very short-distance times (higher the index, worse is the 50-m performance). Sympatho/vagal indices were highest after training where they negatively correlated with short-distance times (higher the index, better is the 100-m performance). V OBLA did not correlate with the performances. Therefore, autonomic HRV indices and not V OBLA predict short and very short, most anaerobic, performances. Results also suggest that a strong cardiac vagal control has no effect on short performances and is even detrimental to very short performances, and that the capacity to powerfully increase the sympathetic tone during exercise may improve short, but not very short performances.

Effects of temperature and fatigue on the electromechanical delay components.

INTRODUCTION: Neuromuscular activation can be influenced by both muscle temperature (Tm) and fatigue. METHODS: To assess the effects of Tm and fatigue on the electromechanical delay (EMD), 15 participants performed voluntary isometric contractions of different intensities under neutral (TmN), low (TmL), and high (TmH) Tm, before and after a fatiguing exercise. During contraction, electromyogram (EMG), mechanomyogram (MMG), and force (F) were recorded from the biceps brachii muscle. The EMD and the latencies between EMG and MMG (Δt EMG-MMG, which includes the electrochemical processes of EMD) and between MMG and F (Δt MMG-F, which includes the mechanical processes of EMD) were calculated. RESULTS: TmL increased only Δt EMG-MMG, both before and after fatigue. Fatigue lengthened EMD, Δt EMG-MMG, and Δt MMG-F under all Tm to a similar extent. CONCLUSIONS: While fatigue increased all EMD components, muscle cooling affected only the electrochemical but not the mechanical processes of EMD.

Combined effects of fatigue and temperature manipulation on skeletal muscle electrical and mechanical characteristics during isometric contraction.

Peripheral fatigue and muscle cooling induce similar effects on sarcolemmal propagation properties. The aim of the study was to assess the combined effects of muscle temperature (Tm) manipulation and fatigue on skeletal muscle electrical and mechanical characteristics during isometric contraction. After maximum voluntary contraction (MVC) assessment, 16 participants performed brief and sustained isometric tasks of different intensities in low (Tm(L)), high (Tm(H)) and neutral (Tm(N)) temperature conditions, before and after a fatiguing exercise (6s on/4s off at 50% MVC, to the point of fatigue). During contraction, the surface electromyogram (EMG) and force were recorded from the biceps brachii muscle. The root mean square (RMS) and conduction velocity (CV) were calculated off-line. After the fatiguing exercise: (i) MVC decreased similarly in all Tm conditions (P<0.05), while EMG RMS did not change; and (ii) CV decreased to a further extent in Tm(L) compared to Tm(N) and Tm(H) in all brief and sustained contractions (P<0.05). The larger CV drop in Tm(L) after fatigue suggests that Tm(L) and fatigue have a combined and additional effect on sarcolemmal propagation properties. Despite these changes, force generating capacity was not affected by Tm manipulation. A compensatory mechanism has been proposed to explain this phenomenon.

An observational study on the perceptive and physiological variables during a 10,000-m race walking competition.

In this study, we observed the variations on physiological and perceptual variables during a self-paced 10,000-m race walking (RW) event with the aim to trace a preliminary performance profile of the distance. In 14 male athletes, the heart rate (HR) was monitored continuously throughout the event. The rating of perceived exertion (RPE) was collected using the Borg's 6-20 RPE scale placed at each 1,000 m of an outdoor tartan track. Pacing data were retrieved from the official race results and presented as percent change compared with the first split time. The athletes spent 95.4% at 90-100% of the HRpeak, whereas the other work (4.6%) was negligible. During the race, a shift toward higher HR values was observed because % HRpeak increased by 3.6% in the last vs. the first 1,000-m sector (p = 0.002, effect size [ES] = 1.55 ± 0.68, large). The mean RPE reported by the athletes in the last 1,000 m was significantly higher than in the first 5 sectors (p < 0.02, ES = 1.93-2.96, large to very large). The mean percent change increased between the first 6 sectors and the last 1,000-m sector (p < 0.01, ES = 1.02-2.1, moderate to very large). The analysis of walking velocity at each 1,000-m sector suggested the adoption of a negative pacing. In conclusion, the RPE may be a valid marker of exercise intensity even in real settings. Match physiological and perceptual data with work rate are required to understand race-related regulatory processes. Pacing should be considered as a conscious behavior decided by the athletes based on the internal feedback during the race.

Is it time to consider a new performance classification for high-level male marathon runners?

La Torre, A, Vernillo, G, Agnello, L, Berardelli, C, and Rampinini, E. Is it time to consider a new performance classification for high-level male marathon runners? J Strength Cond Res 25(12): 3242-3247, 2011-Studies have attempted to describe human running performances by the analysis of world-record times. However, to date, no study has analyzed the evolution of high-level marathon performances over time. Thus, the purpose of this study was to analyze these performances across the past 42 years with the aim of delineating a time-based classification. To identify the nature of the phenomenon represented by the sequence of observations, we examined the data collected (i.e., 8,400 times from 1969 to 2010) as a time series. The leading time (LT) and the mean 200 times (T200) per year underwent a nonlinear but significant decrement (r = -0.92, p < 0.001 and r = -0.98, p < 0.001, respectively). In fact, from 1969 to 2010, the mean time differences were 3 minutes 20 seconds ± 1 minute 59 seconds and 7 minutes 1 second ± 2 minutes 48 seconds, corresponding to an improvement of 5 and 10 seconds per year for LT and T200, respectively. Furthermore, trend analysis suggested a disruption in marathon time improvements, indicating the presence of 3 points in the time series in which the performance significantly improved with respect to that of the previous years, corresponding to the years 1983-1984 (p < 0.001), 1997-1998 (p < 0.003), and 2003 (p < 0.001). In conclusion, despite the trend in high-level marathon performances being better explained by a nonlinear tendency, significant improvements in the ability of the high-level marathon runners to complete the distance were observed. These improvements are likely to be related to sociological, environmental, physiological, and training-method factors. Researchers and coaches should take into account these enhancements by using the time classification proposed in this study to better reflect the marathon performance profile of their athletes.

Exercise intensity and pacing strategy of a 5-km indoor race walk during a World Record attempt: a case study.

The aim of this case study was to describe the physiological and regulatory processes, by means of heart rate (HR) monitoring and pacing strategy, in a top-level race walker (age: 32 years; height: 1.76 m; body mass: 62 kg; training volume: 130-150 km·wk) who was focused on the attainment of the 5-km indoor race walk (RW) World Record. The HRmean was 185 ± 14.9 b·min, with an HRmean/HRmax ratio of 0.96. Almost the whole race (91.8%) was performed to an intensity ≥90% of the HRmax; lower intensity work was negligible (8.1%). The race profile was a reverse J-shaped pacing curve; in fact, the athlete completed the first 1,000 m in the fastest time, slowing during the middle 3,000 m, and increasing the speed during the final 1,000 m of the race. Despite the attempt failed (the athlete performed only the 2009 World leading performance, 18 minutes 23 seconds 47 tenths), these data suggest that a more linear strain distribution for the entire performance would be optimal instead of a fast-start strategy, which leads to a drastic decrement of the walking velocity. Moreover, this study supports the use of HR monitoring combined with the regulation of the effort to understand the physiological and regulatory processes during an indoor RW event.