Performance of Commercial Dermatoscopic Systems That Incorporate Artificial Intelligence for the Identification of Melanoma in General Practice: A Systematic Review.

BACKGROUND: Cutaneous melanoma remains an increasing global public health burden, particularly in fair-skinned populations. Advancing technologies, particularly artificial intelligence (AI), may provide an additional tool for clinicians to help detect malignancies with a more accurate success rate. This systematic review aimed to report the performance metrics of commercially available convolutional neural networks (CNNs) tasked with detecting MM. METHODS: A systematic literature search was performed using CINAHL, Medline, Scopus, ScienceDirect and Web of Science databases. RESULTS: A total of 16 articles reporting MM were included in this review. The combined number of melanomas detected was 1160, and non-melanoma lesions were 33,010. The performance of market-approved technology and clinician performance for classifying melanoma was highly heterogeneous, with sensitivity ranging from 16.4 to 100.0%, specificity between 40.0 and 98.3% and accuracy between 44.0 and 92.0%. Less heterogeneity was observed when clinicians worked in unison with AI, with sensitivity ranging between 83.3 and 100.0%, specificity between 83.7 and 87.3%, and accuracy between 86.4 and 86.9%. CONCLUSION: Instead of focusing on the performance of AI versus clinicians for classifying melanoma, more consistent performance has been obtained when clinicians' work is supported by AI, facilitating management decisions and improving health outcomes.

Capturing the electron-electron cusp with the coupling-constant averaged exchange-correlation hole: A case study for Hooke's atoms.

In density-functional theory, the exchange-correlation (XC) energy can be defined exactly through the coupling-constant (λ) averaged XC hole n̄xc(r,r'), representing the probability depletion of finding an electron at r' due to an electron at r. Accurate knowledge of n̄xc(r,r') has been crucial for developing XC energy density-functional approximations and understanding their performance for molecules and materials. However, there are very few systems for which accurate XC holes have been calculated since this requires evaluating the one- and two-particle reduced density matrices for a reference wave function over a range of λ while the electron density remains fixed at the physical (λ = 1) density. Although the coupled-cluster singles and doubles (CCSD) method can yield exact results for a two-electron system in the complete basis set limit, it cannot capture the electron-electron cusp using finite basis sets. Focusing on Hooke's atom as a two-electron model system for which certain analytic solutions are known, we examine the effect of this cusp error on the XC hole calculated using CCSD. The Lieb functional is calculated at a range of coupling constants to determine the λ-integrated XC hole. Our results indicate that, for Hooke's atoms, the error introduced by the description of the electron-electron cusp using Gaussian basis sets at the CCSD level is negligible compared to the basis set incompleteness error. The system-, angle-, and coupling-constant-averaged XC holes are also calculated and provide a benchmark against which the Perdew-Burke-Ernzerhof and local density approximation XC hole models are assessed.

Testing the r2SCAN Density Functional for the Thermodynamic Stability of Solids with and without a van der Waals Correction.

A central aim of materials discovery is an accurate and numerically reliable description of thermodynamic properties, such as the enthalpies of formation and decomposition. The r2SCAN revision of the strongly constrained and appropriately normed (SCAN) meta-generalized gradient approximation (meta-GGA) balances numerical stability with high general accuracy. To assess the r2SCAN description of solid-state thermodynamics, we evaluate the formation and decomposition enthalpies, equilibrium volumes, and fundamental band gaps of more than 1000 solids using r2SCAN, SCAN, and PBE, as well as two dispersion-corrected variants, SCAN+rVV10 and r2SCAN+rVV10. We show that r2SCAN achieves accuracy comparable to SCAN and often improves upon SCAN's already excellent accuracy. Although SCAN+rVV10 is often observed to worsen the formation enthalpies of SCAN and makes no substantial correction to SCAN's cell volume predictions, r2SCAN+rVV10 predicts marginally less accurate formation enthalpies than r2SCAN, and slightly more accurate cell volumes than r2SCAN. The average absolute errors in predicted formation enthalpies are found to decrease by a factor of 1.5 to 2.5 from the GGA level to the meta-GGA level. Smaller decreases in error are observed for decomposition enthalpies. For formation enthalpies r2SCAN improves over SCAN for intermetallic systems. For a few classes of systems-transition metals, intermetallics, weakly bound solids, and enthalpies of decomposition into compounds-GGAs are comparable to meta-GGAs. In total, r2SCAN and r2SCAN+rVV10 can be recommended as stable, general-purpose meta-GGAs for materials discovery.

Comparison of surf lifesaver pressure point control and a commercial arterial tourniquet for major lower limb haemorrhage: A randomised controlled crossover pilot trial.

OBJECTIVE: This pilot study compared non-medically trained surf lifesavers' (SLS) ability, after infographic training, to occlude the femoral artery using a pressure point (PP) versus an arterial tourniquet (AT). METHODS: Using a crossover design, eight SLS applied PP and AT to a participant's leg to occlude the femoral artery. Arterial flow, application time and perceived difficulty were recorded. RESULTS: PP achieved 89.7% and 50.8% blood flow reduction for PP and AT, respectively. Average application time was 50.63 and 113.5 s for PP and AT, respectively. Perceived difficulty using a Likert scale from 0 to 10 (0 being no difficulty and 10 being maximal difficulty) was 2.75 and 3.50 for PP and AT, respectively. CONCLUSION: Infographic-trained SLS showed superior blood flow occlusion using PP. This pilot study will inform a larger trial for untrained beachgoers.

Comparative Density Functional Theory Study of Magnetic Exchange Couplings in Dinuclear Transition-Metal Complexes.

Multicenter transition-metal complexes (MCTMs) with magnetically interacting ions have been proposed as components for information-processing devices and storage units. For any practical application of MCTMs as magnetic units, it is crucial to characterize their magnetic behavior, and in particular, the isotropic magnetic exchange coupling, J, between its magnetic centers. Due to the large size of typical MCTMs, density functional theory is the only practical electronic structure method for evaluating the J coupling. Here, we assess the accuracy of different density functional approximations for predicting the magnetic couplings of eight dinuclear transition-metal complexes, including five dimanganese, two dicopper, and one divanadium with known reliable experimental J couplings spanning from ferromagnetic to strong antiferromagnetic. The density functionals considered include global hybrid functionals which mix semilocal density functional approximations and exact exchange with a fixed admixing parameter, six local hybrid functionals where the admixing parameters are extended to be spatially dependent, the SCAN and r2SCAN meta-generalized gradient approximations (GGAs), and two widely used GGAs. We found that global hybrids tested in this work have a tendency to over-correct the error in magnetic coupling parameters from the Perdew-Burke-Ernzerhof (PBE) GGA as seen for manganese complexes. The performance of local hybrid density functionals shows no improvement in terms of bias and is scattered without a clear trend, suggesting that more efforts are needed for the extension from global to local hybrid density functionals for this particular property. The SCAN and r2SCAN meta-GGAs are found to perform as well as benchmark global hybrids on most tested complexes. We further analyze the charge density redistribution of meta-GGAs as well as global and local hybrid density functionals with respect to that of PBE, in connection to the self-interaction error or delocalization error.

Implementation of artificial intelligence for the detection of cutaneous melanoma within a primary care setting: prevalence and types of skin cancer in outdoor enthusiasts.

Background: There is enthusiasm for implementing artificial intelligence (AI) to assist clinicians detect skin cancer. Performance metrics of AI from dermoscopic images have been promising, with studies documenting sensitivity and specificity values equal to or superior to specialists for the detection of malignant melanomas (MM). Early detection rates would particularly benefit Australia, which has the worlds highest incidence of MM per capita. The detection of skin cancer may be delayed due to late screening or the inherent difficulty in diagnosing early skin cancers which often have a paucity of clinical features and may blend into sun damaged skin. Individuals who participate in outdoor sports and recreation experience high levels of intermittent ultraviolet radiation (UVR), which is associated with the development of skin cancer, including MM. This research aimed to assess the prevalence of skin cancer in individuals who regularly participate in activities outdoors and to report the performance parameters of a commercially available AI-powered software to assess the predictive risk of MM development. Methods: Cross-sectional study design incorporating a survey, total body skin cancer screening and AI-embedded software capable of predictive scoring of queried MM. Results: A total of 423 participants consisting of surfers (n = 108), swimmers (n = 60) and walkers/runners (n = 255) participated. Point prevalence for MM was highest for surfers (6.48%), followed by walkers/runners (4.3%) and swimmers (3.33%) respectively. When compared to the general Australian population, surfers had the highest odds ratio (OR) for MM (OR 119.8), followed by walkers/runners (OR 79.74), and swimmers (OR 61.61) rounded out the populations. Surfers and swimmers reported comparatively lower lifetime hours of sun exposure (5,594 and 5,686, respectively) but more significant amounts of activity within peak ultraviolet index compared with walkers/runners (9,554 h). A total of 48 suspicious pigmented lesions made up of histopathology-confirmed MM (n = 15) and benign lesions (n = 33) were identified. The performance of the AI from this clinical population was found to have a sensitivity of 53.33%, specificity of 54.44% and accuracy of 54.17%. Conclusions: Rates of both keratinocyte carcinomas and MM were notably higher in aquatic and land-based enthusiasts compared to the general Australian population. These findings further highlight the clinical importance of sun-safe protection measures and regular skin screening in individuals who spend significant time outdoors. The use of AI in the early identification of MM is promising. However, the lower-than-expected performance metrics of the AI software used in this study indicated reservations should be held before recommending this particular version of this AI software as a reliable adjunct for clinicians in skin imaging diagnostics in patients with potentially sun damaged skin.

Exact constraints and appropriate norms in machine-learned exchange-correlation functionals.

Machine learning techniques have received growing attention as an alternative strategy for developing general-purpose density functional approximations, augmenting the historically successful approach of human-designed functionals derived to obey mathematical constraints known for the exact exchange-correlation functional. More recently, efforts have been made to reconcile the two techniques, integrating machine learning and exact-constraint satisfaction. We continue this integrated approach, designing a deep neural network that exploits the exact constraint and appropriate norm philosophy to de-orbitalize the strongly constrained and appropriately normed (SCAN) functional. The deep neural network is trained to replicate the SCAN functional from only electron density and local derivative information, avoiding the use of the orbital-dependent kinetic energy density. The performance and transferability of the machine-learned functional are demonstrated for molecular and periodic systems.

Physiotherapists' perceptions of their role in treating and managing people with depression and anxiety disorders: A systematic review.

BACKGROUND: Despite the prevalence of mental health disorders rising worldwide, physio-therapists' perceptions of their role and ability to holistically treat people with anxiety and depression remain unclear. PURPOSE: This research aimed to understand the physiotherapists' perception of their role in treating and managing people with anxiety and depression while revealing barriers and facilitators in practice. METHODS: PubMed, PsycInfo, CINAHL, EMBASE, Web of Science, and Google Scholar were searched systematically for mixed-method, quantitative, or qualitative designs. Using the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews, data was extracted, critically appraised, assigned quality grades, and synthesized through meta-aggregation. RESULTS: A total of 2991 records were initially sourced, with eleven studies included in the systematic review. The studies were published worldwide between 2016 and 2021, with the majority (n = 8) published in 2020-2021. Participating physiotherapists most frequently had a Bachelor's degree (35.7-62.6%), followed by a Master's degree (28.4-37.4%). Meta-aggregation revealed the synthesized finding that physiotherapists perceived their role to include treating people with anxiety and depression despite feeling underprepared. Physiotherapists perceive many barriers and facilitators, such as education, when treating people with anxiety and depression. CONCLUSION: Physiotherapists have positive perceptions toward anxiety and depression, despite feeling underprepared in their ability to implement psychosocial strategies.

The current management of scaphoid fractures in the emergency department across an Australian metropolitan public health service: A retrospective cohort study.

BACKGROUND: Scaphoid fractures are commonly present to emergency departments (EDs), challenging medical practitioners to achieve accurate diagnosis and management. This is because of the prevalence of radiographically occult scaphoid fractures and complications associated with missed diagnoses. Clinical Guidelines are limited for treatment of suspected scaphoid fractures, and heterogeneity in the literature further complicates management. This study aimed to explore the differences in management between practitioners in the ED and determine if immobilizing clinically suspected scaphoid fractures is supported by current evidence. This study also aimed to establish if there are predictors to assist in the diagnosis of a scaphoid fracture in the ED. METHODS: A retrospective cohort study analyzed clinical data from patient's charts who attended the ED for a scaphoid fracture in 2019. Using retrospective patient chart audits and a Data Extraction Form, the clinical data regarding the assessment, treatment, diagnosis, and follow-up outcomes were collected. Descriptive analysis and multivariable logistic regression were performed to assess current management and find out predictors of a scaphoid fracture. RESULTS: There was significance between practitioners performing physical assessments and providing treatment (P < .001). Physiotherapists performed assessment and education combined treatment more frequently than nurse practitioners and doctors. Thirty-four cases (11.7%) were negative for fracture in ED and positive in follow-up at the orthopedic clinic. There was an estimated loss of income of $327,433.60 (Australian dollar) for 221 patients who missed work due to overtreatment with immobilization. The strongest predictors for a confirmed scaphoid fracture were of male gender (odds ratio, 3.2; 95% confidence interval, 2.1-5.0; P < .001) and a positive x-ray in ED (odds ratio, 36.6; 95% confidence interval, 17.4-77.0; P < .001). CONCLUSION: Management of scaphoid fractures across the Gold Coast Hospital Health Service ED followed commonly accepted practices involving x-ray and immobilization; however, this conservative approach to management is associated with increased health costs and low rates of conversion to a confirmed scaphoid fracture. Male gender was the only significant predictor associated with a scaphoid fracture.

Point prevalence of non-melanoma and melanoma skin cancers in Australian surfers and swimmers in Southeast Queensland and Northern New South Wales.

Background: Surfing and swimming are two popular outdoor aquatic activities in Australia with an estimated 2.7 million surfers and three million swimmers; however, these activities are associated with intermittent exposure to ultraviolet radiation. Our aim was to determine the point prevalence of pre-skin cancer (actinic keratosis (PSC)), non-melanoma (NMSC) and melanoma skin cancers (MSC) in Australian surfers and swimmers. Methods: This cross-sectional study involved Australian surfers who completed a survey that included physiological demographics, aquatic activity-specific demographics, history of skin cancer followed by screening. Results: A total of 171 surfers (n = 116) and swimmers (n = 55) participated in the study. Both groups were identified as having a history of skin cancer (surfers 41.4%, swimmers 36.4%) and a family history of skin cancer (surfers 52.6%, swimmers 43.6%). The majority of both groups reported using a high percentage of a chemical or physical skin cancer prevention strategy (surfers 100%, Swimmers 92.7%, P = 0.003). Significantly more surfers were identified with a skin cancer of any type vs. swimmers (50% vs. 27.3%; OR 2.67; P = 0.005) with most the common skin cancer being PSC (44.7% vs. 11.3%, P = 0.076) followed by basal cell carcinoma (BCC) (24.2% vs. 7.6%, P = 0.068). There was a total of seven MSC identified in surfers and swimmers (4.6% vs. 0.8%, respectively, P = 0.137). Most skin cancers in surfers were located on the face (28.0%) followed by the arm and back (12.1% each), whereas in swimmers, the majority of skin cancers were identified on the face (17.3%), followed by the arm and lower leg (15.4% each). The highest number of melanomas were identified in surfers (n = 6) and mainly located on the face (n = 2) and back (n = 2). There was a single melanoma identified on the back in a swimmer. With the groups combined, the majority (42.9%) of melanomas were identified on the back in participants, followed by the face (28.6%). Rates per 100,000 of NMSC and MSC in surfers and swimmers (respectively) were BCC (11,206 vs. 14,545), squamous cell carcinoma (SCC) in situ (13,793 vs. 12,727), SCC (1,724 vs. 3,636) and MSC (5,172 vs. 1,818). When compared to the general Australian population, surfers and swimmers had higher odds ratios (OR), which included BCCs (OR 7.3 and 9.4, respectively), SCCs (OR 1.7 and 3.5, respectively) and MSC (OR 96.7 and 18.8, respectively). Conclusion: Surfers and swimmers had consistently higher rates of PSC, NMSC and MSC than the general Australian population. Point prevalence of MSC (groups combined) was 76-fold higher than the general Australian population. These findings highlight the clinical importance of regular skin cancer screenings in individuals who surf or swim for early detection and treatment of skin cancer. Additionally, these aquatic enthusiasts should be advised of the benefits of sun protection strategies such as chemical and physical barriers to reduce the likelihood of developing skin cancer.

Aquatic exercise and mental health: A scoping review.

OBJECTIVES: The aims of this review were to 1) summarise the breadth and types of research regarding the impact of aquatic exercise on mental health completed to date, 2) provide a clear indication of the intervention type, volume, measurement tools used, and populations best served in relation to this activity and its effectiveness and 3) to identify domains within the literature that can be developed so recommendations can be made for future investigations. METHOD: A scoping review was performed under the PRISMA guidelines. A systematic search of Pubmed, SPORTDiscus, PsycInfo and Google Scholar databases was conducted. Studies observing the effect of aquatic exercises on mental health and related parameters were considered for inclusion. The data from the selected studies were then extracted and analysed methodically. PRIMARY CONDITIONS MEASURED: Depression, anxiety, mood, self-esteem, and psychological well-being were the primary mental states for which findings could be clearly extracted. RESULTS: Of the 1635 articles that resulted from the search, 23 articles met all inclusion criteria. Of these, 12 were randomised controlled trials. Cumulatively, the findings of this review trend towards aquatic exercise being effective in generating positive changes in mental health. CONCLUSION: Aquatic exercise, specifically winter swimming, leisure swimming, competitive swimming and aquatic aerobics, can be a promising conservative therapy for mental health management. However, it is recommended that further research be conducted to solidify these findings and establish the long-term effects of this intervention on mental health.

Construction of meta-GGA functionals through restoration of exact constraint adherence to regularized SCAN functionals.

The strongly constrained and appropriately normed (SCAN) meta-GGA exchange-correlation functional [Sun et al., Phys. Rev. Lett. 115, 036402 (2015)] is constructed as a chemical environment-determined interpolation between two separate energy densities: one describes single-orbital electron densities accurately and another describes slowly varying densities accurately. To conserve constraints known for the exact exchange-correlation functional, the derivatives of this interpolation vanish in the slowly varying limit. While theoretically convenient, this choice introduces numerical challenges that degrade the functional's efficiency. We have recently reported a modification to the SCAN meta-GGA, termed restored-regularized-SCAN (r2SCAN) [Furness et al., J. Phys. Chem. Lett. 11, 8208 (2020)], that introduces two regularizations into SCAN, which improve its numerical performance at the expense of not recovering the fourth order term of the slowly varying density gradient expansion for exchange. Here, we show the derivation of a progression of density functional approximations [regularized SCAN (rSCAN), r++SCAN, r2SCAN, and r4SCAN] with increasing adherence to exact conditions while maintaining a smooth interpolation. The greater smoothness of r2SCAN seems to lead to better general accuracy than the additional exact constraint of SCAN or r4SCAN does.

Skin cancer and sun protective behaviours in water-based sports: A scoping review.

BACKGROUND: Individuals who participate in outdoor sports are subject to an increased risk of developing skin cancer. To date, there has been no review examining skin cancer and sun protective behaviours specific to outdoor, water-based sports. Therefore, this scoping reviews objectives were to (a) summarize volume and type of the scientific literature available relating to skin cancer, (b) examine current sun protective behaviours and (c) identify knowledge gaps to inform future research. METHOD: A scoping review was conducted to address the objectives following the PRISMA guidelines. Seven databases were searched; identified studies were screened based on title, abstract and full text for outdoor water-based sports, which examined skin cancer and/or sun protective behaviours. Data were extracted, synthesized and critically appraised using a modified AXIS tool. Percentage frequencies were calculated, and key results were placed in tabular or graphical presentation. RESULTS: Nine cross-sectional studies were identified, all defined as low-level evidence. A combined sample of 4377 participants across six countries and five water-based sports showed BCC (71%) was the most common skin cancer, followed by melanoma (18%) and SCC (10%). The head (41%) and upper limbs (27%) were the most common location. CONCLUSION: This review highlights the minimal research available and demonstrates those in water-based sports are at high risk of developing skin cancer. Due to difficulty adhering to sun protective behaviours, the most prevalent location is the upper body. Included studies were of low-level evidence, providing opportunity for future research to expand upon the gaps in the current literature.

Traumatic surfing injuries in New Zealand: a descriptive epidemiology study.

BACKGROUND: New Zealand (NZ) has nearly 14,000 km of coastline and a surfing population of approximately 315,000 surfers. Given its popularity, surfing has a high frequency of injury claims, however, there remains a lack of data on traumatic surfing-related injuries from large population studies. The primary purpose of this study was to examine traumatic surfing injuries in NZ specific to injury incidence, duration, location, type, mechanism of injury and associated risk factors. METHODS: A sample of self-identified surfers currently living in NZ participated in an online retrospective cross-sectional survey between December 2015 and July 2016. Demographic and surfing injury data were collected and analysed. RESULTS: The survey yielded 1,473 respondents (18.3% female); a total of 502 surfers reported 702 major traumatic injuries with an overall incidence proportion of 0.34 (95% CI [0.32-0.37]). When comparing the number of injured surfers who sustained an injury at various body locations, a significantly higher proportion of competitive surfers, compared to recreational surfers, had an injury at the neck (6.8% vs 4%, χ 2 (1,1473) = 5.84, P = 0.019); shoulder (7.4% vs 4.3%, χ 2 (1,1473) = 6.34, P = 0.017), upper back (1% vs 2.4%, χ 2 (1,1473) = 4.77, P = 0.043), lower back (7% vs 3.1%, χ 2 (1,1473) = 11.98, P = 0.001) and knee (7% vs 3.4%, χ 2 (1,1473) = 9.67, P = 0.003). A significantly higher proportion of surfers who performed aerial manoeuvres compared to those who did not reported a higher proportion of knee injuries (9.7% vs 3.9%, χ 2 (1,1473) = 13.00, P = 0.001). With respect to injury duration, the shoulder represented the largest proportion of chronic injuries (>3 months) (44.4%), and the head and face represented the largest proportion of acute injuries (≤3 months) (88%). Muscle and tendon injuries were reported most frequently (25.6%) and direct contact injuries accounted for 58.1% of all injury mechanisms. Key risk factors for traumatic injury included: competitive compared to recreational status (41.0% vs 30.1%, Relative Risk (RR) = 1.36, P < 0.001), ability to perform aerial manoeuvres (48.1% vs 31.8%, RR = 1.51, P < 0.001) and intermediate or above skill level surfers compared to beginner surfers (35.8% vs 22.7%, RR = 1.58, P < 0.001). CONCLUSION: One third of recreational surfers sustained a major traumatic injury in the previous 12 months. For competitive or aerialist surfers the risk was greater, with this proportion approximately half. Overall, the head/face was the most common location of traumatic injury, with competitive surfers being more likely to sustain a neck, shoulder, lower back, and knee injury compared to recreational surfers. The shoulder was associated with the highest proportion of injuries of chronic duration. Future research should investigate injury mechanisms and causation using prospective injury monitoring to better underpin targeted injury prevention programs.

The clinical diagnosis of Achilles tendinopathy: a scoping review.

BACKGROUND: Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. METHODOLOGY: A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. RESULTS: A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. CONCLUSIONS: There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

Effect of personal activity intelligence (PAI) monitoring in the maintenance phase of cardiac rehabilitation: a mixed methods evaluation.

BACKGROUND: Personal activity intelligence (PAI) is a single physical activity metric based upon heart rate responses to physical activity. Maintaining 100 PAI/week is associated with a 25% risk reduction in cardiovascular disease mortality and 50 PAI/week provides 60% of the benefits. The effect of utilising this metric within a cardiac population has not been previously investigated. The aim of this study was to determine the effect of PAI monitoring on the amount and/or intensity of physical activity for people in the maintenance phase of cardiac rehabilitation and to explore participants' perceptions of this approach. METHODS: A concurrent mixed methods approach was undertaken. Participants in the maintenance phase of cardiac rehabilitation monitored PAI for six weeks via a wearable physical activity monitoring device (WPAM). In the first three weeks participants were blinded to their PAI score. A quality-of-life questionnaire (EQ-5D-5L) was completed, and semi-structured interviews conducted to investigate attitudes to PAI monitoring. Daily PAI data was collected throughout the 6-week period. RESULTS: Twenty participants completed the trial. PAI earned/day was increased after participants could view their data (mean difference: 2.1 PAI/day (95% CI 0.3, 4.0), p = 0.027). The median change in percentage of days participants achieved a Total PAI score of 25 (p = 0.023) and 50 (p = 0.015) were also increased. The mean change in total scores for the EQ-5D-5L and EQVAS were improved after 6 weeks (0.6 ± 1.05; 95% CI (0.11-1.09); p = 0.019); (5.8/100; 95% CI (2.4-9.2); p = 0.002 respectively). Thematic framework analysis identified three global themes (perceptions on the WPAM, PAI and factors affecting exercise). Most participants stated motivation to exercise increased after they could view their PAI data. Many of the participants believed they would continue to use PAI long-term. Others were undecided; the latter primarily due to technical issues and/or preferring devices with greater functionality and attractiveness. All participants would recommend PAI. CONCLUSION: This exploratory study showed monitoring PAI via a WPAM increased the amount and/or intensity of physical activity within the cardiac population. Participants found PAI interesting, beneficial, and motivating. If technical issues, aesthetics, and functionality of the WPAM were improved, participants may continue to use the approach long-term. PAI may be a viable strategy to assist people with cardiac disease maintain physical activity adherence.

Self-Consistent Field Methods for Excited States in Strong Magnetic Fields: a Comparison between Energy- and Variance-Based Approaches.

Self-consistent field methods for excited states offer an attractive low-cost route to study not only excitation energies but also properties of excited states. Here, we present the generalization of two self-consistent field methods, the maximum overlap method (MOM) and the σ-SCF method, to calculate excited states in strong magnetic fields and investigate their stability and accuracy in this context. These methods use different strategies to overcome the well-known variational collapse of energy-based optimizations to the lowest solution of a given symmetry. The MOM tackles this problem in the definition of the orbital occupations to constrain the self-consistent field procedure to converge on excited states, while the σ-SCF method is based on the minimization of the variance instead of the energy. To overcome the high computational cost of the variance minimization, we present a new implementation of the σ-SCF method with the resolution of identity approximation, allowing the use of large basis sets, which is an important requirement for calculations in strong magnetic fields. The accuracy of these methods is assessed by comparison with the benchmark literature data for He, H2, and CH+. The results reveal severe limitations of the variance-based scheme, which become more acute in large basis sets. In particular, many states are not accessible using variance optimization. Detailed analysis shows that this is a general feature of variance optimization approaches due to the masking of local minima in the optimization. In contrast, the MOM shows promising performance for computing excited states under these conditions, yielding results consistent with available benchmark data for a diverse range of electronic states.

Effect of Stand-Up Paddle Boarding on Hydration Status in Recreational and Competitive Individuals.

Stand up paddle (SUP) boarding is a popular water-based aquatic sport and recreational activity that continues to grow in popularity, however, little is known about its effect upon hydration status in recreational and elite level participants. The aim of this study was to examine the hydration status in SUP by investigating fluid loss through measurement of nude body mass. Thirty participants successfully completed the study. Hydration status was assessed by measurements of nude body mass taken pre and post SUP session. Intensity of the session was monitored throughout each session using a telemetry heart rate (HR) monitor; both mean and maximum HRs were assessed. Environmental conditions were recorded prior to each session and participants rated perceived hydration pre and post activity. SUP sessions average duration was 68 ± 13 mins (mean HR: 135 ± 20 bpm, peak HR: 167.1 ± 12 bpm). The average mass lost in a SUP session was 0.82 ± 0.4 kg (absolute), 0.03 ± 1 (relative BMI), 0.43 ± 0.2 (relative BSA) and the overall percentage of loss was 1.2 ± 0.6 % (p < 0.01, d = 0.47). Key predictors (p < 0.05) of fluid loss included ambient air temperature, gender (males), mean HR and SUP session duration. Results from this study suggest that SUP participants may require fluid loss monitoring to allow for effective rehydration strategies. Pre-hydration strategies are also recommended to avoid dehydration which is associated with decreased performance (aerobic and strength), increased core temperature, heart rate and may lead to detrimental health outcomes such as renal failure and heat illness in extreme circumstances.

Fluid Loss in Recreational Surfers.

Surfing offers unique challenges to thermoregulation and hydration. The purpose of this study was to quantify fluid loss in recreational surfers, and to analyze the effects of water temperature, air temperature, exercise intensity, duration, and garment thickness on the total amount of fluid lost during a surf session. A total of 254 male and 52 female recreational surfers were recruited from San Diego, Costa Rica, and Australia to participate in the study. Participants' hydration status was assessed by comparing nude body mass pre- and post-surf session. Heart rate (HR), used as an index of exercise intensity, was measured throughout the session. Environmental conditions and surf characteristics were recorded. The difference between average pre-mass (73.11 ± 11.88 kg) and average post-mass (72.51 ± 11.78) was statistically significant (0.60 ± 0.55, p < 0.001). Surfers experienced a 0.82 ± 0.73% reduction in body mass. In multivariable linear regression, session duration and body mass index (BMI) were significantly associated with fluid loss. For every 10-minute increase in session duration, there was a 0.06 kg (SE = 0.001; p < 0.001) increase in fluid loss, and for every two unit increase in BMI, fluid loss increased by 0.05 kg (SE = 0.03; p = 0.02). Results suggest that prolonged surfing at high environmental temperatures in participants with high BMI's resulted in significant body water deficits. Since there is no opportunity to rehydrate during a surf session, surfers must properly pre-hydrate before surfing in order to avoid the detrimental effects of dehydration.

Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis.

BACKGROUND: While chronic exercise training has been demonstrated to be an effective non-pharmacological treatment for chronic low back pain (CLBP), there has been a relative lack of evidence or clinical guidelines for whether a posterior chain resistance training programme provides any benefits over general exercise (GE). OBJECTIVES: To determine if chronic posterior chain resistance training (PCRT), defined as exercise programmes of ≥6 weeks duration focused on the thoracic, lumbar and hip extensor musculature, is more effective than GE in improving pain, level of disability, muscular strength and the number of adverse events in recreationally active and sedentary individuals with CLBP. METHODS: Four electronic databases were systematically searched from 25 September 2019 until 30 August 2020. Using the Joanna Briggs Institute (JBI) Critical Appraisal Tools checklist for randomized controlled trials (RCTs), articles were critically appraised and compared against the inclusion/exclusion criteria. Standardized mean difference (SMD), risk difference (RD) and confidence interval (CI) were calculated using Review Manager 5.3. RESULTS: Eight articles were included, with a total of 408 participants (203 PCRT, 205 GE). Both PCRT and GE were effective in improving a number of CLBP-related outcomes, but these effects were often significantly greater in PCRT than GE, especially with greater training durations (i.e. 12-16 weeks compared to 6-8 weeks). Specifically, when compared to GE, PCRT demonstrated a greater reduction in pain (SMD = - 0.61 (95% CI - 1.21 to 0.00), p = 0.05; I2 = 74%) and level of disability (SMD = - 0.53 (95% CI - 0.97 to - 0.09), p = 0.02; I2 = 52%), as well as a greater increase in muscle strength (SMD = 0.67 (95% CI 0.21 to 1.13), p = 0.004; I2 = 0%). No differences in the number of adverse events were reported between PCRT and GE (RD = - 0.02 (95% CI - 0.10 to 0.05), p = 0.57; I2 = 72%). CONCLUSION: Results of the meta-analysis indicated that 12-16 weeks of PCRT had a statistically significantly greater effect than GE on pain, level of disability and muscular strength, with no significant difference in the number of adverse events for recreationally active and sedentary patients with CLBP. Clinicians should strongly consider utilizing PCRT interventions for 12-16 weeks with patients with CLBP to maximize their improvements in pain, disability and muscle strength. Future research should focus on comparing the efficacy and adverse events associated with specific PCRT exercise training and movement patterns (i.e. deadlift, hip lift) in treating this population. TRIAL REGISTRATION: PROSPERO CRD42020155700 .