The Strength Characteristics of Elite and Subelite Female Gaelic Football Players.

ABSTRACT: Hughes, W, Healy, R, Lyons, M, Higginbotham, C, Lane, A, and Beattie, K. The strength characteristics of elite and subelite female Gaelic football players. J Strength Cond Res 38(6): 1072-1081, 2024-There is currently an underrepresentation of sports science research focused on the female athlete, specifically in the context of Gaelic football. The aims of this study are to (a) compare the strength characteristics of elite and subelite players and (b) establish normative-based values and percentile scores for the strength characteristics of female Gaelic football players. Ninety-two female Gaelic football players were recruited for this study and subsequently categorized as elite (intercounty n = 30, age; 25.1 ± 5.3 years, stature; 1.69 ± 0.06 m, mass; 69.5 ± 5.9 kg) or subelite (club n = 62, age; 25.4 ± 6.8 years, stature; 1.66 ± 0.06 m, mass; 65.1 ± 8.9 kg). The physical strength characteristics of the subjects were assessed through the isometric midthigh pull (IMTP), countermovement jump (CMJ), and 10-5 repeated jump test. Statistically significant differences were found in the physical strength characteristics between the groups with elite players demonstrating greater peak force (large effect), relative peak force (moderate effect), and reactive strength index (large effect). Statistically significant differences were also observed for key CMJ phase characteristics with elite players producing greater RSI mod (moderate effect), jump height (large effect), and propulsion peak power (large effect) than subelite players. This study demonstrated that there are moderate to large differences between playing standards with elite players displaying superior reactive-, explosive-, and maximal-strength than their subelite counterparts. The strength characteristics evaluated in this study may be used in conjunction with other performance indices to distinguish between elite and subelite playing standards in female Gaelic football players.

Durable responses at 24 months with high-frequency spinal cord stimulation for nonsurgical refractory back pain.

OBJECTIVE: The objective of this study was to evaluate the 24-month durability of pain relief, function, quality of life, and safety outcomes for patients with nonsurgical refractory back pain (NSRBP) treated with high-frequency spinal cord stimulation (SCS) within a large, national, multicenter randomized controlled trial (RCT). METHODS: Following the completion of an RCT comparing high-frequency SCS plus CMM with CMM alone for the treatment of NSRBP, patients gave additional consent for a follow-up extension to 24 months. Presented is the cohort analysis of all patients treated with high-frequency SCS following the optional crossover at 6 months. The outcomes assessed to 24 months included responder rate of ≥ 50% pain relief measured according to the visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), quality of life (EQ-5D 5-level [EQ-5D-5L]), opioid reduction. RESULTS: Of the 125 patients who received a permanent implant, 121 completed the 12-month follow-up, 101 gave additional consent for extended follow-up, and 98 completed the 24-month follow-up. At 24 months after implantation, the mean back pain VAS score was reduced by 73% and the responder rate was 82%. ODI and EQ-5D-5L both improved by at least double the minimal clinically important difference for each measure. No unexpected adverse events were observed, and the rates of serious adverse events (3.4%) and device explantations (4.8%) were low. CONCLUSIONS: The addition of high-frequency SCS to CMM in patients with NSRBP offers profound improvements at 24 months in pain, function, quality of life, and reduced opioid use. This study provides much-needed evidence to inform current clinical practice for managing patients with NSRBP.

Image-localized biopsy mapping of brain tumor heterogeneity: A single-center study protocol.

Brain cancers pose a novel set of difficulties due to the limited accessibility of human brain tumor tissue. For this reason, clinical decision-making relies heavily on MR imaging interpretation, yet the mapping between MRI features and underlying biology remains ambiguous. Standard (clinical) tissue sampling fails to capture the full heterogeneity of the disease. Biopsies are required to obtain a pathological diagnosis and are predominantly taken from the tumor core, which often has different traits to the surrounding invasive tumor that typically leads to recurrent disease. One approach to solving this issue is to characterize the spatial heterogeneity of molecular, genetic, and cellular features of glioma through the intraoperative collection of multiple image-localized biopsy samples paired with multi-parametric MRIs. We have adopted this approach and are currently actively enrolling patients for our 'Image-Based Mapping of Brain Tumors' study. Patients are eligible for this research study (IRB #16-002424) if they are 18 years or older and undergoing surgical intervention for a brain lesion. Once identified, candidate patients receive dynamic susceptibility contrast (DSC) perfusion MRI and diffusion tensor imaging (DTI), in addition to standard sequences (T1, T1Gd, T2, T2-FLAIR) at their presurgical scan. During surgery, sample anatomical locations are tracked using neuronavigation. The collected specimens from this research study are used to capture the intra-tumoral heterogeneity across brain tumors including quantification of genetic aberrations through whole-exome and RNA sequencing as well as other tissue analysis techniques. To date, these data (made available through a public portal) have been used to generate, test, and validate predictive regional maps of the spatial distribution of tumor cell density and/or treatment-related key genetic marker status to identify biopsy and/or treatment targets based on insight from the entire tumor makeup. This type of methodology, when delivered within clinically feasible time frames, has the potential to further inform medical decision-making by improving surgical intervention, radiation, and targeted drug therapy for patients with glioma.

Integrated molecular and multiparametric MRI mapping of high-grade glioma identifies regional biologic signatures.

Sampling restrictions have hindered the comprehensive study of invasive non-enhancing (NE) high-grade glioma (HGG) cell populations driving tumor progression. Here, we present an integrated multi-omic analysis of spatially matched molecular and multi-parametric magnetic resonance imaging (MRI) profiling across 313 multi-regional tumor biopsies, including 111 from the NE, across 68 HGG patients. Whole exome and RNA sequencing uncover unique genomic alterations to unresectable invasive NE tumor, including subclonal events, which inform genomic models predictive of geographic evolution. Infiltrative NE tumor is alternatively enriched with tumor cells exhibiting neuronal or glycolytic/plurimetabolic cellular states, two principal transcriptomic pathway-based glioma subtypes, which respectively demonstrate abundant private mutations or enrichment in immune cell signatures. These NE phenotypes are non-invasively identified through normalized K2 imaging signatures, which discern cell size heterogeneity on dynamic susceptibility contrast (DSC)-MRI. NE tumor populations predicted to display increased cellular proliferation by mean diffusivity (MD) MRI metrics are uniquely associated with EGFR amplification and CDKN2A homozygous deletion. The biophysical mapping of infiltrative HGG potentially enables the clinical recognition of tumor subpopulations with aggressive molecular signatures driving tumor progression, thereby informing precision medicine targeting.

Equitable and timely access to outpatient COVID-19 treatment: A review of centralized workflow implementation at an integrated health system.

BACKGROUND: During the evolution of the COVID-19 pandemic, health care entities had to adapt to rapidly changing research and best practices in disease prevention and treatment to maintain the delivery of high-quality patient care. Prompt interdisciplinary efforts amongst physician, pharmacist, nursing, and information technology teammates are needed to develop robust centralized strategies to allocate and administer COVID-19 therapies in the ambulatory setting. OBJECTIVE: The objective of this analysis is to demonstrate the impact of a system-wide, centralized workflow on referral times and treatment outcomes for COVID-19 infected patients in the ambulatory setting. METHODS: Upon release of monoclonal antibodies for the treatment of COVID-19, a centralized approach for patient treatment referrals to the University of North Carolina Health Virtual Practice team was developed due to the limited supply. Collaboration with infectious disease colleagues played a pivotal role in the rapid application of therapeutic guidance and creation of treatment prioritization levels. RESULTS: From November 2020 through February 2022, the centralized workflow team facilitated the administration of over 17,000 COVID-19 treatment infusions. The median time from treatment referral to infusion was 2 days from a positive COVID-19 test result. From January through February 2022, 514 oral COVID-19 treatment courses were dispensed from the health system's outpatient pharmacies. The median time from referral to treatment was 1 day from diagnosis. CONCLUSION: Given the ongoing strain and demand of COVID-19 on the health care system, a centralized, multidisciplinary team of experts allowed for efficient delivery of COVID-19 therapies through one provider touchpoint. The collaboration between outpatient pharmacies, infusion sites, and Virtual Practice culminated in a sustainable, centralized treatment approach that supported widespread reach, and equitable dose distribution, to the most vulnerable patient populations.

Effects of resistance exercise training on depressive symptoms among young adults: A randomized controlled trial.

Evidence supports the antidepressant effects of resistance exercise training (RET); however, findings among young adults at-risk for elevated depressive symptoms are limited. This randomized controlled trial examined the effects of eight weeks of ecologically-valid, guidelines-based RET, compared to a wait-list control, on depressive symptoms among 55 young adults (26±5y; 36 female) with and without subclinical, or analogue, Generalized Anxiety Disorder (AGAD; Psychiatric Diagnostic Screening Questionnaire GAD subscale ≥6 and Penn State Worry Questionnaire ≥45) and Major Depressive Disorder (AMDD). Following a three-week familiarization period, participants completed one-on-one, twice-weekly RET sessions. The 16-item, self-reported Quick Inventory of Depressive Symptomatology (QIDS) assessed depressive symptoms. RM-ANCOVAs examined between-group differences, and significant interactions were decomposed with simple effects analysis. Hedges' d effect sizes (95%CI) quantified the magnitude of differences in change between groups across time. Stratified analyses were conducted among subsamples with AMDD and AGAD. There were no baseline depressive symptom differences between groups. Attendance was 83%, and compliance was 80%. RET induced statistically significant, clinically-meaningful, large-magnitude reductions in depressive symptoms from baseline to week eight in the total (d = 1.01; [95%CI: 0.44-1.57]), AMDD (d = 1.71; [95%CI: 0.96-2.46]), and AGAD (d = 1.39; [95%CI: 0.55-2.24]) samples. These findings support guidelines-based RET as a promising treatment for mild depression.

Orellanine: From Fungal Origin to a Potential Future Cancer Treatment.

Fungal metabolites represent an underutilized resource in the development of novel anticancer drugs. This review will focus on the promising fungal nephrotoxin orellanine, found in mushrooms including Cortinarius orellanus (Fools webcap). Emphasis will be placed on its historical significance, structural features, and associated toxicomechanics. Chromatographic methods for analysis of the compound and its metabolites, its synthesis, and chemotherapeutic potential are also discussed. Although orellanine's exceptional selectivity for proximal tubular cells is well documented, the mechanics of its toxicity in kidney tissue remains disputed. Here, the most commonly proposed hypotheses are detailed in the context of the molecule's structure, the symptoms seen following ingestion, and its characteristic prolonged latency period. Chromatographic analysis of orellanine and its related substances remains challenging, while biological evaluation of the compound is complicated by uncertainty regarding the role of active metabolites. This has limited efforts to structurally refine the molecule; despite numerous established methods for its synthesis, there is minimal published material on how orellanine's structure might be optimized for therapeutic use. Despite these obstacles, orellanine has generated promising data in preclinical studies of metastatic clear cell renal cell carcinoma, leading to the early 2022 announcement of phase I/II trials in humans.

The Effect of Different Strength Training Modalities on Sprint Performance in Female Team-Sport Athletes: A Systematic Review and Meta-Analysis.

BACKGROUND: There has been a rise in the participation, professionalism, and profile of female sports in recent years. Sprinting ability is an important quality for successful athletic performance in many female team sports. However, much of the research to date on improving sprint performance in team sports is derived from studies with male participants. Given the biological differences between the sexes, this may be problematic for practitioners when programming to enhance sprint performance in female team-sport athletes. Therefore, the aims of this systematic review were to investigate (1) the overall effect of lower body strength training on sprint performance, and (2) the effect of specific strength training modalities (i.e., reactive-; maximal-; combined-; special-strength) on sprint performance in female team-sport athletes. METHODS: An electronic database search was performed using PubMed, MEDLINE, SPORTDiscus, CINAHL, The Cochrane Library, and SCOPUS to identify relevant articles. A random-effects meta-analysis was performed to establish standardised mean difference with 95% confidence intervals and the magnitude and direction of the effect. RESULTS: Fifteen studies were included in the final analysis. The 15 studies represent a total sample size of 362 participants (intervention n = 190; control n = 172) comprising 17 intervention groups and 15 control groups. The overall effects revealed small improvements in sprint performance in favour of the experimental group over 0-10 m and moderate improvements over sprint distances of 0-20 m and 0-40 m. The magnitude of improvement in sprint performance was influenced by the strength modality (i.e., reactive-, maximal-, combined-, and special-strength) utilised in the intervention. Reactive- and combined-strength training methods had a greater effect than maximal- or special-strength modalities on sprint performance. CONCLUSION: This systematic review and meta-analysis demonstrated that, when compared with a control group (i.e., technical and tactical training), the different strength training modalities exhibited small to moderate improvements in sprint performance in female team-sport athletes. The results of a moderator analysis demonstrated that youth athletes (< 18 years) yielded a greater improvement in sprint performance compared with adults (≥ 18 years). This analysis also supports the use of a longer programme duration (> 8 weeks) with a higher total number of training sessions (> 12 sessions) to improve overall sprint performance. These results will serve to guide practitioners when programming to enhance sprint performance in female team-sport athletes.

The design and evaluation of an integrated training load and injury/illness surveillance system in competitive swimming.

OBJECTIVE: To design and evaluate an integrated training load monitoring and injury/illness surveillance system in a competitive swimming environment. DESIGN: Descriptive/mixed methods. SETTING: Swim Ireland National Training Centres. PARTICIPANTS: Fourteen competitive athletes and seven coaches/medical data collectors participated in the evaluation process. OUTCOME MEASURES: System satisfaction, usefulness and burden were evaluated. Barriers to the implementation and effectiveness of the system were explored. RESULTS: Most athletes were 'extremely' or 'very' satisfied with the overall data collection process and also found it to be 'extremely' or 'very' useful in the training centre environment. All practitioners were 'extremely satisfied with the system and found it to be either 'extremely' or 'very' useful in their role. Process constraints and data access and control were significant themes related to the athletes, while practitioners highlighted communication and cooperation amongst stakeholders, layering context to the data, maintaining data integrity and the coach's influence in the monitoring process as being important to the monitoring/surveillance process. CONCLUSIONS: Training load monitoring and injury/illness surveillance are necessary to elevate the standard of prospective injury/illness prevention research. Integrated systems should be designed in line with key consensus statements, while also being implemented in a way that counteracts the challenges within the real-world training environment.

Mera: A scalable high throughput automated micro-physiological system.

There is an urgent need for scalable Microphysiological Systems (MPS's)1 that can better predict drug efficacy and toxicity at the preclinical screening stage. Here we present Mera, an automated, modular and scalable system for culturing and assaying microtissues with interconnected fluidics, inbuilt environmental control and automated image capture. The system presented has multiple possible fluidics modes. Of these the primary mode is designed so that cells may be matured into a desired microtissue type and in the secondary mode the fluid flow can be re-orientated to create a recirculating circuit composed of inter-connected channels to allow drugging or staining. We present data demonstrating the prototype system Mera using an Acetaminophen/HepG2 liver microtissue toxicity assay with Calcein AM and Ethidium Homodimer (EtHD1) viability assays. We demonstrate the functionality of the automated image capture system. The prototype microtissue culture plate wells are laid out in a 3 × 3 or 4 × 10 grid format with viability and toxicity assays demonstrated in both formats. In this paper we set the groundwork for the Mera system as a viable option for scalable microtissue culture and assay development.

Risk factors for acute ankle sprains in field-based, team contact sports: a systematic review of prospective etiological studies.

OBJECTIVE: The aim of this systematic review was to identify prospectively measured ankle sprain risk factors in field-based team contact sports. METHODS: Eight databases including SPORTDiscus, CINAHL Complete, MEDLINE (EBSCO), Education Source, Web of Science, Scopus, Embase, and Pubmed were searched using specific Boolean terms. A modified-CASP diagnostic test assessed the quality of the included studies. Extensive data extraction included but was not limited to injury definition, protocols for injury diagnosis and recording, and outcomes associated with ankle sprain. RESULTS: 4012 records were returned from the online search and 17 studies met the inclusion criteria for this review. Twelve different risk factors including anatomic alignment of the foot and ankle, joint laxity, height, mass, BMI (body mass index), age, ankle strength, hip strength, single leg landing performance (ground reaction force, pelvic internal rotation, and knee varus), and single leg reach were all found to be associated with ankle sprain incidence. Injury definitions and methods of diagnosis and recording varied across the 17 studies. CONCLUSION: This review updates the literature on prospective risk factors for ankle sprain in a specific population rather than heterogeneous cohorts previously studied. From more than 20 categories of risk factors investigated for ankle sprain association across 17 studies in field-based team contact sports, 12 variables were found to be associated with increased incidence of ankle sprain. In order to reduce the risk of ankle sprain, BMI, ankle plantar and dorsiflexion strength, hip strength, and single leg landing performance should be factored in to athlete assessment and subsequent program design. More studies utilizing standardized definitions and methods of recording and reporting are needed. Future prospective etiological studies will allow strength and conditioning coaches, physiotherapists, and physicians to apply specific training principles to reduce the risk and occurrence of ankle sprain injuries.

The Interplay Between Expected Psychological Responses to Exercise and Physical Activity in Analogue Generalized Anxiety Disorder: a Cross-sectional Study.

BACKGROUND: Expectations for psychological responses to exercise are not well characterized, particularly in people at risk for anxiety-related illnesses. Given the substantial evidence for salutary effects of exercise on anxiety symptoms and emerging recognition for expectations as a critical mechanism of placebo/nocebo effects, this study explored the interplay between expectations and physical activity in young adults with and without analogue generalized anxiety disorder. METHODS: Participants (N=470, 23.2±4.8 years, 63% female) completed a physical activity and mood survey, including a 7-day physical activity recall questionnaire, and a 20-item questionnaire designed to measure positive and negative expectations for psychological and perceptual responses to exercise, particularly expectations for symptoms in the generalized anxiety disorder symptom profile. Analogue generalized anxiety disorder status was determined using the Generalized Anxiety Disorder subscale of the Psychiatric Diagnostic Screening Questionnaire. RESULTS: For select outcomes, expected exercise-induced changes significantly differed according to analogue generalized anxiety disorder (whole-body pain, sleep quality, psychological well-being, stress, relaxation) and active versus inactive (anxious mood, depressed mood, concentration, physical function, psychological well-being, relaxation) status. However, these findings did not survive corrections for multiple comparisons and the magnitude of these differences was small, approximating 0.25 standard deviations. Expectations for anxious (Spearman's ρ=-0.14, p≤0.002) and depressed mood (ρ=-0.15, p≤0.002), and psychological well-being (ρ=0.15, p≤0.001) were significantly associated with higher physical activity levels. Exercise expectations for anxious mood explained a significant, but small (+1.5%, p≤0.03), amount of variance in physical activity. CONCLUSIONS: Expectations for exercise-induced improvements did not significantly differ between young adults based on analogue generalized anxiety disorder or physical activity status.

Injury Trends for School Rugby Union in Ireland: The Need for Position-specific Injury-prevention Programs.

BACKGROUND: Concern has been raised over the injury risk to school Rugby union (Rugby) players and the potential long-term health consequences. Despite the increase in studies for this cohort, the influence of playing position on injury incidence and presentation is unclear. PURPOSE: To describe the incidence, nature and severity of match injuries for school Rugby in Ireland overall, and as a function of playing position. STUDY DESIGN: Prospective cohort study. METHODS: Data were collected from 15 male (aged 16-19 years) school Senior Cup teams across 2 seasons. In total, 339 players participated in season 1, whereas 326 players participated in season 2. Injury data were recorded onto a bespoke online platform. Match exposure was also recorded. RESULTS: The incidence rate of match injuries (24-hour time loss) was 53.6 per 1000 hours. Across both seasons, 6810 days were lost from play due to injury. Forwards (65.4 per 1000 hours) sustained significantly more (P < 0.05) injuries than backs (40.5 per 1000 hours). The head, shoulder, knee, and ankle were the most common injured body regions; however, forwards sustained significantly more (P < 0.05) head and shoulder injuries than backs. The tackle was responsible for the majority of injuries in both groups. The highest proportion of injuries occurred during the third quarter. CONCLUSION: Clear differences in injury presentation and incidence were evident when comparing forwards versus backs. The high rate of head and shoulder injuries in the forwards suggest the need for more targeted injury-prevention strategies and further research on education and laws around the tackle event. The spike of injuries in the third quarter suggests that fatigue or inadequate half-time warm-up may be a contributing factor warranting further exploration. CLINICAL RELEVANCE: This study demonstrates clear differences in injury presentation according to playing position in school Rugby and highlights the need for a more tailored approach to the design and implementation of injury-prevention strategies. LEVEL OF EVIDENCE: Level 3.

Effects of Variable Resistance Training Within Complex Training on Neuromuscular Adaptations in Collegiate Basketball Players.

The aim of this study was to investigate the differences in neuromuscular performance between variable resistance training and constant resistance training within complex training. Twenty-one well-trained collegiate basketball players were randomly assigned to either an experimental group (variable resistance training) or a control group (constant resistance training) and completed a twice weekly training program over an 8-week period. Training programs were the same except that the experimental group included variable resistance via elastic bands (40% of the total load). Maximum strength, vertical jump, horizontal jump, and sprint performance were assessed pre- and post-intervention. Both groups demonstrated significant increases in the back squat 1RM (experimental group +36.5% and control group +32.3%, both p < 0.001), countermovement jump (experimental group +12.9%, p = 0.002 and control group +5.6%, p = 0.02), and squat jump performance (experimental group +21.4% and control group +12.9%, both p < 0.001), whereas standing broad jump performance improved only in the experimental group (+2.9%, p = 0.029). Additionally, the experimental group showed significant improvement in the squat jump (p = 0.014) compared with the control group. However, no statistically significant differences were found between groups for countermovement jump (p = 0.06) and sprint performance at 10 m (p = 0.153) and 20 m (p = 0.076). We may conclude that both training modalities showed similar improvements in maximum strength. Performing variable resistance training within a complex training program is more efficient to enhance selective power performance in well-trained collegiate basketball players.

Reference intervals for clinical biochemistry and haematology tests during normal pregnancy.

BACKGROUND: Pregnancy induces physiological changes which affect biochemical and haematological parameters. As the significance of laboratory test results change throughout pregnancy, the reference interval (RI) or key result interpretive guide should be specific to pregnancy. This study sought to establish trimester-specific-RIs for routine biochemical and haematological tests in healthy white European women with singleton pregnancies with comparison to RIs for non-pregnant European adults. METHODS: A retrospective analysis of a prospective longitudinal single-centre study of healthy pregnant women conducted between November 2018 and December 2020 in a tertiary academic hospital with approximately 3000 births annually. Inclusion criteria: signed informed consent, age ≥18 years, white European, body mass index (BMI) <25 kg/m2, blood pressure <140/90mmHg, non-smoker, no previous pathology or gestational diabetes. Trimester defined as T1: up to 13 weeks + 6 days, T2: 14-27 weeks + 6 days and T3: ≥28-41 weeks + 6 days. Baseline demographics, anthropometric and laboratory measurements were recorded. In total, 31 biochemical and 10 haematological ISO15189:2012 accredited tests were measured using Roche Cobas® and Sysmex XN-9100™ analysers, respectively. RIs were established according to the International Federation of Clinical Chemistry (IFCC) recommended method. RESULTS: Apparently healthy pregnant women (n = 124) with bio-banked serum samples in each trimester were recruited. At the booking visit, 49.2% (n = 61) of participants were nulliparous, with median age of 34.4 (IQR: 31.3-37.3) years, gestational age of 89 (IQR: 84-93) days, BMI of 22.5 (IQR: 21.0-23.7) kg/m2 and systolic and diastolic blood pressure of 116 (110-125) mmHg and 67 (61-75) mmHg, respectively. CONCLUSIONS: Normative trimester-specific biological intervals for routinely requested biochemical and haematological medical laboratory tests were established. These RIs will be invaluable to result interpretation and the management of pregnant women.

Effect of STN/GPi DBS on swallowing function in Parkinson's disease as assessed by Video fluoroscopy: A retrospective study.

INTRODUCTION: The goal of the study is to objectively assess changes in swallowing (using "gold standard" video fluoroscopy (VFS)) following Deep Brain Stimulation (DBS) surgery in Parkinson's disease (PD) patients. There are few studies on the effect of DBS on swallowing in PD. We use VFS to assess swallowing function pre- and post-DBS. METHODS: Our study participants underwent pre- and post-DBS VFS (6 months later) in the practically defined on state. We converted VFS reports into an objective numerical scale. Higher scores denote more severe dysphagia. We used non-parametric test (Wilcoxon signed rank test) to test if the difference between pre- and post-DBS swallow score is significantly different from 0. RESULTS: Fifty-four PD patients completed pre- and post-DBS evaluations. Twenty-five patients had bilateral GPi DBS (46.3%) and 29 had bilateral STN DBS (53.7%). The mean (SD) post-DBS swallow score is 1.9 (2.0) and pre-DBS swallow score is 1.6 (1.3). The difference is not significantly different from 0 (p = 0.16). In our study, swallow scores for majority of the patients (39 out of 54) did not change after DBS regardless of lead location. Six (11.1%) PD patients had post-DBS swallow score decrease on average by 1 (SD: 0) points. 9 (16.7%) patients had post-DBS swallow score increase on average by 2.7 (SD: 2.3) points. CONCLUSION: There was no statistically significant change in the swallow scores pre-and 6 months post-DBS with VFS when assessed in the practically defined on state, regardless of the site of bilateral lead implantation. Hence, we believe that DBS does not improve or reduce swallow function in a clinically meaningful way in PD.

Factors associated with greater patient satisfaction in outpatient neurosurgical clinics: Recommendation for surgery, older age, cranial chief complaint, and public health insurance.

OBJECTIVE: Patient satisfaction has increasingly played a role in determining care quality. Surveys are used to gauge patient experience, satisfaction of care, and likelihood to recommend providers and facilities. The aim of the study is to evaluate whether clinical and demographic data predict greater patient satisfaction with providers in the outpatient neurosurgery clinic. METHODS: Press-Ganey (Press Ganey Associates, South Bend, IL) evaluations of 1521 patients were reviewed in an academic neurosurgical clinic from January 1, 2019 through February 1, 2021. We analyzed associations between Press-Ganey ratings and patient demographics, chief complaint, psychiatric comorbidities, number of orders placed, medication prescriptions, surgical recommendation, payor status, and referral source. We used univariate logistic regression to assess for associations between independent variables and Press-Ganey ratings. Multivariable logistic regression was used for associated factors. RESULTS: For the Likelihood to Recommend question, older age (p = 0.003), cranial chief complaint (p = 0.046), and recommendations for surgery (p < 0.001) were significantly associated with "good" ratings. For the rating of Care Received, older age (p = 0.002), cranial chief complaint (p = 0.05), and recommendations for surgery (p = 0.002) were significantly associated with "good" ratings. For Confidence in Care Provider question, recommendations for surgery (p = <0.001) and government insurance type (p = 0.002) were significantly associated with "good" ratings. CONCLUSIONS: Patients with older age, cranial pathologies, a recommendation for surgery, and government health insurance were significantly associated with favorable patient satisfaction with providers in the outpatient neurosurgery clinic. Prospective studies should target patient populations who are younger, have spinal complaints, have non-surgical needs, and have commercial insurance to improve satisfaction.

International survey of injury surveillance practices in competitive swimming.

OBJECTIVE: The purpose of this study was to identify the injury surveillance practices being used in competitive swimming environments. It explored the nature of the data collected, the injury definitions used and the perceived effectiveness of injury surveillance. Finally, this study also examined barriers to injury surveillance. DESIGN: Online cross-sectional. PARTICIPANTS: Twenty-two responders working in competitive swimming. OUTCOME MEASURES: Injury surveillance methods, data collected, perceived level of effectiveness and barriers associated with injury surveillance. RESULTS: Fifteen responders participated in injury surveillance, with 13 responders using a recognised definition for injury. Ten responders did not use any sports injury classification system. Ten responders found injury surveillance to be very effective at identifying injury trends, while previous injury history and training load data were perceived to be most influential in preventing injury. Limited time, funding and compliance were common obstacles, while poor staff communication and engagement were barriers to the effective implementation of injury surveillance. CONCLUSIONS: The implementation of injury surveillance is related to the system objectives, competitive level of those under surveillance and the resources available. This implementation requires the balance of adhering to the principles outlined in prominent consensus statements and overcoming the barriers associated with implementing a system effectively.

Serum protein and electrolyte imbalances are associated with chemotherapy induced neutropenia.

Introduction: Cancer and its treatment using various chemotherapeutic agents can have many adverse side effects. These side effects often result in significant changes in haematological and biochemical composition of blood. As a result, the regular monitoring of serum biochemical and haematological changes plays an important role in management of disease. The present study aimed to determine the relationship between haematological and biochemical changes in neutropenic cancer patients following chemotherapy. Specifically we evaluated the association between neutrophil count and serum proteins and electrolytes. Methods: For this purpose we analysed retrospectively collected laboratory results from two independent patient cohorts. Each cohort was divided into a control group consisting of patients with normal haematological parameters and a study group which included patients with reduced neutrophil counts. Neutropenic patients (study group) were cancer patients on chemotherapy. Results and conclusion: Blood samples of cancer patients in study group showed reduction in haemoglobin, neutrophils and platelets. Neutropenic group showed a significant reduction in serum albumin, total protein, calcium, and potassium. Our results show that patients with severe neutropenia had pronounced changes in serum protein and electrolytes and increased incidence of abnormal serum protein and electrolyte level. The changes in the neutrophil counts showed a positive correlation with the changes in serum protein and electrolyte levels. A similar trend was seen in both the patient cohorts: the discovery set (176 patients) and the validation set (200 patients). Taken together our results suggest that chemotherapy-induced neutropenia is associated with dysregulation in haemoglobin, platelets, serum proteins and electrolytes.