The concentration of platelets in PRP does not affect pain outcomes in lateral epicondylitis: a systematic review and meta-analysis.

Aim: To investigate the analyze the relationship between concentration platelet-dose in platelet-rich plasma (PRP) injections and improvements in pain when treating lateral epicondylitis. Methods: A systematic review was conducted into five medical databases, exploring the difference in pain outcomes based on concentration of PRP. Results: Initial querying of the databases yielded 1408 articles with 20 articles ultimately included. There was no statistical significance between effect sizes of the two treatment groups (high and low platelet concentration; p = 0.976). Conclusion: Both large and small concentrations of platelets depict significant reduction in pain, however, between subgroups there was no significance. It can thus be concluded that concentration of platelets in PRP does not impact overall pain relief.

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Unanticipated mid-flight external trunk perturbation increased frontal plane ACL loading variables during sidestep cuttings.

Unanticipated trunk perturbation is commonly observed when anterior cruciate ligament (ACL) injuries occur during direction-changing manoeuvres. This study aimed to quantify the effect of mid-flight medial-lateral external trunk perturbation directions/locations on ACL loading variables during sidestep cuttings. Thirty-two recreational athletes performed sidestep cuttings under combinations of three perturbation directions (no-perturbation, ipsilateral-perturbation, and contralateral-perturbation relative to the cutting leg) and two perturbation locations (upper-trunk versus lower-trunk). The pushing perturbation was created by customised devices releasing a slam ball to contact participants near maximum jump height prior to cutting. Perturbation generally resulted in greater peak vertical ground reaction force and slower cutting velocity. Upper-trunk contralateral perturbation showed the greatest lateral trunk bending away from the travel direction, greatest peak knee flexion and abduction angles, and greatest peak internal knee adduction moments compared to other conditions. Such increased ACL loading variables were likely due to the increased lateral trunk bending and whole-body horizontal velocity away from the cutting direction caused by the contralateral perturbation act at the upper trunk. The findings may help understand the mechanisms of indirect contact ACL injuries and develop effective cutting techniques for ACL injury prevention.

Falling decreased anterior cruciate ligament loading variables during single-leg landings after mid-flight external trunk perturbation.

Mid-flight external upper-trunk perturbation is associated with increased anterior cruciate ligament (ACL) injury risk during landing. This study aimed to assess the effect of natural, soft, and falling landing techniques on knee mechanics and vertical ground reaction forces (VGRF) during single-leg landings with/without mid-flight medial-lateral external upper-trunk pushing perturbation. Twenty-eight participants performed single-leg landings using the three landing techniques with/without mid-flight pushing perturbation. The perturbation was created by a customized apparatus releasing a slam ball and pushing the participants near the peak jump height at the upper trunk. Perturbation resulted in significantly greater lateral trunk bending angles, knee flexion angles at initial contact, peak knee abduction angles, and peak knee adduction moments compared to no perturbation. The falling condition significantly demonstrated the greatest lateral trunk bending angles, knee flexion angles, and peak knee external rotation moments and the smallest peak knee abduction angles, peak VGRF, and peak knee extension moments compared to natural/soft landings regardless of perturbation conditions. Mid-flight external perturbation resulted in variables associated with greater ACL loading during single-leg landings. Falling demonstrated variables associated with smaller ACL loading, particularly for perturbation conditions. Incorporating falling techniques into jump-landing training programs may guide players to safely fall on the ground when perturbation occurs. Falling provides an alternative strategy to potentially decrease indirect contact ACL injury risk when the sports environment allows.

Indirect contact matters: Mid-flight external trunk perturbation increased unilateral anterior cruciate ligament loading variables during jump-landings.

PURPOSE: To determine the effect of unanticipated mid-flight medial-lateral external perturbation of the upper or lower trunk on anterior cruciate ligament (ACL) loading variables during jump-landings. METHODS: Thirty-two participants performed double-leg vertical jump-landings while bilateral kinematics and kinetics were collected under 6 conditions (upper or lower trunk perturbation locations; no, left, or right perturbation directions). Two customized catapult apparatuses were created to apply pushing perturbation to participants near the maximal jump height. RESULTS: The ball contacted participants near the center of mass for the lower-trunk conditions and approximately 23 cm above the center of mass for the upper-trunk conditions. Under upper-trunk perturbation, the contralateral leg demonstrated significantly smaller knee flexion angles at initial contact and greater peak knee abduction angles, peak vertical ground reaction forces, peak knee extension moments, and peak knee adduction moments compared to other legs among all conditions. Under lower-trunk perturbation, the contralateral leg showed significantly smaller knee flexion angles at initial contact and increased peak vertical ground reaction forces and peak knee extension moments compared to legs in the no-perturbation conditions. CONCLUSION: Mid-flight external trunk pushing perturbation increased ACL loading variables for the leg contralateral to the perturbation. The upper-trunk perturbation resulted in greater changes in ACL loading variables compared to the lower-trunk perturbation, likely due to trunk and ipsilateral leg rotation and more laterally located center of mass relative to the contralateral leg. These findings may help us understand the mechanisms of indirect-contact ACL injuries and develop jump-landing training strategies under mid-flight trunk perturbation to better prevent ACL injury.

Extended visuomotor experience with inverted movements can overcome the inversion effect in biological motion perception.

Studies have demonstrated that perceiving human and animal movements as point-light displays is effortless. However, simply inverting the display can significantly impair this ability. Compared to non-dancers and typical dancers, vertical dancers have the unique experience of observing and performing movements upside down as being suspended in the air. We studied whether this unique visuomotor experience makes them better at perceiving the inverted movements. We presented ten pairs of dance movements as point-light displays. Each pair included a version performed on the ground whereas the other was in the air. We inverted the display in half of the trials and asked vertical dancers, typical dancers, and non-dancers about whether the display was inverted. We found that only vertical dancers, who have extended visual and motor experience with the configural and dynamic information of the movements, could identify the inversion of movements performed in the air. Neither typical dancers nor non-dancers, who have no motor experience with performing the inverted movements, could detect the inversion. Our findings suggest that motor experience plays a more critical role in enabling the observers to use dynamic information for identifying artificial inversion in biological motion.

Direct Speech-Language Intervention Effects on Augmentative and Alternative Communication System Use in Adults With Developmental Disabilities in a Naturalistic Environment.

PURPOSE: Research involving the effects of augmentative and alternative communication (AAC) intervention in adults, especially in naturalistic settings, has been identified as a critical public health need. Despite rapid advances in high-tech AAC, many adults with developmental disabilities have experienced reduced access to assistive technology and AAC, which can function as a de facto environmental barrier to participation, for these individuals. As a means of decreasing barriers to participation, this study targeted skill increases in the operational, linguistic, social, and strategic use of AAC systems. METHOD: This study used a preexperimental, single-case AB design to identify skill level changes in the operational, linguistic, social, and strategic use of their AAC system from baseline to the completion of intervention. The four adult participants with developmental disabilities and limited use of natural speech as a primary modality of communication were identified through a collaborative relationship between a communication sciences and disorder university program and a state-run adult day program for individuals who had aged out of the K-12 school system. Each participant received direct intervention in the four areas described across 7 weeks. RESULTS: Visual analysis and percent of nonoverlap of all pairs were used to identify changes in performance occurring between baseline and the conclusion of the intervention period. Results revealed increases across the specific skills, with individuals' variation across participants and target area. Out of 22 total goals targeted, strong effect sizes were observed for 10 goals and moderate effect sizes were observed for seven. CONCLUSIONS: Skill increases in the four areas of AAC system use can be achieved with direct intervention in adults with developmental disabilities and limited use of natural speech as a primary modality of communication. This approach also underscores the value of collaborations between university training programs, providers of adult services, and adult participants as a cost-effective strategy for service delivery.

First detected case of rabbit Haemorrhagic disease virus 2 (RHDV2) in the Irish hare (Lepus timidus hibernicus).

BACKGROUND: Rabbit haemorrhagic disease virus (RHDV) is a Lagovirus, a subgroup of the family Caliciviridae. RHDV2 is a variant first described in France in 2010, and has since spread globally. It has been reported in several Lagomorph species (rabbits, hares, and their relatives) as well as other mammals including voles and shrews. The disease has raised international concerns for its potential impact on population abundance trajectories, particularly as 25% of Lagomorphs are currently Red-Listed by the International Union for the Conservation of Nature (IUCN). The Irish hare (Lepus timidus hibernicus) is a subspecies of the mountain hare, L. timidus, and is endemic to Ireland, making it an Evolutionarily Significant Unit of intrinsic value. CASE PRESENTATION: The first case of RHDV2 was detected in a wild Irish hare in July 2019. The individual exhibited atypical neurological behaviour (running in circles) prior to death. On necropsy, pink tinged foam was seen in the trachea and congestion was noted in the lungs, but there was no evidence of haemorrhages in any other organ. Both the liver and spleen were tested by reverse transcription real time qPCR confirming high levels of RHDV2 RNA. Histopathology confirmed multifocal necrotising hepatitis. CONCLUSION: The Irish hare is susceptible to RHDV2 infection. Further investigation is warranted to explore the clinical, epidemiological, and population biology implications.

High light and temperature reduce photosynthetic efficiency through different mechanisms in the C4 model Setaria viridis.

C4 plants frequently experience high light and high temperature conditions in the field, which reduce growth and yield. However, the mechanisms underlying these stress responses in C4 plants have been under-explored, especially the coordination between mesophyll (M) and bundle sheath (BS) cells. We investigated how the C4 model plant Setaria viridis responded to a four-hour high light or high temperature treatment at photosynthetic, transcriptomic, and ultrastructural levels. Although we observed a comparable reduction of photosynthetic efficiency in high light or high temperature treated leaves, detailed analysis of multi-level responses revealed important differences in key pathways and M/BS specificity responding to high light and high temperature. We provide a systematic analysis of high light and high temperature responses in S. viridis, reveal different acclimation strategies to these two stresses in C4 plants, discover unique light/temperature responses in C4 plants in comparison to C3 plants, and identify potential targets to improve abiotic stress tolerance in C4 crops.

Associations Between Static and Dynamic Field Balance Tests in Assessing Postural Stability of Female Undergraduate Dancers.

Balance testing on dancers has used a wide variety of assessment tools. However, as most field balance tests have been developed for either sport or elderly populations, the evidence of associations between tests and their functional relevance to dance is inconclusive. We assessed possible associations between five such field balance tests . A total of 83 female undergraduate dance students (20 ± 1.5 years; 163 ± 6.6 cm; 61 ± 10.8 kg) volunteered for the tests. They executed the Star Excursion Balance Test (SEBT), the modified Romberg test, the Airplane test, the BioSway Balance System (Biodex, Shirley, New York, USA), and a dance-specific pirouette test. Spearman's correlation coefficients examined relationships between the measures of the balance tests. Results showed strongest relationships between some SEBT reach directions (p < 0.01) and very weak to moderate relationships between some balance tests, including some SEBT directions, Romberg, Airplane, Biosway, and pirouette (p < 0.01 and p < 0.05). Our findings suggest that current tests used to assess dancers' postural stability need further investigation to ensure functionality and relevance.

Up-scheduling and codeine supply in Australia: analysing the intervention and outliers.

BACKGROUND AND AIMS: Over-the-counter codeine products were up-scheduled to prescription only in Australia from February 2018. This trend study aimed to identify changes in codeine supply before and after the February 2018 implementation. DESIGN, SETTING AND CASES: Time-series regression analysis of monthly medicine supplies in Australia from 2014 to 2018. The February 2018 up-scheduling was pre-specified as the intervention; outlier analysis was used to detect automatically sudden unexpected changes before February 2018. MEASUREMENTS: Per-capita supplies based on national data for pharmaceutical wholesales and population exposure. Weight of supplies in milligrams for low-dose codeine (≤ 15 mg per tablet or ≤ 1.92 mg per ml, originally sold over the counter but up-scheduled after February 2018), high-dose combination codeine (30 mg per tablet, prescription only throughout the study period) and all codeine. FINDINGS: Several level shifts in supply occurred during the 5 years, led by one of -4.4% [95% confidence interval (CI) = -6.6 to -2.1%] in high-dose codeine in 2015, followed by shifts in low-dose codeine of -40.0% (CI = -46.9 to -32.3%) and -82.2% (CI = -84.3 to -79.9%), respectively, before and after February 2018. High-dose codeine supply increased by 4.4% (CI = 1.8-7.1%) immediately after up-scheduling. Also detected were transient increases and decreases in 2016 and 2017. Compared with pre-2015 levels, the February 2018 up-scheduling was associated with reductions of 45.7% (CI = 43.2-48.0%) and 89.3% (CI = 87.9-90.6%), respectively, in all and low-dose codeine supply but no change in high-dose codeine supply. The level shifts and transient changes were located around various regulatory activities, including public announcements and expert advisory meetings on up-scheduling. CONCLUSION: Up-scheduling of over-the-counter codeine products in Australia in 2018 appears to have been associated with a near halving of Australia's national codeine supply. The transition occurred in multiple forms and phases.

Quantitative Proteomics and Phosphoproteomics Support a Role for Mut9-Like Kinases in Multiple Metabolic and Signaling Pathways in Arabidopsis.

Protein phosphorylation is one of the most prevalent posttranslational modifications found in eukaryotic systems. It serves as a key molecular mechanism that regulates protein function in response to environmental stimuli. The Mut9-like kinases (MLKs) are a plant-specific family of Ser/Thr kinases linked to light, circadian, and abiotic stress signaling. Here we use quantitative phosphoproteomics in conjunction with global proteomic analysis to explore the role of the MLKs in daily protein dynamics. Proteins involved in light, circadian, and hormone signaling, as well as several chromatin-modifying enzymes and DNA damage response factors, were found to have altered phosphorylation profiles in the absence of MLK family kinases. In addition to altered phosphorylation levels, mlk mutant seedlings have an increase in glucosinolate metabolism enzymes. Subsequently, we show that a functional consequence of the changes to the proteome and phosphoproteome in mlk mutant plants is elevated glucosinolate accumulation and increased sensitivity to DNA damaging agents. Combined with previous reports, this work supports the involvement of MLKs in a diverse set of stress responses and developmental processes, suggesting that the MLKs serve as key regulators linking environmental inputs to developmental outputs.

Bilateral Differences in Dancers' Dynamic Postural Stability During Jump Landings.

Although traditional dance training aims to train dancers' legs equally, the recognized practice of predominately starting and repeating exercises on one side more than the other has led to suggestions that technique classes may cause lateral bias. Such an imbalance could lead to a greater risk of injury; however, despite this potential risk, little is known about the effects of bilateral differences on dancers' postural stability during jump landings, a key dynamic action in dance. Therefore, the aim of this study was to examine the effects of possible bilateral differences on dynamic postural stability during single-leg landing using a time-to-stabilization protocol. Thirty-two injury-free female university undergraduate dancers (19 ± 1.9 years; 164.8 ± 6.7 cm; 62.6 ± 13.6 kg) volunteered for the study. They completed a two-foot to one-foot jump over a bar onto a force platform while stabilizing as quickly as possible. The landing leg was randomly assigned, and participants completed three trials for each leg. No significant differences in dynamic postural stability between right and left legs were revealed, and poor effect size was noted (p > 0.05): MLSI: t = -.04, df = 190, p = 0.940 (CI = -.04, .04, r² = 0); APSI: t = .65, df = 190, p = 0.519 (CI = -.06-, .12, r² = .09); VSI: t = 1.85, df = 190, p = 0.066 (CI = -.02, .68, r² = .27); DPSI: t = 1.88, df = 190, p = 0.061 (CI = -.02, .70, r² = .27). The results of this study do not support the notion that dance training may cause lateral bias with its associated risk of injury. Furthermore, dancers' self-perceptions of leg dominance did not correlate with their ability to balance in single-leg landings or to absorb the ground reaction forces often associated with injury. Even when biased training exists, it may not have detrimental effects on the dancer's postural stability.

Does Gesture Lighten the Load? The Case of Verbal Analogies.

Gesturing has been shown to relay benefits to speakers and listeners alike. Speakers, for instance, may be able to reduce their working memory load through gesture. Studies with children and adults have demonstrated that gesturing while describing how to solve a problem can help to save cognitive resources related to that explanation, allowing them to be allocated to a secondary task. The majority of research in this area focuses on procedural mathematical problem solving; however, the present study examines how gesture interacts with working memory load during a verbal reasoning task: verbal analogies. Unlike previous findings which report improved performance on secondary tasks while gesturing during a primary task, our results show that participants showed better performance in a secondary memory task when being prohibited from gesturing during their explanation of verbal analogies compared to being allowed to gesture. These results suggest that the relationship between gesture and working memory may be more nuanced, with the type of task and gestures produced influencing how gestures interact with working memory load.

Comparison of Center of Pressure and Kinematic Differences in Grand Plié With and Without the Barre.

The purpose of this study was to determine what differences exist when performing grand plié with and without the barre. Differences in center of pressure (COP) sway, trunk kinematics, and lower extremity kinematics were used in this analysis for both first (P1) and fifth positions (P5). It was hypothesized that use of the barre would result in decreased COP sway, but increased asymmetries in trunk and lower extremity kinematics would be seen compared with the same movements performed without the barre in both positions. Sixteen collegiate dancers (1 male, 15 female) performed three trials of grand plié in P1 and P5 (right leg crossed in front) with or without the barre, for a total of 12 trials. For the barre condition (BC), participants demonstrated less time to complete grand plié, slightly less depth in grand plié, and decreased anterior-posterior (AP) sway compared to the without barre condition (WBC). The BC condition showed increased peak left trunk rotation, right knee flexion, decreased right and left peak hip flexion, and increased right hip abduction in both P1 and P5. Comparing P1 to P5, there was decreased AP sway, decreased peak left trunk rotation, decreased peak right and left hip flexion, increased left hip abduction, and decreased right knee flexion in both BC and WBC conditions. For the BC, there was increased right hip abduction in P1 compared to P5. Our results indicate that while use of the barre provides proprioceptive information, which helps dancers to control balance and learn a motor control strategy, grand plié should also be taught without the barre to challenge the dancer's balance control with different movement patterns in space.

Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement.

PURPOSE: Patients with community-acquired pneumonia (CAP) at low risk of death by CURB-65 scoring system are usually unnecessarily treated as inpatients generating additional economic and clinical burden. We aimed to implement an evidence-based clinical pathway to reduce hospital admissions of low-risk CAP and investigate factors related to mortality and readmissions within 30 days. PATIENTS AND METHODS: From November 2015 to August 2017, a clinical pathway was implemented at 20 hospitals. We included patients aged >18 years, with a diagnosis of CAP by the attendant physician. The main outcome was the monthly proportion of low-risk CURB-65 admission after the implementation of the clinical pathway. Logistic regression models were performed to assess variables associated with mortality and readmission in the admitted population within 30 days. RESULTS: We included 10,909 participants with suspected CAP. The proportion of low-risk CAP admitted decreased from 22.1% to 12.8% in the period. Among participants with low risk, there has been no perceptible increase in deaths (0.80%) or readmissions (6.92%). Regression analysis identified that CURB-65 variables, presence of pleural effusion (OR= 1.74; 95%CI=1.08-2.8; p=0.02) and leucopenia (OR= 2.47; 95%CI=1.11-5.48; p=0.02) were independently associated with 30-day mortality, whereas a prolonged hospital stay (OR= 2.09; 95%CI=1.14-3.83; p=0.01) was associated with 30-day readmission in the low-risk population. CONCLUSION: The implementations of a clinical pathway diminished the proportion of low-risk CAP admissions with no apparent increase in clinical outcomes within 30 days. Nonetheless, additional factors influence the clinical decision about the site of care management in low-risk CAP.

Ecological impacts of human-induced animal behaviour change.

A growing body of literature has documented myriad effects of human activities on animal behaviour, yet the ultimate ecological consequences of these behavioural shifts remain largely uninvestigated. While it is understood that, in the absence of humans, variation in animal behaviour can have cascading effects on species interactions, community structure and ecosystem function, we know little about whether the type or magnitude of human-induced behavioural shifts translate into detectable ecological change. Here we synthesise empirical literature and theory to create a novel framework for examining the range of behaviourally mediated pathways through which human activities may affect different ecosystem functions. We highlight the few empirical studies that show the potential realisation of some of these pathways, but also identify numerous factors that can dampen or prevent ultimate ecosystem consequences. Without a deeper understanding of these pathways, we risk wasting valuable resources on mitigating behavioural effects with little ecological relevance, or conversely mismanaging situations in which behavioural effects do drive ecosystem change. The framework presented here can be used to anticipate the nature and likelihood of ecological outcomes and prioritise management among widespread human-induced behavioural shifts, while also suggesting key priorities for future research linking humans, animal behaviour and ecology.

Neuronal antibody prevalence in children with seizures under 3 years: A prospective national cohort.

OBJECTIVE: To report the prevalence of anti-neuronal antibodies in a prospective whole-nation cohort of children presenting with seizures before their third birthday. METHODS: This was a prospective population-based national cohort study involving all children presenting with new-onset epilepsy or complex febrile seizures before their third birthday over a 3-year period. Patients with previously identified structural, metabolic, or infectious cause for seizures were excluded. Serum samples were obtained at first presentation and tested for 7 neuronal antibodies using live cell-based assays. Clinical data were collected with structured proformas at recruitment and 24 months after presentation. In addition, patients with seizures and clinically suspected autoimmune encephalitis were independently identified by a review of the case records of all children <3 years of age in Scotland who had undergone EEG. RESULTS: Two hundred ninety-eight patients were identified and recruited and underwent autoantibody testing. Antibody positivity was identified in 18 of 298 (6.0%). The antibodies identified were GABA receptor B (n = 8, 2.7%), contactin-associated protein 2 (n = 4, 1.3%), glycine receptor (n = 3, 1.0%), leucine-rich glioma inactivated 1 (n = 2, 0.7%), NMDA receptor (n = 1, 0.3%), and GABA receptor A (n = 1, 0.3%). None of these patients had a clinical picture of autoimmune encephalitis. Seizure classification and clinical phenotype did not correlate with antibody positivity. CONCLUSIONS: Autoimmune encephalitis is very rare in early childhood. However serum neuronal antibodies are identified in 6.4% of children presenting with seizures at <3 years of age. Antibody testing should not be a routine clinical test in early childhood-onset epilepsy because, in the absence of other features of autoimmune encephalitis, antibody positivity is of doubtful clinical significance. Antibody testing should be reserved for patients with additional features of encephalitis.