Monitoring Readiness to Train and Perform in Female Football: Current Evidence and Recommendations for Practitioners.

PURPOSE: Monitoring player readiness to train and perform is an important practical concept in football. Despite an abundance of research in this area in the male game, to date, research is limited in female football. The aims of this study were, first, to summarize the current literature on the monitoring of readiness in female football; second, to summarize the current evidence regarding the monitoring of the menstrual cycle and its potential impact on physical preparation and performance in female footballers; and third, to offer practical recommendations based on the current evidence for practitioners working with female football players. CONCLUSIONS: Practitioners should include both objective (eg, heart rate and countermovement jump) and subjective measures (eg, athlete-reported outcome measures) in their monitoring practices. This would allow them to have a better picture of female players' readiness. Practitioners should assess the reliability of their monitoring (objective and subjective) tools before adopting them with their players. The use of athlete-reported outcome measures could play a key role in contexts where technology is not available (eg, in semiprofessional and amateur clubs); however, practitioners need to be aware that many single-item athlete-reported outcome measures instruments have not been properly validated. Finally, tracking the menstrual cycle can identify menstrual dysfunction (eg, infrequent or irregular menstruation) that can indicate a state of low energy availability or an underlying gynecological issue, both of which warrant further investigation by medical practitioners.

Motivational predictors of children's involvement in out-of-school activities: An application of a football program.

The "11 for Health in Denmark" in-school educational football program has shown to have numerous positive physiological and psychological effects in 10- to 12-year-old schoolchildren. A key part of the successful application of the program, however, has not yet been examined, namely the motivational processes underlying participation and behavioral changes. This study examined such motivational processes (i.e., autonomous motivation, beliefs, and intentions) using the trans-contextual model (TCM) and investigated if the 11 for Health in Denmark program increased intentions to participate in physical activity (PA) outside of school in 10- to 12-year-old schoolchildren. Using a web-based questionnaire, Danish-speaking schoolchildren (N = 276 [boys, 50.4%]; Mage  = 10.44, SD = 0.35) from three schools and seven classes completed TCM-based questionnaires at three time-points (weeks 0, 1, and 5) while participating in the 11 for Health in Denmark program. Single-indicator structural equation modeling was performed to examine goodness-of-fit and parameter estimates. A path analysis using maximum likelihood estimation was used to test the direct and indirect effects of the TCM model. The results partly supported a mediation sequence, as we found significant direct effects in eight of 13 motivational variables (ß = -0.25-0.83, p < 0.05), indirect effects in one of nine variables (ß = 0.15, p < 0.01), but no effects with regard to PA behavior. Findings provide evidence for a motivational link between Danish-speaking schoolchildren's autonomous and controlled motivation from in school to out of school, and may inform future interventions promoting motivation and participation in out of school PA.

Monitoring load, wellness, and psychological variables in female and male youth national team football players during international and domestic playing periods.

Aim: To study differences in total load exposure, wellness, and psychological variables in youth female (N = 19) and male (N = 20) national team football players during domestic and international playing periods, respectively. Procedures: The players filled out questionnaires on well-being, stress, and resilience before and after both playing periods lasting 8 days each. The Hooper index was used to monitor daily wellness levels during both playing periods. The number of training sessions and matches were recorded, and the session rating of perceived exertion was collected. Training load, monotony, and strain were calculated. Daily measurements were used to evaluate in-period changes, and composite scores were used to describe differences between periods. Results: The international compared to the domestic playing period was for both groups characterized by more matches played, longer field training session durations, and of fewer gym-based sessions (P < 0.05). The male players increased total exposure time (25%; P < 0.05), monotony (P < 0.001), and strain (P < 0.001), which was not changed in the female players. Well-being decreased (P < 0.05) during the international playing period in male players. Stress levels were higher (P < 0.05) for both genders during the international compared to the domestic playing period. During the international playing period, positive correlations were found between the initial levels of stress, and the change in stress (P = 0.03; r2 = 0.12), and between the changes in total load and changes in well-being (P = 0.02; r2 = 0.12), whereas a negative correlation was found between the changes in wellness and stress (P = 0.03; r2 = 0.14). Conclusion: A playing period characterized by increased match focus, longer field training sessions, and fewer gym-based training activities may lead to changes in the physical and mental profiles of youth national team football players. Alterations to load exposure and wellness may influence mental health. Players with high initial stress levels may be subjected to greater changes compared to other players. Sports scientists and medical staff may benefit from initiating structured monitoring systems to track alterations in physical load and mental health in youth national team players.

Well-Being, Physical Fitness, and Health Profile of 2,203 Danish Girls Aged 10-12 in Relation to Leisure-time Sports Club Activity-With Special Emphasis on the Five Most Popular Sports.

ABSTRACT: Madsen, M, Larsen, MN, Cyril, R, Møller, TK, Madsen, EE, Ørntoft, C, Lind, RR, Ryom, K, Christiansen, SR, Wikman, J, Elbe, AM, and Krustrup, P. Well-being, physical fitness, and health profile of 2,203 Danish girls aged 10-12 in relation to leisure-time sports club activity-with special emphasis on the five most popular sports. J Strength Cond Res 36(8): 2283-2290, 2022-This study investigated the relationship between leisure-time sports club activities and well-being as well as physical health parameters in 10-12-year-old Danish girls. Two thousand two hundred three girls took part in the study, which included questionnaires on participation in leisure-time sports clubs, well-being, Yo-Yo intermittent recovery level 1 children's test, long jump, balance tests, body composition, blood pressure (BP), and resting heart rate (RHR). Data were analyzed according to whether the girls participated in leisure-time sport and according to the 5 most frequently reported sports. Girls enrolled in leisure-time sports had higher physical well-being (49.3 ± 8.6 vs. 45.2 ± 8.3), psychological well-being (50.4 ± 9.0 vs. 49.4 ± 9.8), experienced more peer and social support (50.2 ± 10.0 vs. 48.9 ± 10.7), and perceived a more positive school environment (52.5 ± 8.0 vs. 50.5 ± 9.3), as well as showing higher Yo-Yo (+39%), long jump (+10%), and balance performance (+15%) than girls not involved in sport clubs. The girls active in sports clubs had higher relative muscle mass (+5%), lower fat percentage (-11%), body mass index (-5%), RHR (-3.4 b·min -1 ), and diastolic BP (-1.4 mm Hg) compared with girls not involved in sport ( p < 0.05). Girls who played soccer showed higher aerobic fitness compared with inactive girls (+67%), dancers (+39%), swimmers (+38%), and gymnasts (+16%). Gymnasts had a lower fat percentage than inactive girls (-19%), team handballers (-10%), swimmers (-12%), and soccer players (-4%). Girls participating in club-based leisure-time sports showed higher well-being and better fitness and health profiles than girls not involved in any sports club activities. Girls involved in soccer had better aerobic fitness and gymnasts a lower fat percentage.

The Danish "11 for Health" program raises health knowledge, well-being, and fitness in ethnic minority 10- to 12-year-olds.

OBJECTIVES: This study investigated the effects of the health promotion intervention "11 for Health in Denmark" program on 10- to 12-year-old ethnic minority schoolchildren's enjoyment, health knowledge, well-being, and fitness. METHODS: 1122 Danish 5th grade schoolchildren with ethnic minority background from 154 schools were randomized (5:1) to an intervention group (IG, n = 944) or a control group (CG, n = 178). The IG and CG were also divided into subgroups of children active in a sports club (IGPA: n = 644; CGPA: n = 122) and not active in a sports club (IGPI: n = 300, CGPI: n = 56). IG participated in the "11 for Health in Denmark" 11-week program, consisting of 2 × 45 min per week of football drills, small-sided games, and health education, whereas CG continued their regular activities. Pre-post physical testing and questionnaires were applied (short version of the multidimensional well-being questionnaire KIDSCREEN-27, and a 34-item health knowledge questionnaire). RESULTS: The "11 for Health in Denmark" program was rated moderate-to-high on a 1-5 scale for enjoyment by girls (3.57) and boys (3.65). The intervention had positive between-group effect on health knowledge in relation to hygiene (IG vs GC: 10.6% points (CI95%: 6.9:14.3), p < 0.05), nutrition (9.6% point (CI95%: 7.4:11.8), p < 0.01) and physical activity 4.4% points (CI95%: 2.2:6.6) as well as overall health knowledge (5.7% points, (CI95%: 4.3;7.1), p < 0.05), with similar effects for girls and boys. The IGPI subgroup showed a positive effect on well-being (p = 0.04, school and learning) and also fitness effects on performance and VO2  max (p = 0.02: p = 0.01). The IGPA subgroup showed a positive effect on fitness scores (p = 0.02, BMI). CONCLUSION: The intervention program was enjoyable and had a positive impact on health knowledge of ethnic minority background schoolchildren. In addition, the intervention program had the strongest positive effects on well-being and fitness scores for the non-sports club-active children.

Implementation facilitation of the "11 for Health in Denmark": A case study in a Danish 5th grade class.

The "11 for Health in Denmark" concept aims to enhance 10-12-year-old schoolchildren's physical activity levels and health knowledge through an 11-week football intervention and has been shown to induce positive effects in numerous areas. However, little is known about the implementation facilitation of this concept in schools. This case study therefore aims to gain a deeper understanding of the implementation facilitation of "11 for Health" in a Danish 5th grade class comprising 22 schoolchildren (12 boys and 10 girls, Mage 11.86±) and one teacher. Data were derived from multiple school situations using photographs and videos, observations, and informal interviews. Five themes were identified: (1) environmental and organizational factors impacting on the implementation; (2) familiarization with the concept for the teacher and schoolchildren; (3) previous clique formation; (4) the central role of the teacher; and (5) the importance of how praise partners are allocated. We found high adherence to the "11 for Health" concept, in which the teacher played a key role by applying an autonomy-supportive style of teaching and using the praise partner concept in a suitable manner. A clique of football-playing boys was a resource, as their praising of classmates encouraged adherence. However, familiarization with the "11 for Health" concept was a challenge and the clique's competitive nature occasionally built barriers to other schoolchildren without football experience, potentially leading to a more controlled form of motivation. Based on the results, we encourage teachers to apply autonomy-supportive teaching when applying the "11 for Health" concept.

Physical performance and loading for six playing positions in elite female football: full-game, end-game, and peak periods.

The present study investigated the position-specific match demands and heart rate response of female elite footballers, with special focus on the full-game, end-game, and peak-intensity periods. In total, 217 match observations were performed in 94 players from all eight teams of the best Danish Women's League, that is, goalkeepers (GK, n = 10), central defenders (CD, n = 23), full-backs (FB, n = 18), central midfielders (CM, n = 28), external midfielders (EM, n = 18), and forwards (FW, n = 11). Positional data (GPS; 10 Hz Polar Team Pro) and HR responses were collected. HRmean and HRpeak were 87%-89% and 98%-99% of HRmax , for outfield players, with no positional differences. CM, EM, and FB covered 8%-14% greater (P < .001) match distances than CD. EM, FW, FB, and CM performed 40%-64% more (P < .05) high-speed running and 41%-95% more (P < .01) very-high-speed running (VHSR) than CD. From the first to the last 15-minute period, total distance, except for FW, number of VHSR, except FB, peak speed and sum of accelerations and sum of decelerations decreased (P < .05) for all outfield positions. In the most intense 5-minute period, EM, FB, and CM performed 25%-34% more (P < .01) HSR than CD, whereas EM, FW, and FB performed 36%-49% more (P < .01) VHSR than CD. In conclusion, competitive elite female matches impose high physical demands on all outfield playing positions, with high aerobic loading throughout matches and marked declines in high-speed running and intense accelerations and decelerations toward the end of games. Overall physical match demands are much lower for central defenders than for the other outfield playing positions, albeit this difference is minimized in peak-intensity periods.

Can psychological characteristics, football experience, and player status predict state anxiety before important matches in Danish elite-level female football players?

Elite football can make players feel nervous, and personality characteristics, as well as experience, affect how well pressure is handled before important games. Studying the psychological characteristics of female football players can provide information on how well psychological pressure is handled and generate knowledge on how to support players in order to improve performance. Based on a sample of 128 female elite football players from 8 top-level teams, the present study investigates whether psychological characteristics and football experience/player stus in elite female football players can predict state anxiety before important matches. Our results outline that high age and national team experience negatively predicted most of the trait anxiety subscales. In line with previous research, no psychological differences were found between goalkeepers, defenders, midfielders, and strikers while starting players revealed to have significantly lower trait anxiety. When measuring before important matches, we found that somatic state anxiety was negatively associated with senior national team experience and positively associated with worry trait anxiety and fear of failure. Cognitive state anxiety was negatively associated with hope for success and positively associated with somatic and worry trait anxiety. Self-confidence was positively associated with youth national team experience and negatively associated with worry trait anxiety. It can be concluded that psychological characteristics and national team experience are both important for optimal state anxiety before important matches in elite-level women's football. Implications for practice and future research are discussed.

Well-being, physical fitness and health profile of 10-12 years old boys in relation to leisure-time sports club activities: a cross-sectional study.

OBJECTIVES: This study investigated the correlation between sports club activities and well-being and physical health parameters in 10-12 years old boys. DESIGN: Cross sectional. SETTING: Danish schools. PARTICIPANTS: 2293 boys took part in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Questionnaires on participation in sports clubs and well-being and testing of physical health profile through measurement of body composition, resting heart rate (RHR), blood pressure and postural balance, jump and Yo-Yo IR1C performance. Data were analysed by participation in sport and according to the five most frequently reported sports. RESULTS: Boys enrolled in sports clubs had higher physical well-being (51.7±9.7 vs 45.9±8.7) and psychological well-being (53.3±9.6 vs 51.4±10.0), experienced more peers and social support (50.9±9.9 vs 48.0±11.6), and had a more positive perception of the school environment (48.6±7.5 vs 45.9±8.1) than boys not involved in sports clubs. In addition, they showed better Yo-Yo IR1C (+46%), long jump (9%) and balance test performance (+20%). The boys active in sports clubs had higher relative muscle mass (+6%) and lower fat percentage (-3%), body mass index (-6%) and RHR (-5%) compared with boys not involved in sports clubs (p<0.05). Boys enrolled in football clubs had higher aerobic fitness compared with boys not active in clubs (+11%), handball players (+5%), swimmers (+8%) and badminton players (+7%). Moreover, the boys enrolled in football clubs had lower fat percentage (-17%) and higher relative muscle mass (+4%) than swimmers. CONCLUSION: Boys participating in club-based sports showed markedly higher levels of well-being and better physical health profiles than boys not involved in sports club activities. Footballers had superior aerobic fitness and body composition compared with those active in other sports. Results suggest that sports club activities seem to be beneficial for young boys' well-being, fitness and physical health profile, with the greatest benefits achieved by boys involved in football.

An 11-week school-based 'health education through football programme' improves health knowledge related to hygiene, nutrition, physical activity and well-being-and it's fun! A scaled-up, cluster-RCT with over 3000 Danish school children aged 10-12 years old.

ObjectivesOur large-scale cluster randomised controlled trial aimed to investigate the effects on health knowledge and enjoyment of an 11 week 'health education through football' programme for children aged 10-12 years old. Methods 3127 Danish school children (49% girls) aged 10-12 years from a total of 154 schools located in 63% of the Danish municipalities (69 of 98) took part in the analysis. A 5:1 cluster randomisation was performed at school level for the intervention group (IG) or the control group (CG). The twice-weekly 45 min intervention was the '11 for Health in Denmark' programme, which includes health education, football drills and small-sided games. The health education element focused on hygiene, nutrition, physical activity and well-being. Outcomes: The participants completed a 34-item multiple-choice computer-based health knowledge questionnaire preintervention and postintervention. IG also evaluated whether the programme was enjoyable. Results Between-group differences (p<0.05) were observed in overall health knowledge in favour of IG (+7.2% points, 95% CI 6.1% to 8.4%, effect size, ES:0.59), with similar effects for girls (+7.4% points, 95% CI 5.9% to 9.0%, ES:0.57) and for boys (+7.0% points, 95% CI 5.3% to 8.7%, p<0.05, ES:0.51). Marked between-group differences were observed in favour of IG, for health knowledge related to hygiene (IG vs CG:+13.9% points, 95% CI 11.1% to 16.7%, ES:0.53), nutrition (+10.3% points, 95% CI 8.5% to 12.1%, ES:0.53), physical activity (+5.9% points, 95% CI 4.1% to 7.7%, ES:0.36) and well-being (+4.4% points, 95% CI 2.7% to 6.1%, ES:0.28). Both girls and boys gave the programme moderate to high scores for enjoyment (3.6±1.0 and 3.7±1.1, respectively). Conclusion Health education through sport, using the '11 for Health' model, was enjoyable for girls and boys aged 10-12 years old, and improved health knowledge related to hygiene, nutrition, physical activity and well-being.

Resilience as a protective factor for well-being and emotional stability in elite-level football players during the first wave of the COVID-19 pandemic.

Background: In Denmark, the first COVID-19 pandemic lockdown resulted in a compact season finisher for elite footballers, potentially impacting their mental health.Purpose: This study aimed to investigate the protective role of resilience and the impeding role of trait anxiety on elite footballers' level and variability of well-being and emotional stability.Material and Methods: One hundred and twenty-five male elite-level players (Mage = 25.04 ± 4.82) completed baseline measures on trait anxiety and resilience. Additionally, well-being and positive and negative affect were assessed before games (n = 24) over 62 days. Separate two-level regression analysis using Bayesian statistics was conducted to test potential relationships. Results: Results show a credible positive relationship between the average level of well-being and within-person variability over time as well as the average level in positive affect. This indicates that resilience might be a protector for mental health. In addition, higher levels of trait anxiety (i.e., subscale concentration disruption) were associated with higher levels of negative affect and higher variability over time. This indicates that trait anxiety might facilitate negative affect. No other credible relationships were found. Conclusion: High resilience and low trait anxiety are identified as relevant factors for mental health within elite footballers during COVID-19. Implications for practice are discussed.

Xdrop: Targeted sequencing of long DNA molecules from low input samples using droplet sorting.

Long-read sequencing can resolve regions of the genome that are inaccessible to short reads, and therefore are ideal for genome-gap closure, solving structural rearrangements and sequencing through repetitive elements. Here we introduce the Xdrop technology: a novel microfluidic-based system that allows for targeted enrichment of long DNA molecules starting from only a few nanograms of DNA. Xdrop is based on the isolation of long DNA fragments in millions of droplets, where the droplets containing a target sequence of interest are fluorescently labeled and sorted using flow cytometry. The final product from the Xdrop procedure is an enriched population of long DNA molecules that can be investigated by sequencing. To demonstrate the capability of Xdrop, we performed enrichment of the human papilloma virus 18 integrated into the genome of human HeLa cells. Analysis of the sequencing reads resolved three HPV18-chr8 integrations at base-pair resolution, and the captured fragments extended up to 30 kb into the human genome at the integration sites. Further, we enriched the complete TP53 locus in a leukemia cell line and could successfully phase coexisting mutations using PacBio sequencing. In summary, our results show that Xdrop is an efficient enrichment technology for studying complex genomic regions.

The "11 for Health in Denmark" intervention in 10- to 12-year-old Danish girls and boys and its effects on well-being-A large-scale cluster RCT.

BACKGROUND: The present study investigates the well-being effects for 10- to 12-year-old children  who participated in the school-based intervention "11 for Health in Denmark," which comprises physical activity (PA) and health education. Subgroup analyses were carried out for boys and girls. METHOD: Three thousand sixty-one children were randomly assigned to an intervention group (IG) or a control group (CG) by 5:1 cluster randomization by school. 2533 children (mean age 11.5 ± 0.4; 49.7% boys) were assigned to IG and 528 children (mean age 11.4 ± 0.5; 50.8% boys) were assigned to CG. IG participated in the "11 for Health in Denmark" 11-week program, consisting of 2 × 45 min per week of football drills, small-sided games, and health education. CG did not participate in any intervention and continued with their regular education. Before and after the intervention period, both groups answered a shortened version of the multidimensional well-being questionnaire KIDSCREEN-27. RESULTS: The "11 for Health in Denmark" intervention program had a positive effect on physical well-being in girls (IG: 48.6 ± 8.5 to 50.2 ± 9.3), whereas the improvement was not significant in boys. The program also had a positive impact on well-being scores for peers and social support (IG: 50.2 ± 10.2 to 50.8 ± 10.1), though when analyzed separately in the subgroups of boys and girls the changes were not significant. No between-group differences were found for psychological well-being or school environment. CONCLUSION: The intervention program had a positive between-group effect on physical well-being in girls, whereas the change was not significant in boys. The overall scores for peers and social support improved during the intervention period, but no subgroup differences were found.

Physical Fitness and Body Composition in 10-12-Year-Old Danish Children in Relation to Leisure-Time Club-Based Sporting Activities.

This study investigated whether the physical fitness and body composition of 10-12-year-old Danish children are related to participation in leisure-time club-based sporting activities. The study involved 544 Danish 10-12-year-old 5th-grade municipal schoolchildren (269 boys and 275 girls, 11.1 ± 0.4 years). After answering a questionnaire about leisure-time sporting activities, the children were divided into four groups: football club participation (FC; n=141), other ball games (OBG; n=42), other sports (OS; n=194), and no sports-club participation (NSC; n=167). The children completed a battery of health and fitness tests, including a 20 m sprint test, a standing long-jump test, the Yo-Yo IR1 children's test (YYIR1C), and body composition, blood pressure, resting heart rate (HRrest), and the flamingo balance test. The children engaged in club-based ball games (FC and OBG) had higher (p<0.05) lean body mass than NSC (FC: 17.5 ± 2.9; OBG: 18.4 ± 2.6; OS: 16.7 ± 2.9; NSC: 16.4 ± 2.8 kg), performed better (p<0.05) in the YYIR1C test (FC: 1083 ± 527; OBG: 968 ± 448; OS: 776 ± 398; NSC: 687 ± 378 m), and had lower (p<0.05) %HRmax after 1, 2, and 3 min of YYIR1C. Moreover, HRrest was lower (p<0.05) for FC than for OS and NSC (FC: 68 ± 9 vs OS: 72 ± 10 and NSC: 75 ± 10 bpm), and lower (p<0.05) for OBG than for NSC (OBG: 70 ± 10 vs NSC: 75 ± 10 bpm). This study found that 10-12-year-old Danish children engaged in club-based football and other ball games had better exercise capacity, lower resting heart rate, and higher muscle mass than children not engaged in leisure-time sports. Thus, participation in club-based leisure-time ball-game activities seems to be of importance for the fitness and health profile of prepubertal children.

Nurses' Use of iPads in Home Care-What Does It Mean to Patients?: A Qualitative Study.

Although the use of technology is growing, little is known about how patients perceive technology in the form of tools used by health professionals. The prevailing view in the literature is that technology is cold, compared with the warm hands of nurses, but research regarding nurses' use of technology such as tablets is scarce. Even scarcer is research on how patients perceive the use of technological tools. This study examines patients' perspectives on the use of iPads by home care nurses. Semistructured interviews were conducted with seven participants who were receiving home care in Denmark, aged 62 to 90 years, with different backgrounds and experiences with technology. Participants viewed nurses' use of iPads as an everyday occurrence, reflecting societal growth in the use of technology, and some perceived it as a sign of professionalism with the potential to enhance care. Their perceptions varied somewhat according to their baseline knowledge and experience with the technology. Although nurses may view technology as cold, the findings suggest that patients have a slightly warmer view of it. More patient-centered research into the use of technology in healthcare is needed.

Is therapeutic judgement influenced by the patient's socio-economic status? A factorial vignette survey.

Background In Denmark patients are entitled to rehabilitation regardless of socio-economic status (SES). During this process therapists have to balance cost effectiveness with providing equal treatment. Aim To investigate whether occupational therapists and physiotherapists were influenced by the patient's SES. Material and method An experimental factorial vignette survey was used. Four different vignettes describing fictitious patient cases with different SES variables were randomly allocated to therapists working in somatic hospitals. Thereafter, the therapists judged specific clinical situations and general attitudes in relation to the patient's SES. Chi-square was used to test the statistical association between the variables. Results No statistically significant associations were found between the specific clinical situations and the patient's SES. A statistical significant association was found between general attitudes and the patient's SES. Subgroup analysis revealed a statistically significant association between the therapist's gender, age, and the therapeutic judgement in relation to SES. Conclusion In the specific clinical situations, Danish therapists seem to maintain their professional ethical principles, although they might face ethical dilemmas during their clinical decision-making. In order to prevent and resolve these dilemmas, they have to be made explicit. However, further research on how SES influences the health care professional's judgement is warranted.

The effect of rater training on scoring performance and scale-specific expertise amongst occupational therapists participating in a multicentre study: a single-group pre-post-test study.

PURPOSE: In order to enhance the quality of the data collected in a multicentre validation study of a revised Danish version of the McGill Ingestive Skills Assessment (MISA), the authors developed a rater training programme. The purpose of the present study was to evaluate the effect of the training on scoring performance and scale-specific expertise amongst raters. METHOD: During 2 days of rater training, 81 occupational therapists (OTs) were qualified to observe and score dysphagic clients' mealtime performance according to the criteria of 36 MISA-items. The training effects were evaluated pre- to post-training using percentage exact agreement (PA) of scored MISA items of a case-vignette and a Likert scale self-report of scale-specific expertise. RESULTS: PA increased significantly from pre- to post-training (Z = -4.404, p < 0.001), although items for which the case-vignette reflected deficient mealtime performance appeared most difficult to score. The OTs scale-specific expertise improved significantly (knowledge: Z = -7.857, p < 0.001 and confidence: Z = -7.838, p < 0.001). CONCLUSION: Rater training improved OTs scoring performance when using the Danish MISA as well as their perceived scale-specific expertise. Future rater training should emphasis the items identified as those most difficult to score. Additionally, further studies addressing different training approaches and durations are warranted. IMPLICATIONS FOR REHABILITATION: When occupational therapists (OTs) use the McGill Ingestive Skills Assessment (MISA) they observe, interpret and record occupational performance of dysphagic clients participating in a meal. This is a highly complex task, which might introduce unwanted variability in measurement scores. A 2-day rater training programme was developed and this builds on the findings of several studies. These suggest that combinations of different training methods tend to yield the most effective results. Participation in the newly developed training programme on how to administer the MISA significantly reduces unwanted variability in measurement scores and improves OTs' competency. The training programme could be used in undergraduate and postgraduate dysphagia education initiatives to help OTs understanding of the content and the scoring criteria for each aspect of occupational performance during a meal, thus developing observation skills as well as recognizing and avoiding the most common errors in measurement scores.

Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine.

A 67-year-old man underwent surgery under general anaesthesia to obtain a biopsy from a tumour in the left maxillary sinus. Before the procedure a mucosal detumescence containing epinephrine and cocaine was applied onto the nasal mucosa. Shortly after termination of anaesthesia the patient developed tachycardia and an abrupt rise in blood pressure followed by a drop to critical levels. The patient turned pale and clammy but denied chest pain at any time. An ECG showed inferolateral ST-segment elevation, and troponin T was elevated at 0.773 ng/mL. An acute coronary angiography demonstrated normal coronary arteries; however, left ventriculography showed apical ballooning of the left ventricle, and the diagnosis of takotsubo cardiomyopathy was made. This was confirmed by a subsequent transthoracic echocardiography. Four days later the patient had complete resolution of the symptoms, and a new echocardiography showed normalisation of the left ventricular systolic function with no signs of apical ballooning.

Legume receptors perceive the rhizobial lipochitin oligosaccharide signal molecules by direct binding.

Lipochitin oligosaccharides called Nod factors function as primary rhizobial signal molecules triggering legumes to develop new plant organs: root nodules that host the bacteria as nitrogen-fixing bacteroids. Here, we show that the Lotus japonicus Nod factor receptor 5 (NFR5) and Nod factor receptor 1 (NFR1) bind Nod factor directly at high-affinity binding sites. Both receptor proteins were posttranslationally processed when expressed as fusion proteins and extracted from purified membrane fractions of Nicotiana benthamiana or Arabidopsis thaliana. The N-terminal signal peptides were cleaved, and NFR1 protein retained its in vitro kinase activity. Processing of NFR5 protein was characterized by determining the N-glycosylation patterns of the ectodomain. Two different glycan structures with identical composition, Man(3)XylFucGlcNAc(4), were identified by mass spectrometry and located at amino acid positions N68 and N198. Receptor-ligand interaction was measured by using ligands that were labeled or immobilized by application of chemoselective chemistry at the anomeric center. High-affinity ligand binding was demonstrated with both solid-phase and free solution techniques. The K(d) values obtained for Nod factor binding were in the nanomolar range and comparable to the concentration range sufficient for biological activity. Structure-dependent ligand specificity was shown by using chitin oligosaccharides. Taken together, our results suggest that ligand recognition through direct ligand binding is a key step in the receptor-mediated activation mechanism leading to root nodule development in legumes.