Pharmacokinetic serum concentrations of VRC01 correlate with prevention of HIV-1 acquisition.

BACKGROUND: The phase 2b proof-of-concept Antibody Mediated Prevention (AMP) trials showed that VRC01, an anti-HIV-1 broadly neutralising antibody (bnAb), prevented acquisition of HIV-1 sensitive to VRC01. To inform future study design and dosing regimen selection of candidate bnAbs, we investigated the association of VRC01 serum concentration with HIV-1 acquisition using AMP trial data. METHODS: The case-control sample included 107 VRC01 recipients who acquired HIV-1 and 82 VRC01 recipients who remained without HIV-1 during the study. We measured VRC01 serum concentrations with a qualified pharmacokinetic (PK) Binding Antibody Multiplex Assay. We employed nonlinear mixed effects PK modelling to estimate daily-grid VRC01 concentrations. Cox regression models were used to assess the association of VRC01 concentration at exposure and baseline body weight, with the hazard of HIV-1 acquisition and prevention efficacy as a function of VRC01 concentration. We also compared fixed dosing vs. body weight-based dosing via simulations. FINDINGS: Estimated VRC01 concentrations in VRC01 recipients without HIV-1 were higher than those in VRC01 recipients who acquired HIV-1. Body weight was inversely associated with HIV-1 acquisition among both placebo and VRC01 recipients but did not modify the prevention efficacy of VRC01. VRC01 concentration was inversely correlated with HIV-1 acquisition, and positively correlated with prevention efficacy of VRC01. Simulation studies suggest that fixed dosing may be comparable to weight-based dosing in overall predicted prevention efficacy. INTERPRETATION: These findings suggest that bnAb serum concentration may be a useful marker for dosing regimen selection, and operationally efficient fixed dosing regimens could be considered for future trials of HIV-1 bnAbs. FUNDING: Was provided by the National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIAID) (UM1 AI068614, to the HIV Vaccine Trials Network [HVTN]; UM1 AI068635, to the HVTN Statistical Data and Management Center [SDMC], Fred Hutchinson Cancer Center [FHCC]; 2R37 054165 to the FHCC; UM1 AI068618, to HVTN Laboratory Center, FHCC; UM1 AI068619, to the HPTN Leadership and Operations Center; UM1 AI068613, to the HIV Prevention Trials Network [HPTN] Laboratory Center; UM1 AI068617, to the HPTN SDMC; and P30 AI027757, to the Center for AIDS Research, Duke University (AI P30 AI064518) and University of Washington (P30 AI027757) Centers for AIDS Research; R37AI054165 from NIAID to the FHCC; and OPP1032144 CA-VIMC Bill & Melinda Gates Foundation.

Injury Prevention Programs Based on Flywheel vs. Body Weight Resistance in Recreational Athletes.

ABSTRACT: Monajati, A, Larumbe-Zabala, E, Sampson, MG, and Naclerio, F. Injury prevention programs based on flywheel vs. body weight resistance in recreational athletes. J Strength Cond Res 35(2S): S188-S196, 2021-This study compares the effect of an isoinertial flywheel technology vs. a traditional gravity-dependent exercise protocol on modifiable factors associated with the incidence of hamstring strain (HAM) and anterior cruciate ligament (ACL) injuries. Furthermore, the effect on repeated sprint ability was also considered. Eighteen recreationally trained volleyball players completed one of the following 6-week protocols: (a) flywheel (FY) included 3 exercises using a YoYo isoinertial-squat machine and 3 exercises with a Versa-Pulley isoinertial device, and (b) gravity-dependent (GT) involved 6 similar exercises with no external resistance (participants' body weight). Both programs consisted in 2 sessions·wk-1 performing 2 sets of 8 repetitions with 2 minutes of rest. Outcomes included a 10-second tuck jump assessment (TJA), landing knee valgus score, hamstring and quadriceps concentric and eccentric isokinetic 60°·s-1 peak torque, optimal peak torque localization, conventional and functional hamstring-to-quadriceps ratio, and 30-m repeated shuttle sprint ability (RSSA) test. FY improved TJA (-2, interquartile range [IQR] = -3 to -1) and valgus (-1, IQR = -1 to 0) scores, hamstring eccentric (20.37, 95% confidence interval [CI] = 9.27-31.47 N·m) and concentric (17.87, 95% CI = 0.40-35.34 N·m) peak torque, as well as the RSSA (-0.28, 95% CI = -0.45 to -0.10 seconds), whereas GT only improved hamstring eccentric peak torque (21.41, 95% CI = 9.00-33.82 N·m). A 6-week protocol using flywheel technology seems to elicit better positive adaptations to protect athletes from HAM and ACL injuries and to enhance RSSA performance compared to exercising with no external resistance other than athletes' body weight.

Blood pressure-lowering efficacy of a 6-week multi-modal isometric exercise intervention.

Isometric exercise training (IET) is an effective method for reducing resting blood pressure (BP). To date, no research studies have been conducted using multiple exercises within an IET intervention. Previous research has suggested that varied exercise programmes may have a positive effect on adherence. Therefore, this randomized controlled study aimed to investigate the BP-lowering efficacy of a multi-modal IET (MIET) intervention in healthy young adults. Twenty healthy participants were randomized to an MIET [n = 10; four women; SBP 117.9 ± 6.9 mmHg; DBP 66.3 ± 5.1 mmHg] or control (CON) group (n = 10; five women; SBP, 123.3 ± 10.4 mmHg; DBP, 77.3 ± 6.7 mmHg). The MIET group completed three sessions per week of 4, 2-min isometric contractions, with a 1-min rest between each contraction, for 6 weeks. Resting BP and heart rate (HR) were measured at baseline and post-intervention. Pre-to-post intervention within-group reductions in resting BP were observed (SBP: 5.3 ± 6.1 mmHg, DBP: 3.4 ± 3.7 mmHg, MAP: 4.0 ± 3.9 mmHg, HR: 4.8 ±6 .6 bpm), although clinically relevant (≥2 mmHg), these changes were not statistically significant. Significant (p < 0.05) between-group differences were found between the intervention and control groups, indicating that the MIET intervention has a greater BP-lowering effect compared to control. The clinically relevant post-training reductions in resting BP suggest that MIET may be a promising additional IET method for hypertension prevention. These findings; however, must be interpreted with caution due to the small sample size and the non-clinical cohort.

Efficacy and safety of PT20, an iron-based phosphate binder, for the treatment of hyperphosphataemia: a randomized, double-blind, placebo-controlled, dose-ranging, Phase IIb study in patients with haemodialysis-dependent chronic kidney disease.

BACKGROUND: Hyperphosphataemia is a common complication of chronic kidney disease (CKD). PT20 (ferric iron oxide adipate) is an investigational molecule engineered to offer enhanced phosphate-binding properties relative to other phosphate binders. METHODS: In this double-blind, parallel-group, placebo-controlled, dose-ranging study (ClinicalTrials.gov identifier NCT02151643), the efficacy and safety of 28 days of oral PT20 treatment were evaluated in patients with dialysis-dependent CKD. Participants were randomly assigned in an 8:8:8:13:13 ratio to receive PT20 (400, 800, 1600 or 3200 mg) or placebo three times daily. RESULTS: Among 153 participants, 129 completed treatment [7 discontinued because of adverse events (AEs), 2 because of hyperphosphataemia and 15 for other reasons]. PT20 treatment for 28 days resulted in a statistically significant and dose-dependent reduction in serum phosphate concentration. There were no statistically significant effects of PT20 treatment on changes in haemoglobin or ferritin concentrations or transferrin saturation between Days 1 and 29. The incidence of treatment-emergent AEs was broadly similar across the PT20 and placebo groups (42-59% versus 44%). The most common PT20 treatment-related AEs were gastrointestinal, primarily diarrhoea (13-18%) and discoloured faeces (3-23%). No serious AEs were considered to be related to study treatment. There were no clinically significant changes in laboratory results reflecting acid/base status or increases in ferritin that could indicate the absorption of components of PT20. CONCLUSIONS: In this first study investigating the efficacy and safety of PT20 in patients with hyperphosphataemia and dialysis-dependent CKD, PT20 significantly lowered serum phosphate concentrations and was generally well tolerated.

Surface Electromyography Analysis of Three Squat Exercises.

The aim of this study was to perform an electromyography comparison of three commonly used lower limb injury prevention exercises: a single-leg squat on a bench (SLSB), a double-leg squat (DLS) and a double-leg squat on a BOSU® balance trainer (DLSB). After determining the maximum isometric voluntary contraction of the hamstring and quadriceps, eight female athletes performed 3 repetitions of each exercise, while electromyography activity of the biceps femoris (BF), semitendinosus (ST), vastus lateralis (VL) and vastus medialis (VM) was monitored. Comparisons between exercises revealed higher activation in BF (descending phase: p = 0.016, d = 1.36; ascending phase: p = 0.046, d = 1.11), ST (descending phase: p = 0.04, d = 1.87; ascending phase: p = 0.04, d = 1.87), VL (ascending phase: p = 0.04, d = 1.17) and VM (descending phase: p = 0.05, d = 1.11; ascending phase: p = 0.021, d = 1.133) muscles for the SLSB compared to the DLSQ. Furthermore, higher muscular activation of the ST (ascending phase: p = 0.01, d = 1.51; descending phase: p = 0.09, d = 0.96) and VM (ascending phase: p = 0.065, d = 1.03; descending phase: p = 0.062, d = 1.05) during the SLSB with respect to the DLSB was observed. In conclusion, the SLSB elicits higher neuromuscular activation in both hamstring and quadriceps muscles compared to the other two analysed exercises. Additionally, the higher muscle activation of both medial muscles (ST and VM) during the SLSB suggests that single leg squatting exercises may enhance lower limb medial to lateral balance, and improve knee stability in the frontal plane.

Perceptual, Mechanical, and Electromyographic Responses to Different Relative Loads in the Parallel Squat.

Chapman, M, Larumbe-Zabala, E, Gosss-Sampson, M, Colpus, M, Triplett, NT, and Naclerio, F. Perceptual, mechanical, and electromyographic responses to different relative loads in the parallel squat. J Strength Cond Res 33(1): 8-16, 2019-The effectiveness of the OMNI-RES (0-10) Scale and the electromyographic signal for monitoring changes in the movement velocity were examined during a set to muscular failure using different percentages of 1 repetition maximum (1RM) in the parallel squat exercise (PSQ). Twelve men (26.3 ± 5.8 years) were evaluated on 8 separate days with 48 hours of rest between sessions. After determining the 1RM value, participants underwent 7 tests until achieving muscular failure with the following percentage ranges: 30 to <40%, 40 to <50%, 50 to <60%, 60 to <70%, 70 to <80%, 80 to <90%, and >90%. An optical rotary encoder measured mean accelerative velocity (MAV), and the OMNI-RES (0-10) Scale was used to express the rating of perceived exertion (RPE) after every repetition of each set. In addition, the normalized root mean square signal of the surface electromyography (N-EMG) was calculated for the vastus medialis muscle. The RPE expressed after the first repetition and when the maximum value of MAV was achieved along the sets was lower (p < 0.001, d > 0.8) than the RPE that corresponded to a 10% drop in MAV and at failure. In addition, the initial RPE was useful to distinguish different loading zones by anchoring the OMNI-RES value to the magnitude of the relative load (<60%, 60 to <70% or ≤70% 1RM). Similar patterns were observed using the N-EMG. In conclusion, apart from differentiating between relative loads during a set to failure in the PSQ, the RPE and the N-EMG can both reflect changes associated with the initial, maximal, 10% drop in movement velocity and the muscular failure.

Using Perceptual and Neuromuscular Responses to Estimate Mechanical Changes During Continuous Sets in the Bench Press.

Chapman, M, Larumbe-Zabala, E, Gosss-Sampson, M, Triplett, NT, and Naclerio, F. Using perceptual and neuromuscular responses to estimate mechanical changes during continuous sets in the bench press. J Strength Cond Res 33(10): 2722-2732, 2019-This study analyzed the effectiveness of the OMNI-RES (0-10) and the electromyographic signal for monitoring changes in the movement velocity during a set to muscular failure performed with different relative loads in the bench press (BP) exercise. Ten males (30.8 ± 5.7 years) were evaluated on 8 separate days with 48 hours of rest between sessions. After determining the 1 repetition maximum value, participants performed 7 sets to failure with the following relative loads ranges: 30 < 40%, 40 < 50%, 50 < 60%, 60 < 70%, 70 < 80%, 80 < 90%, and >90%. The mean accelerative velocity (MAV), the rating of perceived exertion (RPE), and the normalized root-mean-square (N-RMS) signal from the anterior deltoids were measured for every repetition of each set. The RPE expressed after the first repetition and when the maximum value of MAV was achieved over the sets was lower (p < 0.001, d > 0.80) than the RPE associated with a 10% drop in MAV and at failure. Furthermore, the initial RPE was useful to distinguish different loading zones between the light relative loads (30 < 40% vs. 40 < 50% vs. 50 < 60%) and from these 3 zones to the higher relative load ranges (60 to >90%). Similar, but less clear, differences were observed for the N-RMS. In conclusion, apart from differentiating between relative loads, the RPE and in some cases N-RMS can both reflect changes associated with the initial, maximal, 10% drop in movement velocity, and muscular failure during a continuous set in the BP.

Validity and reliability of a novel optoelectronic device to measure movement velocity, force and power during the back squat exercise.

This study analysed the validity and reliability of a new optoelectronic device (Velowin) for the measurement of vertical displacement and velocity as well as to estimate force and mechanical power. Eleven trained males with Mean (SD) age = 27.4 (4.8) years, completed an incremental squat exercise test with 5 different loads (<30-90% of their 1-repetition maximum) while displacement and vertical velocity of the barbell were simultaneously measured using an integrated 3D system (3D motion capture system + force platform) and Velowin. Substantial to almost perfect correlation (concordance correlation coefficient = 0.75-0.96), root mean square error as coefficient of variation ±90% confidence interval ≤10% and good to excellent intraclass correlation coefficient = 0.84-0.99 were determined for all the variables. Passing and Bablock regression methods revealed no differences for average velocity. However, significant but consistent bias were determined for average or peak force and power while systematic and not proportional bias was found for displacement. In conclusion, Velowin, in holds of some potential advantages over traditionally used accelerometer or linear transducers, represents a valid and reliable alternative to monitor vertical displacement and velocity as well as to estimate average force and mechanical power during the squat exercise.

Stigma, Emotion Appraisal, and the Family Environment as Predictors of Carer Burden for Relatives of Individuals Who Meet the Diagnostic Criteria for Borderline Personality Disorder.

There is some research exploring carers' experiences within the National Health Service in the UK, but only one has focused on carers of individuals with borderline personality disorder (BPD). Ninety-eight carers completed a questionnaire-based study; 57 carers of individuals who meet the diagnostic criteria for BPD were compared to 41 carers of individuals with other mental health problems. The study aimed to investigate whether perceived stigma, perceived threat of strong emotions, and expressed emotion (EE) within the family environment predicted carer burden. The results showed that carers of those who met the diagnosis for BPD experienced higher levels of carer burden, stigma, EE, emotional over involvement (EOI), criticism (CC), and perceived threat of strong emotions than carers of individuals with other mental health difficulties. EOI, CC, carer group (BPD and mental health), and gender of participant were predictors of carer burden, with EOI explaining the most variance of burden.

Satellite telemetry reveals higher fishing mortality rates than previously estimated, suggesting overfishing of an apex marine predator.

Overfishing is a primary cause of population declines for many shark species of conservation concern. However, means of obtaining information on fishery interactions and mortality, necessary for the development of successful conservation strategies, are often fisheries-dependent and of questionable quality for many species of commercially exploited pelagic sharks. We used satellite telemetry as a fisheries-independent tool to document fisheries interactions, and quantify fishing mortality of the highly migratory shortfin mako shark (Isurus oxyrinchus) in the western North Atlantic Ocean. Forty satellite-tagged shortfin mako sharks tracked over 3 years entered the Exclusive Economic Zones of 19 countries and were harvested in fisheries of five countries, with 30% of tagged sharks harvested. Our tagging-derived estimates of instantaneous fishing mortality rates (F = 0.19-0.56) were 10-fold higher than previous estimates from fisheries-dependent data (approx. 0.015-0.024), suggesting data used in stock assessments may considerably underestimate fishing mortality. Additionally, our estimates of F were greater than those associated with maximum sustainable yield, suggesting a state of overfishing. This information has direct application to evaluations of stock status and for effective management of populations, and thus satellite tagging studies have potential to provide more accurate estimates of fishing mortality and survival than traditional fisheries-dependent methodology.

Analysis of the Hamstring Muscle Activation During two Injury Prevention Exercises.

The aim of this study was to perform an electromyographic and kinetic comparison of two commonly used hamstring eccentric strengthening exercises: Nordic Curl and Ball Leg Curl. After determining the maximum isometric voluntary contraction of the knee flexors, ten female athletes performed 3 repetitions of both the Nordic Curl and Ball Leg Curl, while knee angular displacement and electromyografic activity of the biceps femoris and semitendinosus were monitored. No significant differences were found between biceps femoris and semitendinosus activation in both the Nordic Curl and Ball Leg Curl. However, comparisons between exercises revealed higher activation of both the biceps femoris (74.8 ± 20 vs 50.3 ± 25.7%, p = 0.03 d = 0.53) and semitendinosus (78.3 ± 27.5 vs 44.3 ± 26.6%, p = 0.012, d = 0.63) at the closest knee angles in the Nordic Curl vs Ball Leg Curl, respectively. Hamstring muscles activation during the Nordic Curl increased, remained high (>70%) between 60 to 40° of the knee angle and then decreased to 27% of the maximal isometric voluntary contraction at the end of movement. Overall, the biceps femoris and semitendinosus showed similar patterns of activation. In conclusion, even though the hamstring muscle activation at open knee positions was similar between exercises, the Nordic Curl elicited a higher hamstring activity compared to the Ball Leg Curl.

The Effectiveness of Injury Prevention Programs to Modify Risk Factors for Non-Contact Anterior Cruciate Ligament and Hamstring Injuries in Uninjured Team Sports Athletes: A Systematic Review.

BACKGROUND: Hamstring strain and anterior cruciate ligament injuries are, respectively, the most prevalent and serious non-contact occurring injuries in team sports. Specific biomechanical and neuromuscular variables have been used to estimate the risk of incurring a non-contact injury in athletes. OBJECTIVE: The aim of this study was to systematically review the evidences for the effectiveness of injury prevention protocols to modify biomechanical and neuromuscular anterior cruciate and/or hamstring injuries associated risk factors in uninjured team sport athletes. DATA SOURCES: PubMed, Science Direct, Web of Science, Cochrane Libraries, U.S. National Institutes of Health clinicaltrials.gov, Sport Discuss and Google Scholar databases were searched for relevant journal articles published until March 2015. A manual review of relevant articles, authors, and journals, including bibliographies was performed from identified articles. MAIN RESULTS: Nineteen studies were included in this review. Four assessment categories: i) landing, ii) side cutting, iii) stop-jump, and iv) muscle strength outcomes, were used to analyze the effectiveness of the preventive protocols. Eight studies using multifaceted interventions supported by video and/or technical feedback showed improvement in landing and/or stop-jump biomechanics, while no effects were observed on side-cutting maneuver. Additionally, multifaceted programs including hamstring eccentric exercises increased hamstring strength, hamstring to quadriceps functional ratio and/or promoted a shift of optimal knee flexion peak torque toward a more open angle position. CONCLUSIONS: Multifaceted programs, supported by proper video and/or technical feedback, including eccentric hamstring exercises would positively modify the biomechanical and or neuromuscular anterior cruciate and/or hamstring injury risk factors.

Effects of two different injury prevention resistance exercise protocols on the hamstring torque-angle relationship: a randomized controlled trial.

The effects of two different 6-week lower body injury prevention programmes on knee muscle torque-angle relationship were examined in soccer players. Thirty-two men were randomly assigned to three groups: hamstring-eccentric (ECC) (n = 11), unstable-squatting (UNS) (n = 11), and control (n = 10). Intervention groups performed three training sessions per week using only three ECC or UNS exercises, respectively. Maximal peak knee flexion torque was measured at 35°, 45°, 60°, 80°, 90°, and 100°, pre- and post-intervention. Peak torque increased at 35° (P = 0.034, Cohen's d = 0.67) and 45° (P = 0.004, Cohen's d = 0.96) in the ECC group, and at 60° (P = 0.024, Cohen's d = 1.16), 80° (P = 0.018, Cohen's d = 1.21), and 90° (P = 0.001, Cohen's d = 1.38) in the UNS group. As these specific modifications might respectively and differentially protect athletes against hamstring and knee-joint injuries, the integration of both types of exercises should be considered when designing injury prevention programmes for soccer players.

Emotion and self-cutting: narratives of service users referred to a personality disorder service.

Theory and existing research suggest that emotion regulation capabilities develop during the formative years. Emotion dysregulation is associated with psychological distress and may contribute towards difficulties such as personality disorder and self-harm. This study aimed to explore the contexts in which individuals' narratives of emotional experience and self-harm developed. Eight participants who cut themselves and were seen by a personality disorder service were recruited. Semi-structured interviews were carried out, and interview transcripts were analysed using a narrative approach. Five temporal themes were generated: 'Seen and not heard', 'A big release … to get rid of all the pain and hurt', 'A vicious circle', 'A different world' and 'Trying to turn my life around'. The findings highlight how early experiences may have led participants to perceive emotions as unacceptable and subsequently suppress emotion in adulthood. Suppression of emotions appeared to be related to appraisals of emotions and to secondary emotional distress. Furthermore, cutting was linked to suppression of emotions as well as negative self-beliefs formed during childhood and reinforced through subsequent experiences. The study emphasizes the need for therapeutic approaches to focus on emotions when working with individuals who self-cut. Furthermore, the findings indicate the need for compassionate and validating health services that may help service users develop more optimistic future narratives.

Effect of a carbohydrate-protein multi-ingredient supplement on intermittent sprint performance and muscle damage in recreational athletes.

Carbohydrate-protein-based multi-ingredient supplements have been proposed as an effective strategy for limiting the deleterious effects of exercise-induced muscle damage. This study compares the effects of a commercially available carbohydrate-protein supplement enriched with l-glutamine and l-carnitine-l-tartrate to carbohydrate alone or placebo on sprint performance, muscle damage markers, and recovery from intermittent exercise. On 3 occasions, 10 recreationally trained males ingested a multi-ingredient, a carbohydrate supplement, or a placebo before, during, and immediately after a 90-min intermittent repeated sprint test. Fifteen-metre sprint times, creatine kinase, myoglobin, and interleukin-6 were assessed before (pre), immediately after (post), 1 h after (1h), and 24 h after (24h) exercise. Total sprint time measured during the intermittent protocol was not different between conditions. Fifteen-metre sprint time was slower (p < 0.05) at post, 1h and 24h compared with pre without differences between conditions (p > 0.05). Creatine kinase at 24h was lower (p < 0.05) in the multi-ingredient (461.8 ± 271.8 U·L) compared with both carbohydrate and placebo (606 ± 314.5 U·L and 636 ± 344.6 U·L, respectively). Myoglobin increased (p < 0.05) in all 3 conditions at post and 1h compared with pre, showing lower values at 1h (p < 0.05) for the carbohydrate and a trend (p = 0.060) for multi-ingredient compared with the placebo condition (211.4 ± 127.2 ng·mL(-1) and 239.4 ± 103.8 ng·mL(-1) vs. 484.6 ± 200.0 ng·mL(-1), respectively). Interleukin-6 increased at both post and 1h compared with pre (p < 0.05) with no differences between conditions. In conclusion, ingesting a multi-ingredient supplement before, during, and immediately after a 90-min intermittent sprint test resulted in no effects on performance and fatigue while the accumulation of some biomarkers of muscle damage could be attenuated.

The effects of maximal and submaximal arm crank ergometry and cycle ergometry on postural sway.

Abstract This study aimed to determine whether arm crank ergometry (ACE) disturbed postural sway to the same extent as cycle ergometry (CE). Nine healthy, none specifically trained adults undertook posturographic tests before and after five separate exercise trials consisting of: two incremental exercise tests to exhaustion for ACE and CE to examine postural sway responses to maximal exercise and to determine peak power output (W max); two subsequent tests of 30 min duration for ACE and CE at a relative workload corresponding to 50% of the ergometer-specific W max (ACErel; 53 ± 8 W and CErel; 109 ± 16 W). A final CE trial was performed at the same absolute power output (CEabs) as the submaximal ACE trial to match absolute exercise intensity (i.e., 53 ± 8 W). The centre of pressure (COP) displacement was recorded using a force platform before, immediately after exercise and during a 30-min recovery period. ACE had no effects on postural sway (P > 0.05). An increase in mediolateral COP displacement was observed following maximal CE only (P = 0.001), while anteroposterior COP displacement and COP path length increased following maximal and submaximal CE (P < 0.05). These differences in postural sway according to exercise mode likely stem from the activity of postural muscles when considering that CE recruits lower limb muscles involved in balance. This study provides evidence of an exercise mode which does not elicit post-exercise balance impairments, therefore possesses applications to those at an increased risk of falling.

An evaluation of Knowledge and Understanding Framework personality disorder awareness training: can a co-production model be effective in a local NHS mental health Trust?

5 Boroughs Partnership NHS Foundation Trust, in the Northwest of England, has trained over 500 staff in the Knowledge and Understanding Framework, level 1 personality disorder awareness training. This is a 3-day nationally devised training programme delivered via an innovative co-production model (i.e. co-delivery and partnership working with service users who have lived experience). This paper provides quantitative and qualitative information on the effectiveness of training delivery and also serves to provide some insight into the impact of service-user involvement via such a co-production model. Information on 162 participants using the Knowledge and Understanding Framework bespoke questionnaire (Personality Disorder Knowledge, Attitudes and Skills Questionnaire) suggests that the training can be effectively delivered by and within a local NHS Mental Health Trust. Results immediately post-training suggest an improvement in levels of understanding and capability efficacy and a reduction in negative emotional reactions. Indications from a 3-month follow-up suggest that while understanding and emotional reaction remain improved, capability efficacy regresses back to pre-training levels, suggesting the need for ongoing supervision and/or support to consolidate skills. Discussion includes guidelines for the implementation of a truly integrated co-production model of training provision, as well as advice relating to the maximization of long-term benefits.

Cultivating positive emotions: a useful adjunct when working with people who self-harm?

UNLABELLED: This narrative review draws upon a broad range of literature, including theory and empirical research, to argue that positive emotions are a useful adjunct to therapy when working with individuals who self-harm. The review highlights how self-harm is often employed as a method of emotion regulation and may be both negatively and positively reinforced. It is suggested that individuals who self-harm have potential difficulty in experiencing positive and negative emotions. The compatibility of an emotion focused approach to therapy for individuals who self-harm is therefore deemed an appropriate one. However, current therapeutic models predominantly focus on unpleasant or negative emotions and largely tend to neglect positive emotions, such as happiness. Broaden and build theory indicates that positive emotions can reduce the effects of negative emotions and aid recovery from intolerable negative emotions that may underpin self-harming behaviours. Therefore, the incorporation of positive emotions into therapy is likely to be helpful. In addition, if cultivated over time, positive emotions can build resilience that may enable individuals to cope better with events that precipitate self-injurious behaviours. The review emphasizes how positive emotions represent a valuable addition to therapeutic work but also highlights that the negatively valenced and painful emotions often experienced by those who self-injure must still be addressed. KEY PRACTITIONER MESSAGE: When working with individuals who self-harm it may be beneficial for practitioners to consider clients' experiences of positive emotions, and how to cultivate these, in addition to targeting the negative emotions which tend to underpin self-harming behaviours.

The influence of whole body vibration on the central and peripheral cardiovascular system.

The purpose of this study was to investigate the physiological changes of the cardiovascular system in response to whole body vibration during quiet standing and identify whether there is a greater influence on the central or peripheral cardiovascular system. Twenty healthy participants (12 male and 8 female) were assessed over two separate testing sessions for changes in peripheral skin temperature, peripheral venous function, blood flow velocity in the dorsalis pedis artery, blood pressure and heart rate during quiet standing with 40 Hz 1·9 mm synchronous vibration. Vibration exposure totalled 5 min in 1 min increments with 5 min recovery during each testing session. There were no significant changes in heart rate, blood pressure or peripheral skin temperature. Significant results were obtained for blood flow velocity with increases from 0·5 + 0·2 cm·s(-1) at baseline to 1 + 0·2 cm·s(-1) during vibration, returning to baseline levels during the recovery period. Due to the absence of changes in heart rate, blood pressure or lower leg and foot temperature, the change in blood flow velocity can be attributed to changes in peripheral vascular function. The results suggest a high level of sensitivity of the peripheral vascular system to vibration exposure; therefore, further studies should be completed to ascertain the physiological mechanisms underlying the effects of vibration on the peripheral vascular system.

Effects of a low volume injury prevention program on the hamstring torque angle relationship.

The effects of a 4-week lower body injury prevention program on knee muscle torque-angle relationship were examined in soccer players. Twenty men were randomly allocated to either a control (n = 10) or training group (n = 10). The training group underwent three training sessions per week, comprising 3 sets of 8 repetitions of one open-chain exercise (Nordic curl) and two closed-chain exercises-forward lunges on a Bosu balance trainer and eccentric single leg dead lifts. Maximal peak knee flexion torque was measured at 35°, 45°, 60°, 80°, 90°, and 100° pre- and post-intervention. Significant improvements were observed only at 80° (p = .001; d = .94) along with a nonsignificant trend at 35° (p = .081; d = .43). As these modifications might protect athletes against muscle and joint injuries, the use of both stable-open and unstable-closed kinetic chain exercises emphasizing eccentric hamstring and knee stabilization actions should be integrated into injury prevention programs in team sports athletes.