The effects of simulated vision impairment on performance in football.

Footballers with vision impairment (VI) are eligible to compete in the Para sport if they meet a minimum impairment criteria (MIC) based on measures of their visual acuity (VA) and/or visual field. Despite the requirements of the International Paralympic Committee Athlete Classification Code that each sport uses an evidence-based classification system, VI football continues to use a medical-based system that lacks evidence to demonstrate the relationship between impairment and performance in the sport. The aim of this study was to systematically simulate vision loss to establish the minimum level of impairment that would affect performance in futsal. Nineteen skilled sighted players completed tests of individual technical skill and anticipation performance under six levels of simulated blur that decreased both VA and contrast sensitivity (CS). VA needed to be reduced to a level of acuity that represents worse vision than that currently used for inclusion in VI football before meaningful decreases in performance were observed. CS did not have a clear effect on football performance. These findings produce the first evidence for the minimum impairment criteria in VI football and suggest a more severe degree of impairment may be required for the MIC.

Immunochemotherapy and Maintenance With Obinutuzumab or Rituximab in Patients With Previously Untreated Marginal Zone Lymphoma in the Randomized GALLIUM Trial.

The aim of this study was to explore the efficacy and safety of obinutuzumab (G)- versus rituximab (R)-chemotherapy in a subgroup of patients with previously untreated marginal zone lymphoma (MZL) in the phase III GALLIUM trial (NCT01332968). Patients had stage III/IV (or stage II with bulky disease), splenic, nodal, or extranodal MZL requiring treatment. Patients were randomized 1:1 to receive G- or R-chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone; cyclophosphamide, vincristine, and prednisone; or bendamustine, allocated at patient level). Patients with complete/partial response at the end of induction (EOI) received G/R maintenance. Investigator-assessed progression-free survival (PFS), other time-to-event endpoints, response, and safety were assessed. Overall, 195 patients with MZL were included in this analysis: G-chemotherapy (n = 99), R-chemotherapy (n = 96). Median observation time: 59.3 months. No meaningful difference was observed between arms for PFS (4-y PFS rates: G-chemotherapy, 72.6%; R-chemotherapy, 64.1%), other time-to-event endpoints, or EOI response rates (by computed tomography [CT; G-chemotherapy, 81.8%; R-chemotherapy, 81.3%] and positron emission tomography CT [G-chemotherapy, 79.2%; R-chemotherapy, 87.5%]). All patients experienced ≥1 adverse event (AE). G-chemotherapy was associated with a higher incidence of grade 3-5 (86.1% versus 77.4%), grade 5 (14.9% versus 9.7%), and serious (66.3% versus 51.6%) AEs versus R-chemotherapy. Both arms had a higher incidence of grade 3-5 and serious AEs than patients with follicular lymphoma (GALLIUM), with G-chemotherapy being less tolerable than R-chemotherapy. Based on the observed tolerability of G-chemotherapy versus R-chemotherapy, and the comparable efficacy of G-chemotherapy and R-chemotherapy in this analysis, G-chemotherapy cannot be recommended as first-line treatment for MZL.

Efficacy and safety assessment of prolonged maintenance with subcutaneous rituximab in patients with relapsed or refractory indolent non-Hodgkin lymphoma: results of the phase III MabCute study.

Rituximab plus chemotherapy induction followed by rituximab maintenance for up to 2 years confers a long-term benefit in terms of progression-free survival in patients with indolent non-Hodgkin lymphoma. It is not known whether further prolonged maintenance with rituximab provides additional benefit. The phase III MabCute study enrolled 692 patients with relapsed or refractory indolent non-Hodgkin lymphoma. Patients who responded to induction with rituximab plus chemotherapy and were still responding after up to 2 years' initial maintenance with subcutaneous rituximab were randomized to extended maintenance with subcutaneous rituximab (n=138) or observation only (n=138). The primary endpoint of investigator-assessed progression-free survival in the randomized population was un-addressed by the end of study because of an insufficient number of events (129 events were needed for 80% power at 5% significance if approximately 330 patients were randomized). In total, there were 46 progression-free survival events, 19 and 27 in the rituximab and observation arms, respectively (P=0.410 by stratified log-rank test; hazard ratio 0.76 [95% confidence interval: 0.37- 1.53]). The median progression-free survival was not reached in either randomized arm. There were no new safety signals; however, adverse events were seen slightly more frequently with rituximab than with observation during extended maintenance. Maintenance for up to 2 years with rituximab after response to initial induction therefore remains the standard of care in patients with relapsed or refractory indolent non- Hodgkin lymphoma. (Clinicaltrials.gov identifier: NCT01461928).

Effects of manipulating specific individual constraints on performance outcomes, emotions, and movement phase durations in Rugby Union place kicking.

Place kicks present valuable opportunities to score points in Rugby Union, contributing almost half of all points scored at international level. From an ecological dynamics perspective, place kickers adapt to interacting task, environmental, and individual constraints in performance environments. The aim of this study was to analyse effects of specific manipulations of individual constraints (fatigue; expectation for success) on place kicking performance, movement phase durations, heart rate and self-reported emotions. Under representative task and environmental constraints on an outdoor training pitch, 12 experienced, male place kickers completed four testing sessions under every combination of manipulated high/low expectation for success and manipulated levels of high/low acute fatigue. Within each session of 12 place kicks, performance outcomes from three kicking locations of varying difficulty were recorded. ANOVA revealed a two-way interaction between fatigue and expectation manipulations on mean success percentage (p < 0.05), with higher success under low fatigue + low expectation (M ± SD = 58 ± 13%) and high fatigue + high expectation (M ± SD = 56 ± 14%), compared with separate manipulations of high expectation (M ± SD = 49 ± 14%) or high fatigue (M ± SD = 51 ± 14%). There were no significant effects on any movement phase durations. Manipulating expectation significantly heightened mean heart rate (p < 0.05) and influenced emotions reported by place kickers, including higher anger scores when there was high expectation for success. Coaches are encouraged to integrate place kicking into representative game scenarios in practice environments to faithfully represent key performance constraints (e.g. fatigue; expectation for success) in preparing kickers for competitive situations.

The effect of consistent and varied follow-through practice schedules on learning a table tennis backhand.

In table tennis the follow-through action after a shot is an important part of skill execution. In this experiment, we aimed to extend literature around the contextual interference effect by investigating whether the way the follow-through is organised in practice affects learning of the backhand shot in table tennis. Thirty unskilled participants were allocated to blocked-variable practice, random-variable practice or a control-constant group and aimed backhand shots towards a target following ball projection from a machine. Each group completed these shots in a pre-test, a training phase with follow-through manipulations, a post-test, and a retention test. The random-variable group improved their shot accuracy from pre-test to post-test and from pre-test to retention test (both P < 0.01, d = 1.03), whereas neither the blocked-variable nor the control-constant group displayed any change in shot accuracy. Practising the follow-through in a random-variable fashion enhanced learning of the preceding shot compared with blocked-variable practice or no follow-through instructions. The benefits of learning motor skills under conditions of high contextual interference also apply to how follow-through actions are organised. The findings are valuable to coaches and suggest that instructions related to the follow-through action should be considered as well as the primary skill itself.

Hot hands, cold feet? Investigating effects of interacting constraints on place kicking performance at the 2015 Rugby Union World Cup.

Place kicks in Rugby Union present valuable opportunities to score points outside the spatiotemporal dynamics of open play but are executed under varying performance constraints. We analysed effects of specific task constraints and relevant contextual factors on place kick performance in the 2015 Rugby Union World Cup. Data were collected from television broadcasts for each place kick. In addition to kick outcomes, contextual factors, including time of the kick in the match, score margin at the time of the kick, and outcome of the kicker's previous kick, were recorded. Effects of spatial task constraints were analysed for each kick, using distance (m) and angle (°) of the kick to the goalposts. A binomial logistic regression model revealed that distance from, and angle to, the goalposts were significant predictors of place kick outcome. Furthermore, the success percentage of kickers who missed their previous kick was 7% lower than those who scored their previous kick. Place kick success percentage in the 10 minutes before half-time was 8% lower than the mean tournament success percentage, which was 75% (95% CI 71-78%). The highest kick success percentage was recorded when scores were level (83%; 95% CI 72-91%). Our data highlighted how subtle changes in task constraints and contextual factors can influence performance outcomes in elite performers in international competition. Fluctuations in place kick success suggested that individual constraints, such as thoughts, emotions and fatigue, induced during competition, could interact with perceptions to influence emergent performance behaviours.

Ultrasound guided dry needling and autologous blood injection for patellar tendinosis.

OBJECTIVE: To evaluate the efficacy of ultrasound guided dry needling and autologous blood injection for the treatment of patellar tendinosis. DESIGN: Prospective cohort study. SETTING: Hospital/clinic based. PATIENTS: 47 knees in 44 patients (40 men, 7 women, mean age 34.5 years, age range 17 to 54 years) with refractory tendinosis underwent sonographic examination of the patellar tendon following referral with a clinical diagnosis of patellar tendinosis (mean symptom duration 12.9 months). INTERVENTIONS: Ultrasound guided dry needling and injection of autologous blood into the site of patellar tendinosis was performed on two occasions four weeks apart. MAIN OUTCOME MEASURES: Pre- and post-procedure Victorian Institute of Sport Assessment scores (VISA) were collected to assess patient response to treatment. Follow up ultrasound examination was done in 21 patients (22 knees). RESULTS: Therapeutic intervention led to a significant improvement in VISA score: mean pre-procedure score = 39.8 (range 8 to 72) v mean post procedure score = 74.3 (range 29 to 100), p<0.001; mean follow up 14.8 months (range 6 to 22 months). Patients were able to return to their sporting interests. Follow up sonographic assessment showed a reduction in overall tendon thickness and in the size of the area of tendinosis (hypoechoic/anechoic areas within the proximal patellar tendon). A reduction was identified in interstitial tears within the tendon substance. Neovascularity did not reduce significantly or even increased. CONCLUSIONS: Dry needling and autologous blood injection under ultrasound guidance shows promise as a treatment for patients with patellar tendinosis.