Understanding the relative contribution of technical and tactical performance to match outcome in Australian Football.

The aim of this study was to assess if tactical and technical performance indicators (PIs) could be used in combination to model match outcomes in Australian Football (AF). A database of 101 technical PIs and 14 tactical PIs from every match in the 2009-2016 Australian Football League (AFL) seasons was merged. Two outcome measures Win-loss and Score margin were used as dependent variables. The top 45 ranked technical and tactical PIs from a feature selection process were used to model match outcome using decision tree and Generalised Linear Models (GLMs). Of the top 45 selected features, this included seven tactical PIs. The Win-loss-based Decision tree model achieved a classification accuracy of 89.0% and GLM 93.2%. A Score margin-based GLM achieved a root mean squared error (RMSE) of 6.9 points. A combined approach to the classification of match outcomes provided no improvement in model accuracy compared with previous literature. However, this study has established the relative importance of technical and tactical measures of performance in relation to successful team performance in AF.

Use of cerclage in triplet pregnancies with an asymptomatic short cervix.

OBJECTIVES: The purpose of this study was to compare the outcomes of triplet pregnancies in women with asymptomatic cervical shortening with and without a cervical cerclage. METHODS: A retrospective review of all triplet pregnancies with biweekly serial cervical length surveillance was performed. Cervical shortening was defined as a cervical length of 2.5 cm or less before 24 weeks' gestation. Patients with cervical shortening managed with cerclage were compared to those managed expectantly. The primary outcome was the gestational age at delivery, with secondary outcomes including birth weight, neonatal intensive care unit length of stay, and composite neonatal outcome. Statistical significance was defined as P < .05. RESULTS: Sixteen patients underwent cerclage placement versus 8 managed expectantly (control group). The median gestational ages at delivery were similar between the groups (cerclage, 31.3 weeks; interquartile range [IQR], 29.3-32.3 weeks; control, 29.8 weeks; IQR, 27.5-32.4 weeks; P = .71). The median birth weights were also similar between the groups (cerclage, 1283 g; IQR, 800-1626 g; control, 1109 g; IQR, 776-1500 g; P = .54). There was no significant difference in composite neonatal outcomes between the cerclage and control groups (P = .67). CONCLUSIONS: In this limited case-control study, we found no benefit in terms of pregnancy prolongation or neonatal outcomes with cerclage placement for triplet gestations complicated by an asymptomatic short cervix.

Shots at goal in Australian Football: Historical trends, determinants of accuracy and common strategies.

OBJECTIVES: To understand the historical context of and relationships between, the characteristics of shots at goal and match outcome in the Australian Football League. DESIGN: Observational. METHODS: Descriptive statistics of shots at goal were calculated and compared across 20 seasons. The location, type, and outcome of all shots at goal (n = 43,254), by all teams (2017-19 & 21), were compared with match outcome. RESULTS: The total number of shots per match and the accuracy of shots haven't changed in two decades. Most teams win by having more shots at goal (Wilcoxon-r effect size 0.63) than their opponent (i.e. "majority strategy") and of these, the number of open shots (0.48) is slightly more important than set shots (0.43), followed by shot accuracy (0.29). However, some teams (14 %) win by taking fewer shots at goal from field locations with a higher likelihood of scoring a goal (i.e. "minority strategy"). Arc angle and shot type can be used to predict the outcome of a shot at goal with 60.3 % classification accuracy. The novel shot-outcome prediction model reported here provides a better opportunity to evaluate goal kicking performance of teams and players, because it accounts for the type and difficulty of the shot. CONCLUSIONS: Teams can evaluate the shot accuracy of their players more fairly, by accounting for shot location using the method reported here. Coaches can compare the two shot strategies identified and implement the one that suits the skill profile of their players and increase their likelihood of winning.

A Scoping Review of Focused Ultrasound Enhanced Drug Delivery for Across the Blood-Brain Barrier for Brain Tumors.

BACKGROUND AND OBJECTIVES: Previous mechanisms of opening the blood-brain barrier (BBB) created a hypertonic environment. Focused ultrasound (FUS) has recently been introduced as a means of controlled BBB opening. Here, we performed a scoping review to assess the advances in drug delivery across the BBB for treatment of brain tumors to identify advances and literature gaps. METHODS: A review of current literature was conducted through a MEDLINE search inclusive of articles on FUS, BBB, and brain tumor barrier, including human, modeling, and animal studies written in English. Using the Rayyan platform, 2 reviewers (J.P and C.Y) identified 967 publications. 224 were chosen to review after a title screen. Ultimately 98 were reviewed. The scoping review was designed to address the following questions: (1) What FUS technology improvements have been made to augment drug delivery for brain tumors? (2) What drug delivery improvements have occurred to ensure better uptake in the target tissue for brain tumors? RESULTS: Microbubbles (MB) with FUS are used for BBB opening (BBBO) through cavitation to increase its permeability. Drug delivery into the central nervous system can be combined with MB to enhance transport of therapeutic agents to target brain tissue resulting in suppression of tumor growth and prolonging survival rate, as well as reducing systemic toxicity and degradation rate. There is accumulating evidence demonstrating that drug delivery through BBBO with FUS-MB improves drug concentrations and provides a better impact on tumor growth and survival rates, compared with drug-only treatments. CONCLUSION: Here, we review the role of FUS in BBBO. Identified gaps in the literature include impact of tumor microenvironment and extracellular space, improved understanding and control of MB and drug delivery, further work on ideal pharmacologics for delivery, and clinical use.

The effect of team formation on defensive performance in Australian football.

OBJECTIVES: Understanding the successful characteristics of team formation during different scenarios in Australian Football matches can assist coaches in making important tactical match-day and training decisions. The aims of this study were to explore the outcomes of entries inside 50 m of the goal, in Australian Football and to determine whether there was an association between team formation and team defensive performance after a turnover. DESIGN: Observational. METHODS: Global Positioning System (GPS) data, technical event data and video files from 22 matches in one season were obtained from an elite Australian Football club. Of 1092 forward 50 entries, 392 possession chains that resulted in a turnover were analysed. Variables representing team formation of players at the occurrence of turnover were compared between positive and negative outcomes of the subsequent possession chain. Logistic regression and decision tree modelling were also used to explore associations and variable importance. RESULTS: None of 18 team formation characteristics differed between positive and negative outcomes of turnovers. Multivariate modelling identified that having a team formation with greater width than length made it more likely to result in a positive outcome (Decision tree classification accuracy = 69.5%, AUROC = 0.72). CONCLUSIONS: No single characteristic of team formation affects the outcome of a turnover possession chain, however team formation that was wider than it was long may be associated with a more desirable outcome. The lack of association between most team formation characteristics and defensive outcomes, highlight the risk of over emphasising team formation in tactical planning for some phases of play.

Ischemia-reperfusion and neonatal intestinal injury.

We review research relating ischemia/reperfusion to injury in the neonatal intestine. Epidemiologic evidence suggests that the most common form of necrotizing enterocolitis is not triggered by a primary hypoxic-ischemic event. Its late occurrence, lack of preceding ischemic events, and evidence for microbial and inflammatory processes preclude a major role for primary hypoxic ischemia as the sentinel pathogenic event. However, term infants, especially those with congenital heart disease who have development of intestinal necrosis, and those preterm infants with spontaneous intestinal perforations, are more likely to have intestinal ischemia as a primary component of their disease pathogenesis.

Postdeployment Fertility Challenges and Treatment in the Modern Era.

Current war-fighting environments have shifted dramatically over the past decade, and with this change, new types of injuries are afflicting American soldiers. Operative Enduring Freedom and Operation Iraqi Freedom have noted an increased use of sophisticated improvised explosive devices by adversaries. Injuries not frequently seen in previous conflict are dismounted complex blast injuries, which involve multiple proximal amputations, pelvic fractures, and extensive perineal wounds. Thus, an unforeseen consequence of the decreased mortality rate after these complex blast injuries is a new wave of U.S. service members facing the challenges of recovering from the catastrophic amputations and genitourinary injuries. New applications of sperm retrieval methods may be used in these specific populations, as they recover and wish to purse family-building goals. Spinal cord injuries, traumatic brain injuries, and considerations unique to the female soldier are explored in this review of urologic care in wounded veterans.

The relationship between match performance indicators and outcome in Australian Football.

OBJECTIVES: To identify novel insights about performance in Australian Football (AF), by modelling the relationships between player actions and match outcomes. This study extends and improves on previous studies by utilising a wider range of performance indicators (PIs) and a longer time frame for the development of predictive models. DESIGN: Observational. METHODS: Ninety-one team PIs from the 2001 to 2016 Australian Football League seasons were used as independent variables. The categorical Win-Loss and continuous Score Margin match outcome measures were used as dependent variables. Decision tree and Generalised Linear Models were created to describe the relationships between the values of the PIs and match outcome. RESULTS: Decision tree models predicted Win-Loss and Score Margin with up to 88.9% and 70.3% accuracy, respectively. The Generalised Linear Models predicted Score Margin to within 6.8 points (RMSE) and Win-Loss with up to 95.1% accuracy. The PIs that are most predictive of match outcome include; Turnovers Forced score, Inside 50s per shot, Metres Gained and Time in Possession, all in their relative (to opposition) form. The decision trees illustrate how combinations of the values of these PIs are associated with match outcome, and they indicate target values for these PIs. CONCLUSIONS: This work used a wider range of PIs and more historical data than previous reports and consequently demonstrated higher prediction accuracies and additional insights about important indicators of performance. The methods used in this work can be implemented by other sport analysts to generate further insights that support the strategic decision-making processes of coaches.

Effect of socioeconomic status on food availability and cost of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern.

The authors assessed food availability and cost of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and patients' opinion concerning diet and blood pressure by surveying grocery stores and clinic patients in low- and high-socioeconomic status (SES) areas of Boston, Massachusetts. The proportion of DASH items found in stores in low- and high-SES communities was not significantly different (46.5% compared with 75%; P=.2896). The cost of eating a DASH meal plan was significantly more expensive in high-SES communities (dollars 40.20 compared with $30.73 per week; P=.0413). The authors' results suggest that DASH diet foods are available in low- and high-SES communities, but there is a strong trend toward less food availability in low-SES communities. Eating the DASH diet, however, is more expensive in high-SES communities. Increased information, food availability, and affordability are likely to lead to more widespread adoption of the DASH diet.

The relevance of pharmacokinetic studies in designing efficacy trials in juvenile major depression.

INTRODUCTION: Identifying evidence-based dosing strategies is a key part of new drug development in pediatric populations. Pharmacokinetic (PK) studies can provide important information regarding how best to dose medications in children and adolescents. Utilizing scientifically supported dosing strategies provides the best chance for any given drug to demonstrate both efficacy and acceptable tolerability in definitive, placebo-controlled studies. METHODS: Results of both PK studies and randomized, placebo-controlled efficacy trials (RPCTs) in juvenile major depressive disorder (MDD) are reviewed. The degree to which the medication dosing strategies that were employed in the efficacy studies were supported by the extant PK data is considered. Medications that are reviewed include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, venlafaxine, nefazodone, and mirtazapine. RESULTS: In many instances, the dosing paradigms that were used in the RPCTs differed, sometimes substantially, from the dosing strategies that would have been supported based on the results of PK studies. CONCLUSIONS: Medication dosing regimens may have contributed to the failure of several RPCTs to show drug efficacy in the treatment of pediatric MDD. In addition, the doses of medication used in these RPCTs may also have contributed to the safety and tolerability concerns that have been raised with these drugs. PK and dose-ranging studies should be performed prior to the initiation of definitive efficacy trials so that empirically supported dosing strategies can be incorporated into the design of RPCTs of antidepressants in children and adolescents suffering from MDD.

Player Load in Elite Netball: Match, Training, and Positional Comparisons.

CONTEXT: The activity profile of competition and training in elite netball has not been comprehensively reported in the literature. PURPOSE: To measure and analyze player load in elite netballers during matches and training sessions. The primary research question was, How does player load vary between playing positions in a match and between matches and training sessions? METHODS: Various measures of player load were recorded in 12 elite professional netballers with a mean ± SD age of 26 ± 4.9 y and height of 183.2 ± 8.7 cm. Player load was assessed using a published method that uses accelerometry. Load was represented as total load in arbitrary units (au), playing intensity (au/min), and relative time spent in each of 4 playing intensity zones (low, low to moderate, moderate, and high). Data from 15 games and up to 17 training sessions were analyzed for each player. RESULTS: Player load in matches for the goal-based positions (goal shooter, goal keeper, and goal defense) tended to be lower than the attacking and wing-based positions (goal attack, wing attack, wing defense, and center). The difference was largely due to the amount of time spent in low-intensity activity. Playing intensity of matches was greater than in training sessions; however, the total time spent in moderate- to high-intensity activities was not practically different. CONCLUSIONS: Accelerometry is a valuable method of measuring player load in netball, and the present results provide new information about the activity profile of different playing positions.

Outcomes of expectant management after betamethasone for hypertensive disorders of pregnancy.

OBJECTIVE: Review the latency period after betamethasone (BMZ) for pregnancies complicated by hypertensive disorders of pregnancy (HDP). STUDY DESIGN: A retrospective chart review of patients that received BMZ for the reduction of preterm morbidity for HDP. Patients were grouped by gestational age of administration of BMZ and type of hypertensive disorder of pregnancy for analysis. The primary outcome was the interval between the gestational age of the patient at BMZ administration and delivery. RESULTS: One-hundred and forty-seven subjects received BMZ for HDP during the study period delivering 168 infants. The median interval between administration of BMZ and delivery was 5 days [interquartile range (IQR) 2-20 days]. The median neonatal intensive care unit length of stay (NICU LOS) was 20 days (IQR 6-33 days). Fifty-seven percent of subjects delivered within 7 days of diagnosis and 32% had a latency period >14 days. Seventy-five percent of subjects were ultimately delivered for worsening hypertension. CONCLUSIONS: The median latency period between diagnosis and delivery in the setting of HDP is <7 days. Further studies are warranted to address the use of antihypertensive pharmacotherapy to prolong the latency period for fetal benefit.

Improving quality and patient satisfaction in a pediatric resident continuity clinic through advanced access scheduling.

OBJECTIVE: To evaluate the impact of advanced access scheduling in a pediatric residency clinic on resident and patient satisfaction, medical education, practice quality, and efficiency. METHODS: Residents were assigned to either the advanced access template (10 appointments available to patients and 2 physician overbooks) or the prior template (5 available and 8 overbooks). Outcomes included resident and patient satisfaction, appointment availability, and continuity of care and clinic costs. RESULTS: Patient satisfaction improved in 7 areas (P < .001). Residents in either template did not report an impact on medical education experiences. Significant increases were realized with appointment availability and the number of patients seen. Continuity also increased as the overflow/acute visits decreased (P < .001). Overall costs per visit decreased 22%. Because of the significant improvements in access, continuity, and efficiency, all residents were switched to the advanced access template after completion of the study. CONCLUSIONS: Improvement in access to the primary physician has a significant impact on patient satisfaction with health care delivery. This model optimizes the limited time that residents have in continuity clinic, and it has implications for health care delivery quality improvement.

Pharmacologic treatment of adolescent and child schizophrenia.

Although relatively rare in childhood, the incidence of schizophrenia increases in adolescence. Compared with adult-onset schizophrenia, there are differences in the response to various psychopharmacologic agents and an urgent need for more clinical treatment trials in child-onset schizophrenia. The history, epidemiology and clinical presentation of early- and very early-onset schizophrenia is reviewed with a focus on the available pharmacologic treatment literature. Information on the older typical antipsychotics, newer atypical antipsychotics and most promising new potential agents, their benefits and pitfalls are summarized. Acute management as well as continuation and maintenance therapy recommendations are made.

Modelling the effectiveness of emergency responses

As an aid in designing emergency plans, the effectiveness of alternative emergency response programs can be modelled quantitatively. This paper discusses the determinants of emergency response effectiveness. In an emergency, injury to life and property occurs over time, as a function of hazard exposure. To assess the effectiveness of emergency response in mitigating emergency consequences, it is necessary to model the logistics of response to determine the completion time of protective measures. The reduced consequences ins then determined by assessing the protection afforded against the hazard. General observations from the experience of applying this analytical method in two case studies are discussed (AU)