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Visual attribution in medical imaging seeks to make evident the diagnostically-relevant components of a medical image, in contrast to the more common detection of diseased tissue deployed in standard machine vision pipelines (which are less straightforwardly interpretable/explainable to clinicians). We here present a novel generative visual attribution technique, one that leverages latent diffusion models in combination with domain-specific large language models, in order to generate normal counterparts of abnormal images. The discrepancy between the two hence gives rise to a mapping indicating the diagnostically-relevant image components. To achieve this, we deploy image priors in conjunction with appropriate conditioning mechanisms in order to control the image generative process, including natural language text prompts acquired from medical science and applied radiology. We perform experiments and quantitatively evaluate our results on the COVID-19 Radiography Database containing labelled chest X-rays with differing pathologies via the Frechet Inception Distance (FID), Structural Similarity (SSIM) and Multi Scale Structural Similarity Metric (MS-SSIM) metrics obtained between real and generated images. The resulting system also exhibits a range of latent capabilities including zero-shot localized disease induction, which are evaluated with real examples from the cheXpert dataset., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Abstract: Watson, A, Murray, A, Coughlan, D, Wells, J, Ehlert, A, Xu, J, Turner, A, and Bishop, C. Understanding training load in golf: A survey of swing coaches, performance practitioners, and medical staff. J Strength Cond Res 39(1): e20-e29, 2025-The present study aimed to investigate the current opinions and practices of golf coaches, performance practitioners, and medical staff working in golf, on the topic of monitoring training load in the sport. A cross-sectional, explorative survey was undertaken, which included specific questions for each subgroup using a combination of Likert scale and "Yes" or "No" questions. A total of 89 practitioners completed the survey with 23 being golf coaches, 35 being performance practitioners, and 31 being medical practitioners. Results showed that virtually all technical coaches and support staff practitioners agreed on the importance of monitoring training load in golf. However, our findings identified a noticeable gap between what is current opinion and what is actually done in day-to-day practice, relating to training load monitoring in the sport. Although the majority of coaches and practitioners are in agreement with the value of assessing load in golf, the number that actually monitor and collect data relating to this is substantially lower. Therefore, further consideration and research is undoubtedly required on this topic to help inform and change current practice in golf., (Copyright © 2024 National Strength and Conditioning Association.)

This paper explores the application of positionality and reflexivity drawing on the experience of a British Minority Ethnic (BME) group senior nurse researching nurses with the same ethnic heritage in an IPA study. It explores how using IPA informed reflexivity and positionality as a researcher who shared the same ethnicity with the research participants. The IPA study allowed for the exploration of Internationally Educated Nurses' (IENs) perspectives on their integration into British healthcare and their navigation of career progression. The central aims of an IPA study are to understand the participant's world, its description, the development of a clear, and open interpretative analysis with a descriptive focus on the social, cultural and theoretical context, and the participant's sense-making of their lived experience. In this paper, we discuss how the lead researcher employed reflexivity, stated his intentionality and positionality in the conduct of the IPA study. This paper discusses some examples of the effects of positionality and reflexivity in the conduct of research by researchers of different racial background, and explicate the influence of personal and professional experiences of a researcher in using reflexivity and positionality to ensure cross-cultural validity and reliability of an IPA research. This paper concludes that appropriate use of reflexivity and positionality in an IPA study may recognise the personal and professional influence of a researcher's experiences on the research process, including their ethnicity., (© 2024 The Author(s). Nursing Inquiry published by John Wiley & Sons Ltd.)

Abstract: Gonzalo-Skok, O and Bishop, C. Effects of maturation on the magnitude and direction of asymmetry in jumping and change of direction speed in young elite football players. J Strength Cond Res 39(1): 70-78, 2025-Physical performance is often affected by maturation in young athletes and provides an interesting challenge to optimize performance. The present study analyzed whether maturation affects directional dominance, chronological age, body mass, and biological age predictors and assessed between chronological or biological age-group differences in young footballers. One hundred eight elite male players (U-15 to U-19) were tested on bilateral vertical and unilateral vertical and horizontal jumping, sprinting (40 m), and change of direction (COD) ability over single and multiple CODs (times and the percentage-based COD deficit [%CODD]). Almost half of the players (45%) at post-peak height velocity (PHV) showed consistency in the direction of asymmetry (jumping and COD). Ten-meter sprint time was the main predictor to explain the %CODD. Standing height affects unilateral horizontal jumping, and peak speed and unilateral horizontal jumping were the main predictors for unilateral vertical jumping. Post-PHV reported significantly (p < 0.05, effect size [ES] = 0.76-1.50) greater vertical and horizontal jumping, and linear and COD speed performance than mid-PHV. Significant differences (p < 0.05) in jumping, sprinting, and COD performance were found between U-15 and the rest of groups. Furthermore, the U-16 group showed a significant difference (p < 0.05) to the U-19 (for peak speed) and U-18 groups (for 40-m sprint and peak speed). Significantly (p = 0.04, ES = 0.47) lower %CODD asymmetries were found in mid-PHV compared with post-PHV. The study highlights the impact of maturation on the direction of asymmetry, tending to show the same weak side as maturation increases (i.e., older, and more experienced and mature players). Finally, decreasing between-limbs asymmetry should be considered during maturation, especially as greater football specialization., (Copyright © 2024 National Strength and Conditioning Association.)

Competing Interests: Competing interests: None declared.

Background: Lipedema is a chronic condition characterized by abnormal deposition of subcutaneous adipose tissue, leading to pain. The lack of internationally recognized diagnostic criteria complicates the characterization of pain. Physiological parameters such as pain pressure threshold (PPT) represent promising prognostic markers for diagnosing lipedema, yet they remain understudied. This study aimed to evaluate the reliability and validity of two pain pressure measurements, PPT and the hand-held sphygmomanometer (HHS) in lipedema. Methods: A total of 28 adult females diagnosed with lipedema were recruited. Both PPT, using a digital algometer, and HHS, using a manual aneroid HHS, were performed to assess pain in the lower limbs. The testing was performed in a standing position with PPT and HHS placed on the calf. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were employed to assess the within session reliability, while the validity between PPT and HHS was analyzed using R 2 in a linear regression model. Results: The results showed excellent reliability for both PPT and HHS, with ICC indicating high consistency (ICC = 0.93 to 0.97) and CV showing acceptable scores (CV = 3.62% to 9.06%). In addition, good validity between PPT and HHS was also observed ( R 2 = 0.69 to 0.74), suggesting that HHS can be a reliable alternative to PPT for pain assessment in lipedema. Conclusion: These findings have important clinical implications, as they expand the knowledge of pain characterization in people with lipedema, potentially aiding in diagnostic refinement. In addition, a cost-effective and accessible method for assessing pain was examined (i.e., HHS), showing promising findings and providing an objective method to help diagnose lipedema.

Many countries in the world have pledged to achieve net-zero emissions goals, implementing a range of relevant policies. As the key implementers in these initiatives, the collaboration between government and enterprise is crucial for the realization of net-zero emissions goals and better sustainable environment. However, the heterogeneous interests of these stakeholders often lead to a game. This research constructs an evolutionary game model to analyze the interactions between government and enterprises, utilizing field studies from China and extensive literature review, to illustrate the behavioral strategies and game dynamics of the two parties. The results show that optimal outcomes are achieved when the government effectively engages enterprises, who in turn actively participate in these initiatives. In addition, this study explores how adjusting game parameters, optimizing the distribution of costs and benefits, and establishing incentive-compatible mechanisms can align the strategic behaviors of both parties towards a more stable equilibrium. This approach facilitates a more organic collaborative governance for better sustainable environment, which has proved fundamental for the robust implementation of net-zero emissions policies. The insights provided in this research broaden the theoretical boundaries of climate governance and policy implementation, providing practical guidelines for policy implementers engaged in net-zero emissions and sustainable environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Abstract: Harry, JR, Park, S, Stewart, M, Hite, M, Simms, A, Larsen, M, and Bishop, C. Asymmetry during landing impacts following jumps with aerial rotation in collegiate men's basketball players. J Strength Cond Res XX(X): 000-000, 2024-This project explored whether (a) landing performances and (b) impact force asymmetries were different during countermovement jump (CMJ) landings with leftward versus rightward aerial rotation in 19 collegiate men's basketball players. Replicated single-subject analyses were performed to identify differences that were both statistically significant and important for each individual. Countermovement jump landing performance and loading, attenuation, and control phase durations were compared, while interlimb vertical ground reaction forces (GRF) were compared during each phase of CMJ landings with leftward and rightward rotations, respectively, using the model statistic and coefficient of variation techniques. The model statistic provided random chance probability (α = 0.05). The coefficient of variation provided whether differences exceeded the largest amount of variation from each limb or rotation direction. The bilateral asymmetry index (BAI; difference between dominant and nondominant limbs divided by the sum of the 2 limbs) was also calculated. Statistically significant (model statistic results) and important (coefficient of variation results) differences in landing performance were detected between rotation conditions in 4 subjects. Most subjects did not display significant and important asymmetries for the changes of vertical GRF during any phase of CMJ landings with leftward or rightward rotations. Large amounts of intra-individual variation seem to be an influential factor for these results, as basketball players seem to have unrefined landing strategies that could require targeted training. Because the BAI values reached as high as ± 531% without coinciding with significant and important asymmetry, researchers and practitioners may need to reevaluate the way in which asymmetry indices are interpreted., (Copyright © 2024 National Strength and Conditioning Association.)

Rationale and Key Points: A 12-lead electrocardiogram (ECG) is a painless procedure commonly undertaken in healthcare practice. An ECG machine uses cables or 'leads' attached with stick-on electrodes to specific parts of the body to create a series of ECG traces, which are then printed onto graph paper. This provides a recording of the cardiac electrical activity measured from different angles or perspectives. • A 12-lead ECG is a valuable diagnostic tool that has proven effective in detecting various cardiac abnormalities or enabling healthcare professionals to rule them out. • It is a cost-effective investigation that can be performed by any appropriately trained healthcare professional. • Careful preparation and correct electrode and lead placement are crucial to ensure accuracy when recording a 12-lead ECG., Reflective Activity: How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when recording a 12-lead ECG. • How you could use this information to educate students or colleagues about the preparation and recording of a 12-lead ECG., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Chronic pain can be highly distressing, disabling and complex. The experience of living with chronic pain often leads to a fundamental struggle with one's sense of self and identity. In this article, we briefly review the wide range of conceptualisations of self in pain research. We then introduce a contextual behavioural conceptualisation of self, a more recent approach to self, and discuss its application and relevant evidence in chronic pain. We recommend that it is time to organize and integrate perspectives on self in relation to chronic pain so that research can proceed with less potential confusion or contradiction, and the contextual behaviour science approach can potentially provide a basis for this., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, responsible for Coronavirus Disease 2019 (COVID-19), exhibits a spectrum of clinical manifestations, ranging from asymptomatic to severe pulmonary dysfunction or death. The variability in COVID-19 severity has largely been attributed to the host's genetic characteristics, suggesting a polygenic genetic architecture, without significant strong evidence of sex-related genetic differences. In this Italian retrospective case-control study, we investigated the association between COVID-19 severity (severe vs. asymptomatic/oligosymptomatic healed individuals) and HLA gene variants, analyzed by next-generation sequencing (NGS). We identified significant HLA alleles (according to the conventional nomenclature), SNPs and haplotypes in the HLA-B , -C , -F , -DQA1 , -DRB1 , and -DRB5 genes associated with COVID-19 severity. Interestingly, these variants showed biological sex-related effects. Also, we identified specific haplotypes associated with COVID-19 severity that are shared by different conventional HLA alleles, indicated here as "super-haplotypes". These haplotypes had a biological sex-specific impact on disease severity and markedly increased the risk of severe COVID-19 compared to the conventional HLA alleles (odds ratio of up to 15). Our data suggest that the revision of the current HLA nomenclature may help to identify variants with a stronger effect on disease susceptibility and that association studies could benefit from the stratification of patients by biological sex. If replicated in other disease models, these findings could help to define the functional diversity in immune response between sexes, also based on the HLA system. Finally, due to the global pandemic's mortality rate, we hypothesize here that SARS-CoV-2 may have acted as a natural selection trigger, leading to a drift in HLA allelic frequencies in the general population.

This study investigated the effects of music therapy (MT), a nonpharmacological therapy, on cognitive, behavioral, and physiological outcomes in older adults with mild-to-moderate cognitive decline residing in care home settings. A randomized controlled trial design was employed, with 42 care home residents (Mage = 86.25 years) randomly assigned to either a one-to-one 16-week MT intervention or an active control group receiving storytelling. Experimental and control activities were matched on key aspects, and groups were equivalent at baseline concerning demographic factors, general health, cognitive-behavioral characteristics, and cognitive reserve levels. Pre/postintervention neuropsychological and behavioral measures were collected, alongside saliva samples for cortisol/dehydroepiandrosterone ratio and respiratory sinus arrhythmia analysis as indicators of overall stress and autonomic regulation. The MT group exhibited benefits in cognitive, behavioral, and physiological domains, suggesting potential advantages in maintaining cognitive functioning and reducing neuropsychiatric symptoms. Biomarkers indicated possible mechanisms underlying the effectiveness of MT. The 16 one-to-one interactive MT sessions-delivered over 5 months-had a positive impact on older adults with mild-to-moderate cognitive decline living in care home settings. The implications of these findings for healthy aging and suggestions for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Psychogenic Non-Epileptic Seizures (PNES) and Functional Neurological Disorders (FND) are progressively attracting the attention of healthcare professionals both in the medical or surgical specialties and in psychiatric ones., Methods: Due to FND and PNES complex presentation, often comorbid with other neurological, medical, and psychiatric conditions, starting from our experience with patients presenting with both conditions, we conducted a systematic review of articles that address the comorbidity of PNES and FND with other psychiatric conditions., Results: Our review supports the point that PNES and FND are not autonomous conditions but develop on the grounds of other psychiatric comorbidities including autism, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), and alexithymia. Persons with PNES and FND have often a history of child abuse, neglect, and trauma, and these conditions can also trigger the two conditions if appearing later in life. We also propose policies to endorse the comorbidity theory and improve assessment and treatment., Conclusion: The scrutinized studies confirm that PNES and FND might be comorbid or represent manifestations of what we hypothesize as an integrated biopsychosocial model where early trauma, abuse, and neglect lead to a progressive neuro sensitivity that can present in the same person, usually young female patients, as a combination of dysthymia, alexithymia, autism, PTSD, BPD, FND, and PNES., Competing Interests: The authors declare no conflicts of interest in the conduction, completion and dissemination of the current review., (© 2024 Lazzari et al.)

Background: The presence of inter-limb asymmetry in the human body has traditionally been perceived to be detrimental for athletic performance. However, a systematic review addressing and comprehensively assessing the association of asymmetry between the lower limbs and middle- and long-distance running performance-related metrics is currently lacking., Objective: The main purpose of this systematic review was to examine the relationship between lower inter-limb asymmetry and determinants of running performance in healthy middle- and long-distance runners. The secondary objective was to identify possible avenues for further research in this area., Methods: PubMed, Web of Science and SPORTDiscus were systematically searched for studies investigating the relationship between lower inter-limb asymmetry and (determinants of) running performance in healthy and injury-free middle- and long-distance runners. The quality of studies eligible for inclusion was assessed using the Downs and Black Quality Index Tool., Results: Out of 4817 articles screened, 8 studies were included in this review which assessed the association between functional, morphological, kinematic and kinetic asymmetry and running performance-related metrics. The quality score of the included research varied between 5/10 and 9/10. Our results revealed mixed findings, showing both significant negative (n = 16) and positive (n = 1) associations as well as no significant associations (n = 30) between inter-limb asymmetry and running performance-related metrics., Conclusions: A high heterogeneity across study methods and outcomes was apparent, making it difficult to draw a straightforward conclusion. Our results indicate that the majority of metrics of functional, morphological, kinematic and kinetic inter-limb asymmetry are negatively or not associated with running performance (and/or its determinants). Thus, a more extensive high-quality body of research using standardised asymmetry magnitude metrics is essential to determine whether, and to what extent asymmetry between the lower limbs could affect middle- and long-distance running performance. Future studies should establish potential trade-off values to help practitioners develop evidence-based training programs., Key Points: In the majority of the metrics, the magnitude of lower inter-limb asymmetry was negatively or not associated with middle- and long-distance running performance. Coaches, athletes and researchers should be attentive of the task, time- and metric-specificity as well as the inter- and intra- individual variability of magnitude outcomes, when assessing inter-limb asymmetries., Competing Interests: Declarations. Ethical Approval and Consent to Participate: Not applicable. Consent for Publication: Not applicable. Competing Interests: Joachim D’Hondt, Laurent Chapelle, Chris Bishop, Dirk Aerenhouts, Kevin De Pauw, Peter Clarys and Eva D’Hondt have no conflicts of interest relevant to this review., (© 2024. The Author(s).)

The crucial role of steroid hormones in health and diseases merits their high-throughput, accurate and affordable measurements in biological specimens. Despite advances in analytical methods, sensing and quantifying steroid hormones remains challenging. Immunoassays offer excellent sensitivity but are inherently labour-intensive, costly, and prone to false positives. Mass spectrometry (MS) has been increasingly utilised, with the main hurdle being the isobaric tendencies of similar analytes, which complicates their separation and accurate quantification. This study compares ultrahigh-performance supercritical fluid chromatography separation (UHPSFC) and ultra-high-performance liquid chromatography (UHPLC) for MS detection. It optimises the column chemistry, temperature, and pressure to provide an operational protocol for the resolution and quantification of analytes. It presents the systematic characterisation of UHPSFC-MS performance by investigating spiked blood samples using Solid-Phase Extraction (SPE) and describes the matrix effects associated with MS measurements. Although both separation methods showed adequate resolution, specificity, and retention time, UHPSFC-MS was superior for five out of seven columns tested. With added high-throughput capacities, UHPSFC-MS, thus, offers an optimal solution for the analysis of steroid hormones for research, medical chemistry, and clinical diagnostics., Competing Interests: Declarations Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article’., (© 2024. The Author(s).)

Context: Variables associated with pain catastrophizing and beliefs in athletes presenting with musculoskeletal pain and/or sports-related injuries are largely unexplored., Objective: We aimed to evaluate which anthropometric, sociodemographic, sporting, injury history, and care-seeking characteristics were associated with the Pain Catastrophizing Scale (PCS) and Pain Beliefs and Perceptions Inventory (PBAPI) scores in athletes., Design: This study followed a cross-sectional design., Methods: Three hundred and twelve athletes (40% females) from different sports and levels completed a questionnaire including demographic information, details regarding sports practice, injury history, health care use, PCS, and PBAPI. Univariable associations between PCS and PBAPI scores and each variable were assessed using linear regression. Variables with univariable associations where P < .05 were entered into multivariable regression models., Results: The final multivariable model including gender, recurrent and persistent pain, a history of a severe atraumatic injury, and a history of more than 5 atraumatic injuries explained 14.9% of the variance in PBAPI scores. Performing a team sport and a history of more than 5 atraumatic injuries explained 5.1% of the variance in PCS scores., Conclusions: Gender, sporting, and injury history characteristics explained only a small portion of the variance in PCS and PBAPI scores, whereas having received healthcare support and the number of appointments did not. Most of the variance was left unexplained.

This article explores the factors contributing to drug-related deaths in English and Welsh prisons between 2015 and 2020. Based on content analysis of all Prison and Probation Ombudsman 'other non-natural' fatal incident investigation reports, descriptive statistics were generated. Qualitative analysis explored the circumstances surrounding deaths and key risk factors. Most deaths were of men, whose mean age was 39 years. Drug toxicity was the main factor in causing death, exacerbated by underlying physical health conditions and risk-taking behaviours. A variety of substances were involved. New psychoactive substances became more important over time. A high proportion had recorded histories of substance use and mental illness. During this period, the prison system was under considerable stress creating dangerous environments for drug-related harm. This study highlights the process of complex interaction between substances used, individual characteristics, situational features and the wider environment in explaining drug-related deaths in prisons. Implications for policy and practice are discussed., (© 2023 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

The aim of the current study was to compare the reliability and validity of jump variables determined from torso- and waist-worn inertial measurement units (IMU) in comparison to force platform measures. Twenty-seven students-athletes completed eight countermovement (CMJ) and squat jumps (SJ) on a force platform with IMUs mounted on the pelvis and torso. Variables including jump height and phase-specific duration, impulse and power were calculated from force platform and both IMUs independently. Considering both IMU locations, the coefficients of variation (CV) observed for all CMJ variables were ≤ 2.5 % larger than the force platform with the exception of concentric impulse with the torso-worn worn IMU (6.9 %). Differences in CVs observed between IMU and force platform variables appeared greater in the SJ. For velocity-derived jump height and concentric impulse from both IMU placements, and torso-worn IMU mean power, CVs were > 2.5 % larger than the force platform. Both IMU placements overestimated jump height determined by flight time (+22 to +35 %) and underestimated jump height determined by take-off velocity (-10 to -18 %). In conclusion, the reliability of IMU metrics was largely comparable to the force platform. However, systematic bias was observed for most metrics. Practitioners should exercise caution if seeking to model jump performance with IMUs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: This pilot study assessed text messaging as an early intervention for preventing pressure ulcers (PrUs) in individuals with spinal cord injury (SCI) post-hospital discharge., Method: Thirty-nine wheelchair-users discharged after acquiring a SCI, underwent randomisation into an intervention group (n = 20) with text messages and a control group (n = 19). All participants received standard post-discharge care and completed a skincare questionnaire before and 6-month after discharge. Primary outcomes included feasibility and acceptability of early intervention using text messaging, alongside performance, concordance, and attitudes toward skincare. Secondary outcomes measured perception and the incidence of PrUs., Results: Baseline demographics were comparable between the intervention and control groups. Eight of 20 participants completed 6-month follow-up questionnaires in the intervention group, six participants completed the 6-month questionnaires in the control group,. Participants expressed high satisfaction with text messages, understanding of content, and increased confidence in preventing PrUs. At 6-month post-discharge, the intervention group showed improved prevention practices, heightened awareness of PrU risks, and increased perceived importance of prevention, which were not observed in the control group. However, there were no significant differences in PrU incidence, possibly due to the small sample size and short follow-up., Conclusion: The study demonstrates that using text messaging as an early intervention for PrU prevention in individuals with SCI is feasible and well-received. Preliminary results suggest a positive impact on participants' attitudes and practices, indicating the potential of text messaging to reduce PrU incidence. However, further research with larger samples and extended follow-up is crucial to validate these promising initial findings., Competing Interests: Declaration of competing interest No conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Although inherited thrombophilias are lifelong risk factors for a first thrombotic episode, progression to thrombosis is multifactorial and not all individuals with inherited thrombophilia develop thrombosis in their lifetimes. Consequently, indiscriminate screening in patients with idiopathic thrombosis is not recommended, since presence of a thrombophilia does not necessarily predict recurrence or influence management, and testing should be selective. It follows that a decision to undertake laboratory detection of thrombophilia should be aligned with a concerted effort to identify any significant abnormalities, because it will inform patient management. Deficiencies of antithrombin and protein C are rare and usually determined using phenotypic assays assessing biological activities, whereas protein S deficiency (also rare) is commonly detected with antigenic assays for the free form of protein S since available activity assays are considered to lack specificity. In each case, no single phenotypic assay is capable of detecting every deficiency, because the various mutations express different molecular characteristics, rendering thrombophilia screening repertoires employing one assay per potential deficiency, of limited effectiveness. Activated protein C resistance (APCR) is more common than discrete deficiencies of antithrombin, protein C, and protein S and also often detected initially with phenotypic assays; however, some centres perform only genetic analysis for factor V Leiden, as this is responsible for most cases of hereditary APCR, accepting that acquired APCR and rare F5 mutations conferring APCR will go undetected if only factor V Leiden is evaluated. All phenotypic assays have interferences and limitations, which must be factored into decisions about if, and when, to test, and be given consideration in the laboratory during assay performance and interpretation. This review looks in detail at performance and limitations of routine phenotypic thrombophilia assays., Competing Interests: G.W.M. reports consultancy fees from Technoclone., (Thieme. All rights reserved.)

Background: The benefits of exercise are well known; however, many of the underlying molecular mechanisms are not fully understood. Skeletal muscle secretes myokines, which mediate muscle-organ crosstalk. Myokines regulate satellite-cell proliferation and migration, inflammatory cascade, insulin secretion, angiogenesis, fatty oxidation, and cancer suppression. To date, the effects of different exercise modes (namely, aerobic and resistance exercise) on myokine response remain to be elucidated. This is crucial considering the clinical implementation of exercise to enhance general health and wellbeing and as a medical treatment., Methods: A systematic search was undertaken in PubMed, MEDLINE, CINAHL, Embase, SPORTDiscus, and Web of Science in April 2023. Eligible studies examining the effects of a single bout of exercise on interleukin15 (IL-15), irisin, secreted protein acidic and rich in cysteine (SPARC), oncostatin M (OSM), and decorin were included. A random-effects meta-analysis was also undertaken to quantify the magnitude of change., Results: Sixty-two studies were included (n = 1193). Overall, exercise appeared to induce small to large increases in myokine expression, with effects observed immediately after to 60 min post-exercise, although these were mostly not statistically significant. Both aerobic and resistance exercise resulted in changes in myokine levels, without any significant difference between training modes, and with the magnitude of change differing across myokines. Myokine levels returned to baseline levels within 180 min to 24 h post-exercise. However, owing to potential sources of heterogeneity, most changes were not statistically significant, indicating that precise conclusions cannot be drawn., Conclusion: Knowledge is limited but expanding with respect to the impact of overall and specific effects of exercise on myokine expression at different time points in the systemic circulation. Further research is required to investigate the effects of different exercise modes at multiple time points on myokine response., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Objective: Artificially intelligent socially assistive robots are a growing technology. There is no evidence-based, theory-informed, open access training targeting health and social care professionals on this advanced technology. This collaborative, international European project - the IENE 10 study - developed, delivered, and evaluated the first Massive Open Online Course on socially assistive robots., Methods: A sequential mixed-method design with five phases: (1) literature review; (2) development of the Transcultural Robotic Nursing curriculum model from the care ethics principles of cultural competence and compassion; (3) development of modules, learning units, and assessments; (4) choice of the digital platform, e-facilitators' training, and definition of the evaluation strategy; (5) recruitment campaign. The methodology was collaborative among the six European partner institutions, who all contributed to each phase, from planning to the outputs. All project outputs and MOOC contents were translated into the four languages of the partners., Results: Training needs identified included: knowledge about social robots' functionality; how to operate them; legal, ethical, and human rights' issues. The course had four modules: Awareness, Knowledge, Sensitivity and Competence, with four learning units each. E-learners ( n  = 240) were mostly based in the project partners' countries and with no previous training on social robots. Graduated e-learners ( n  = 185) found their knowledge and skills enhanced, both in relation to social robots and cultural competence. The learning units and the overall quality of the course were rated between good and excellent., Conclusions: The IENE 10 project pioneeringly addressed the training needs of health and social care professionals in the era of AI social robots. The collaborative and sequentially phased design proved useful in the integration of a care ethics model. This work reflects the holistic approach needed for preparing professionals for the complexities of contemporary healthcare., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The interplay between immune cells and malignant cells represents an essential chapter in the eradication of breast cancer. This widely distributed and diverse form of cancer represents a major threat to women worldwide. The incidence of breast cancer is related to several risk factors, notably genetic predisposition and family antecedents. Despite progress in treatment modalities varying from surgery and chemotherapy to radiotherapy and targeted therapies, persistently high rates of recurrence, metastasis, and treatment resistance underscore the urgent need for new therapeutic approaches. Immunotherapy has gained considerable ground in the treatment of breast cancer, as it takes advantage of the complex interactions within the tumor microenvironment. This dynamic interplay between immune and tumor cells has become a key point of focus in immunological research. This study investigates the role of various cancer markers, such as neoantigens and immune regulatory genes, in the diagnosis and treatment of breast tumors. Moreover, it explores the future potential of immune checkpoint inhibitors as therapeutically effective agents, as well as the challenges that prevent their efficacy, in particular tumor-induced immunosuppression and the difficulty of achieving tumor specificity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Naji, Ghouzlani, Rafii, Sadiqi, Kone, Harmak, Choukri, Kandoussi, Karkouri and Badou.)

Specific learning and attention difficulties are often first identified in childhood, but they can cause lifelong academic and occupational challenges. We explored the prevalence of these difficulties and the representation of sex and ethnicity amongst all first-year students in UK higher education across 12 years-almost 5.7 million students-and compared course preferences and University destinations of those with and without difficulties. Students declaring learning/attention difficulties were more likely to be White or of Mixed ethnicity and least likely to be Asian. They were more likely to attend specialist HE institutions or newer universities, and more likely to study courses in creative arts and design, agriculture and architecture than law, languages, computer science, and mathematical sciences. The number of students declaring difficulties has increased year on year, in actual terms and as a proportion of the student body, suggesting that efforts to increase diversity and inclusion have been successful. However, differences remain between students with and without learning/attention difficulties in terms of ethnicity, subjects studied, and HE institutions attended, so more needs to be done to identify and address reasons for this. While this paper reports data from UK students, it addresses an international question and invites similar explorations of other national datasets., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The present study explored how identity authenticity and LGBT+ community connectedness may mediate the effects of interpersonal discrimination on life satisfaction in a sample of LGBT+ participants across three counties. We used a cross-sectional online survey to collect data and paper questionnaires. Participants were 723 LGBT+ people (56.6% females): 308 (42%) of participants were from the UK, 245 (34%) from Italy, and 170 (24%) from Turkey. Participants' age ranged from 18-60 years ( M  = 33.83, SD = 11.55). Analysis of variance and multigroup mediation models implemented through path analysis were performed. The associations of interpersonal discrimination with identity authenticity and connectedness to the LGBT+ community showed cross-country variations. The association between interpersonal discrimination and identity authenticity was stronger in Italy than in the UK but non-significant in Turkey. Interpersonal discrimination showed a negative association with connectedness to the LGBT+ community in Italy and the UK, with Italy exhibiting the strongest effect. Conversely, this association was positive in Turkey. Irrespective of the country, life satisfaction showed a negative association with interpersonal discrimination and positive associations with identity authenticity and connectedness to the LGBT+ community. This study provides valuable insights into the differences and similarities between the experiences of LGBT+ people in the UK, Italy, and Turkey. The social and policy implications that emerge from the study highlight the relevance of addressing structural stigma in different cultures and emphasize the need for targeted interventions and supportive policies at the supranational level to improve the quality of life of LGBT+ individuals.

Accumulating evidence suggests that rhythmic temporal cues in the environment influence the encoding of information into long-term memory. Here, we test the hypothesis that these mnemonic effects of rhythm reflect the coupling of high-frequency (gamma) oscillations to entrained lower-frequency oscillations synchronized to the beat of the rhythm. In Study 1, we first test this hypothesis in the context of global effects of rhythm on memory, when memory is superior for visual stimuli presented in rhythmic compared with arrhythmic patterns at encoding [Jones, A., & Ward, E. V. Rhythmic temporal structure at encoding enhances recognition memory, Journal of Cognitive Neuroscience, 31, 1549-1562, 2019]. We found that rhythmic presentation of visual stimuli during encoding was associated with greater phase-amplitude coupling (PAC) between entrained low-frequency (delta) oscillations and higher-frequency (gamma) oscillations. In Study 2, we next investigated cross-frequency PAC in the context of local effects of rhythm on memory encoding, when memory is superior for visual stimuli presented in-synchrony compared with out-of-synchrony with a background auditory beat [Hickey, P., Merseal, H., Patel, A. D., & Race, E. Memory in time: Neural tracking of low-frequency rhythm dynamically modulates memory formation. Neuroimage, 213, 116693, 2020]. We found that the mnemonic effect of rhythm in this context was again associated with increased cross-frequency PAC between entrained low-frequency (delta) oscillations and higher-frequency (gamma) oscillations. Furthermore, the magnitude of gamma power modulations positively scaled with the subsequent memory benefit for in- versus out-of-synchrony stimuli. Together, these results suggest that the influence of rhythm on memory encoding may reflect the temporal coordination of higher-frequency gamma activity by entrained low-frequency oscillations., (© 2024 Massachusetts Institute of Technology.)

Water-polo players frequently perform overhead throws that could result in shoulder imbalances. For overhead throws, execution of the 'eggbeater kick' (cyclical movement of the legs) is required to lift the body out of the water. Although a symmetrical action, inter-limb differences in task execution could lead to knee frontal plane projection (FPPA) differences. The present study examined imbalances shoulder and knee FPPA in female players. Eighteen competitive female field players (24.1 ± 5.5 years, 1.68 ± 0.06 m, 72.9 ± 13.3 kg) had their shoulder strength assessed in a shot-mimicking position with a portable dynamometer, standing and seated (isolating the shoulder contribution). Anterior: posterior and shooting: non-shooting shoulder comparison were made. Additionally, players performed a drop jump. Knee FPPA was recorded from digitising and comparing the frames just before landing and at stance phase. During standing, players exhibited higher shooting: non-shooting asymmetry (p = 0.032) in the anterior contraction direction, while during seated the shooting shoulder anterior: posterior asymmetry was higher (p = 0.032). Interlimb knee FPPA asymmetry was higher in the stance phase (p = 0.02). Despite the overhead throwing and egg-beater demands impacting differently on each limb, considerable asymmetries do not develop, suggesting the overall training requirements (e.g. swimming, resistance training) were sufficient to maintain the asymmetry within desirable limits.

This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the performance and interpretation of activated partial thromboplastin time (APTT) and prothrombin time (PT) plasma mixing tests in clinical laboratories in all regions of the world. The following areas are included in this document: preanalytical, analytical, postanalytical, and quality assurance considerations as they relate to the proper performance and interpretation of plasma mixing tests. The recommendations are based on good laboratory practice, published data in peer-reviewed literature, and expert opinion., (© 2024 John Wiley & Sons Ltd.)

Background: Factor (F)VIII inhibitors are measured using labor- and resource-expensive Nijmegen or Bethesda assays, which lack sensitivity for low-titer inhibitors and show high variations in quality surveys, mainly because of manual assay procedures., Objectives: The goal of this study was the development of a fast and fully automated FVIII inhibitor assay by using recombinant (r)FVIII as substrate and dedicated equipment for execution of the test., Methods: A new rapid, fully automated, FVIII inhibitor assay is presented, the core of which is use of full-length recombinant FVIII (rFVIII; Kovaltry, Bayer) as inhibitor substrate instead of plasma FVIII, resulting in rapid binding of inhibitors to rFVIII due to absence of von Willebrand factor. Dramatic shortening of incubation time facilitated full automation on an analyzer capable of 3 subsequent sample dilution steps and 3 reagent additions. Equal volume mixtures of sample and rFVIII (1.0 U/mL) were incubated for 10 minutes at 37 °C, whereafter remaining FVIII activity was analyzed with a kinetic chromogenic assay, allowing inhibitor activity calculation without preceding FVIII activity calibration, using a Ceveron s100 analyzer (Technoclone)., Results: Mean titer in 60 nonhemophiliacs was 0.0 BU/mL (SD, 0.1), yielding a limit of blank of 0.1 BU/mL and lower limit of quantification of 0.2 BU/mL. Analyses were performed with the new method and a Nijmegen assay in 28 inhibitor-positive clinical samples, 14 containing emicizumab and 14 without. Correlation coefficient in emicizumab-free type I inhibitor samples was 1.0. Emicizumab dependency of the method was excluded in spiking experiments with inhibitor-positive samples. Reproducibility was tested by analyzing 7 samples in 3 laboratories for 5 days, twice daily; coefficients of variation of all samples were <15%., Conclusion: We present development data of a sensitive and specific rapid, automated FVIII inhibitor assay generating results within 20 minutes that is less resource-intensive than standard assays with potential to improve assay variability., Competing Interests: Declaration of competing interests N.B.B. is an employee of Technoclone. P.J.C.v.V. reports consultancy fees from Technoclone. G.W.M. reports consultancy fees from Technoclone. All other authors report no conflicts of interest relevant to this work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Different studies indicate that female players in team sports such as soccer tend to have a lower change-of-direction (COD) deficit (CODD) than their male counterparts and that players who performed better in linear and curved sprints tended to have a worse CODD, suggesting that maximum speed does not equate to a faster COD. This study assessed how performance variables related to speed and jumping influence the variability of %CODD among adult highly trained female soccer players., Methods: Fifty-two highly trained female soccer players (age 23.1 [3.25] y; height 163.6 [5.49] cm; weight 59.7 [5.71] kg) participated in this study and performed 180COD, 40-m sprint, countermovement jump, and standing broad jump tests., Results: Significant correlations were found between 180CODL, %CODDR, %CODDL, and between-limbs standing broad jump asymmetry (r = .28-.74). A very large correlation existed between %CODDR and %CODDL (r = .91). Regression analyses indicated a strong inverse relationship between the 10-m sprint time and %CODDR and %CODDL. No predictive models were found for 180COD in either limb. Differences in performance variables such as 180CODR, 180CODL, and asymmetry %CODD were significant between the high- and low-%CODD groups, with moderate to large effect sizes., Conclusion: The present study suggests that specific physical-performance variables, particularly acceleration and unilateral horizontal jumping, are vital to improving COD in highly trained female soccer players, highlighting the need for specific training interventions.

This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANOVA indicating a significant impact of female gender in civilians only. A hierarchical regression indicated that moral injury is a predictor of PTSD symptoms in both active-duty and civilian student groups. However, previous family trauma of genocide is associated with PTSD symptoms in active soldiers only. The findings of the current study could contribute insights for clinical practice for combatants and civilians during the current war.

The Breast Cancer UK-Breast Cancer Prevention Conference addressed risk from environmental pollutants and health behaviour-related breast-cancer risk. Epidemiological studies examining individual chemicals and breast cancer risk have produced inconclusive results including endocrine disrupting chemicals (EDCs) Bisphenol A, per- and polyfluorinated alkyl substances as well as aluminium. However, laboratory studies have shown that multiple EDCs, can work together to exhibit effects, even when combined at levels that alone are ineffective. The TEXB-α/β assay measures total estrogenic load, and studies have provided evidence of a link between multiple-chemical exposures and breast cancer. However, prospective studies using TEXB-α/β are needed to establish a causative link. There is also a need to assess real-life exposure to environmental-chemical mixtures during pregnancy, and their potential involvement in programming adverse foetal health outcomes in later life. Higher rates of breast cancer have occurred alongside increases in potentially-modifiable risk factors such as obesity. Increasing body-mass index is associated with increased risk of developing postmenopausal breast cancer, but with decreased risk of premenopausal breast cancer. In contrast, lower rates of breast cancer in Asian compared to Western populations have been linked to soya/isoflavone consumption. Risk is decreased by breastfeeding, which is in addition to the decrease in risk observed for each birth and a young first-birth. Risk is lower in those with higher levels of self-reported physical activity. Current evidence suggests breast-cancer survivors should also avoid weight gain, be physically active, and eat a healthy diet for overall health. A broad scientific perspective on breast cancer risk requires focus on both environmental exposure to chemicals and health behaviour-related risk. Research into chemical exposure needs to focus on chemical mixtures and prospective epidemiological studies in order to test the effects on breast cancer risk. Behaviour-related research needs to focus on implementation as well as deeper understanding of the mechanisms of cancer prevention., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Introduction: Osteosarcoma is the most common primary malignancy of the bone. There is a lack of effective treatments for patients who experience relapsed osteosarcoma. One treatment for relapsed patients is gemcitabine and docetaxel combination chemotherapy (GEMDOX). This systematic review aimed to establish the efficacy of this chemotherapy regimen, as well as identify the common severe toxicities that are associated with it. Resistant osteosarcoma cell lines developed from MG-63 and HOS-143B were used to represent relapsed osteosarcoma patients in a pre-clinical study., Results: We identified 11 retrospective and Phase II studies that were suitable for inclusion in our review. 10.65% of patients had a response to gemcitabine and docetaxel combination therapy and the disease control rate was 35% (n = 197). 36%, 35.3% and 18.04% of patients experienced grade 3 or 4 neutropenia, thrombocytopenia and anaemia respectively (n = 133). Male patients (X 2  = 9.14, p < 0.05) and those below the age of 18 (X 2  = 10.94, p < 0.05) responded better to GEMDOX treatment than females and patients older than 18 years. The resistant osteosarcoma cell lines remained sensitive to either single-agent gemcitabine, docetaxel, and the combination of both. Cisplatin-resistant models (MG-63/CISR8 & HOS-143B/CISR8) were the most responsive to GEMDOX treatment compared to doxorubicin, methotrexate, and triple-combination resistant models., Conclusion: GEMDOX treatment has potential efficacy in relapsed osteosarcoma patients especially those with cisplatin resistance. To directly compare the efficacy of GEMDOX therapy against other therapies randomised phase III clinical trials with adequate patient follow up must be performed to improve treatment options for osteosarcoma., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

The dynamic strength index (DSI) is calculated as the ratio between countermovement jump (CMJ) peak force and isometric mid-thigh pull (IMTP) peak force and is said to inform whether ballistic or strength training is warranted for a given athlete. This study assessed the impact of an individualized in-season resistance training program, guided by DSI on basketball players' physical performance. Forty-three elite players (19.4 ± 2.9 years; 1.97 ± 0.08 cm; 89.1 ± 9.5 kg) were divided into an intervention group (IG) (27 players) and a control group (CG) (16 players). The IG was further split based on DSI into a ballistic group (DSI ≤ 0.90, 11 players) and a strength group (DSI > 0.90, 16 players). Over five weeks, participants underwent two weekly resistance sessions, with the IG following a DSI-based program and the CG a standard program. Performance was measured pre- and post-intervention through 20-m sprints, 505 change of direction test, CMJ, and IMTP. There were statistically significant improvements in the IG, notably in sprint times (η2 = 0.12-0.21, p < 0.05) and 505 test (η2 = 0.15-0.16, p < 0.05), predominantly in the strength group. The CG's performance was either unchanged or declined for different variables. Our results suggest that DSI-guided training effectively enhances basketball players' physical performance within a competitive season., (© Journal of Sports Science and Medicine.)

Background: This study aims to investigate the measurement of breastfeeding prevalence indicators using Demographic and Health Surveys (DHS) data, focusing on early initiation, exclusive breastfeeding, and continued breastfeeding indicators as reported by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and on the discrepancies arising from small changes in their definition., Methods: Two hundred sixty DHS samples from 78 countries were analyzed to re-calculate usual indicators reported by WHO and UNICEF: early initiation of breastfeeding (EIB), exclusive breastfeeding under 6 months (EBF), and continued breastfeeding between 1 and 2 years (CBF12 and CBF24). Additionally, alternative estimates of the same indicators, slightly changing their definition, were calculated to test their robustness., Results: The WHO and UNICEF indicators for early initiation (EIB) primarily capture cases where breastfeeding is initiated "immediately" after birth, omitting those initiated within 0 or 1 hour. This discrepancy leads to substantial underestimation of levels in some regions, particularly South Asia, and in trends. Furthermore, sizable discrepancies between exclusive breastfeeding (EBF) indicators arise from the inclusion or exclusion of plain water in the definition, with significant variations across regions, especially in West and Middle Africa. However, continued breastfeeding indicators showed consistency across definitions, proving them robust for international comparisons and time trend estimations., Conclusion: This study highlights the importance of understanding how breastfeeding indicators are defined and calculated using DHS data. Researchers should be cautious when using WHO and UNICEF indicators for early initiation and exclusive breastfeeding, as they may underestimate prevalence due to their narrow definition. Continued breastfeeding indicators, on the other hand, are less affected by small changes in definitions and provide reliable measures for cross-country comparisons and trend analyses. These findings underscore the need for standardized robust definitions and transparent reporting of breastfeeding indicators in global health assessments., (© 2024. The Author(s).)

Background: Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief self-referral stress workshop programme for sixth-form students aged 16-18 years old., Objective: This study conducted a secondary analysis on the outcomes of participants with elevated depressive symptoms at baseline., Methods: This is an England-wide, multicentre, cluster randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of a brief cognitive-behavioural therapy workshop (DISCOVER) compared with treatment-as-usual (TAU) (1:1). The primary outcome was depression symptoms (Mood and Feelings Questionnaire (MFQ)) at 6-month follow-up, using the intention-to-treat (ITT) population and analysed with a multilevel linear regression estimating a between-group adjusted mean difference (aMD). Cost-effectiveness, taking a National Health Service (NHS) and personal social services perspective, was explored using quality-adjusted life years (QALYs)., Findings: Between 4 October 2021 and 10 November 2022, 900 adolescents at 57 schools were enrolled. 314 students were identified as having elevated symptoms of depression at baseline (>27 on MFQ). In this prespecified subgroup, the DISCOVER arm included 142 participants and TAU included 172. ITT analysis included 298 participants. Primary analysis at 6 months found aMD to be -3.88 (95% CI -6.48, -1.29; Cohen's d=-0.52; p=0.003), with a similar reduction at 3 months (aMD=-4.00; 95% CI -6.58, -1.42; Cohen's d=0.53; p=0.002), indicating a moderate, clinically meaningful effect in the DISCOVER arm. We found an incremental cost-effectiveness ratio of £5255 per QALY, with a probability of DISCOVER being cost-effective at between 89% and 95% compared with TAU., Conclusions and Clinical Implications: DISCOVER is clinically effective and cost-effective in those with elevated depressive symptoms. This intervention could be used as an early school-based intervention by the NHS., Trial Registration Number: ISRCTN90912799., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Scope . This focus collection aims at presenting recent advances in electrical impedance tomography (EIT), including algorithms, hardware, and clinical applications. Editorial . This focus collection of articles published by the journal Physiological Measurement introduces the Progress in EIT and Bioimpedance. It follows conferences in South Korea and Germany, that provided a platform for new research ideas., (Creative Commons Attribution license.)

Abstract: Vasileiou, SS, Asimakidis, ND, Dalamitros, AA, and Manou, V. Effects of an 8-week in-season explosive power training program on neuromuscular performance and lower limb asymmetries in young male soccer players. J Strength Cond Res XX(X): 000-000, 2024-This study analyzed the effects of incorporating 8 weeks of twice-weekly explosive power training on neuromuscular performance and lower-limb asymmetries applied to soccer. Thirty-five young male soccer players were randomly assigned to either the experimental group (EXP: n = 18; mean age: 13.7 ± 0.8 years; height: 166.9 ± 8.4 cm; body mass: 58.5 ± 12.8 kg) or the control group (CON: n = 17; mean age: 13.7 ± 0.9 years; height: 168.8 ± 9.1 cm; body mass: 58.0 ± 11.4 kg). Before (TP1) and after the training period (TP2) neuromuscular performance (countermovement jump [CMJ], 10 and 20 m sprint times [T10 and T20], change of direction ability [COD]) and lower-limb asymmetries (single-leg CMJ [SLCMJ]) were evaluated. The asymmetry index (AI) for COD and CMJ tests was also calculated. Significant differences (from TP1 to TP2) were revealed for all the tested parameters in the EXP group (1.50-4.9%, p < 0.00 to 0.12, effect size [ES] = -0.44 to 0.27). For the CON group, T10, T20 505 for nondominant limb and SLCMJ performances for both limbs were significantly improved (0.85 to 1.5%, p < 0.00 to 0.21, ES = -0.36 to 0.37). Finally, the AI remained relatively unchanged for both tests and groups (1.28-3.33%, p = 0.162-0.521). These results indicate that adding twice-weekly explosive power training for 8 weeks can improve neuromuscular performance and reduce lower-limb asymmetries to a greater degree than soccer training alone in young male soccer players., (Copyright © 2024 National Strength and Conditioning Association.)

Introduction: In the context of transforming mental healthcare towards more personalised and recovery-oriented models, Open Dialogue has attracted significant international interest. Open Dialogue proposes a way of organising services and delivering care that supports an immediate response to crisis, relational continuity of care, a social network approach and the empowerment of networks through shared decision-making and a flattened hierarchy. The ODDESSI trial currently being conducted in the UK is assessing the model's clinical and cost-effectiveness. Practitioners who delivered the approach within the trial undertook a one-year Open Dialogue foundation training programme, however little is known about their training experiences. This study aimed to explore practitioners' experiences of receiving the training and transitioning to dialogic practice., Methods: Individual, joint and focus group interviews with 32 Open Dialogue practitioners were conducted. Thematic analysis was used to analyse the transcripts and transformational learning theory informed the interpretation of the findings., Results: Two themes further divided in subthemes were generated from the data: (1) experiences and impact of formal training and (2) becoming an Open Dialogue practitioner as an ongoing learning process beyond formal training: barriers and facilitators., Discussion: The one-year Open Dialogue foundation training was a transformative experience for participants due to its emphasis on self-work and its impact on a personal level. Practitioners felt adequately prepared by their training for dialogic practice, yet becoming an OD practitioner was seen as a continual process extending beyond formal training, necessitating ongoing engagement with the approach and organisational support. However, the commitment of participants to deliver optimal dialogic care was occasionally impeded by organisational constraints, resource limitations, and often having to concurrently deliver conventional care alongside Open Dialogue., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Anestis, Weaver, Melia, Clarke and Pilling.)

Context.—: The prothrombin time (PT) and activated partial thromboplastin time (APTT) are screening tests used to detect congenital or acquired bleeding disorders. An unexpected PT and/or APTT prolongation is often evaluated using a mixing test with normal plasma. Failure to correct ("noncorrection") prolongation upon mixing is attributed to an inhibitor, whereas "correction" points to factor deficiency(ies)., Objective.—: To define an optimal method for determining correction or noncorrection of plasma mixing tests through an international, multisite study that used multiple PT and APTT reagents and well-characterized plasma samples., Design.—: Each testing site was provided 22 abnormal and 25 normal donor plasma samples, and mixing studies were performed using local PT and APTT reagents. Mixing study results were evaluated using 11 different calculation methods to assess the optimal method based on the expected interpretation for factor deficiencies (correction) and noncorrection (inhibitor effect). Misprediction, which represents the failure of a mixing study interpretation method, was assessed., Results.—: Percentage correction was the most suitable calculation method for interpreting PT mixing test results for nearly all reagents evaluated. Incubated PT mixing tests should not be performed. For APTT mixing tests, percentage correction should be performed, and if the result indicates a factor deficiency, this should be confirmed with the subtraction III calculation where the normal pooled plasma result (run concurrently) is subtracted from the mixing test result with correction indicated by a result of 0 or less. In general, other calculation methods evaluated that performed well in the identification of factor deficiency tended to have high misprediction rates for inhibitors and vice versa., Conclusions.—: No single method of mixing test result calculation was consistently successful in accurately distinguishing factor deficiencies from inhibitors, with between-reagent and between-site variability also identified., (© 2024 College of American Pathologists.)

Single leg drop jump (SLDJ) assessment is commonly used during the later stages of rehabilitation to identify residual deficits in reactive strength but the effects of physical capacity on kinetic and kinematic variables in male soccer players following ACL reconstruction remain unknown. Isokinetic knee extension strength, kinematics from an inertial measurement unit 3D system and SLDJ performance variables and mechanics derived from a force plate were measured in 64 professional soccer players (24.7 ± 3.4 years) prior to return to sport (RTS). SLDJ between-limb differences was measured (part 1) and players were divided into tertiles based on isokinetic knee extension strength (weak, moderate and strong) and reactive strength index (RSI) (low, medium and high) (part 2). Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance ( d  = 0.92-1.05), kinetic ( d  = 0.62-0.71) and kinematic variables ( d  = 0.56) were evident. Stronger athletes jumped higher ( p  = 0.002; d  = 0.85), produced greater concentric ( p  = 0.001; d  = 0.85) and eccentric power ( p  = 0.002; d  = 0.84). Similar findings were present for RSI, but the effects were larger ( d  = 1.52-3.84). Weaker players, and in particular those who had lower RSI, displayed landing mechanics indicative of a 'stiff' knee movement strategy. SLDJ performance, kinetic and kinematic differences were identified between-limbs in soccer players at the end of their rehabilitation following ACL reconstruction. Players with lower knee extension strength and RSI displayed reduced performance and kinetic strategies associated with increased injury risk.

Background: In 2018, the UK Government published its Serious Violence Strategy setting out the Government's commitment to adopting a public health approach to 'serious violence' in England and Wales and encouraging a multi-agency, whole system public health approach to violence prevention. There has been very little research attention and commentary on the roles of alcohol and illegal drugs in the construction of "serious violence" within the Strategy. Method: Drawing on thematic analysis of key policy documents, the ways in which drugs and alcohol have been conceptualised in recent violence policy in the English and Welsh context are explored through the analytical framework of "framing". Results: The overwhelming emphasis on violence associated with the drugs market has skewed attention towards exceptional and sensationalist forms of "serious" violence and diverted it from more common and widespread forms of "everyday" violence, including domestic and alcohol-related violence. Omitting these from the policy purview has implications for those affected and how resources are allocated. Conclusion: To advance inclusive and holistic violence prevention, a wider framing of violence is required and both illegal drugs and alcohol need to be embedded for meaningful working across populations and organisational boundaries., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Improving harmonization of the clinical interpretation of anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies immunoglobulin G (IgG)/immunoglobulin M (IgM) in the diagnosis of antiphospholipid syndrome (APS) is desirable. Likelihood ratios (LRs) with corresponding test-result intervals can identify the power of a test to discriminate between a diseased and nondiseased patient and may be useful for the semiquantitative interpretation of aCL/aβ2GPI results., Objectives: To determine moderate and high thresholds for aCL and aβ2GPI IgG/IgM measured with chemiluminescent immunoassay, enzyme-linked immunosorbent assay, fluorescence enzyme immunoassay, and multiplex flow immunoassay., Methods: aCL and aβ2GPI antibodies IgG/IgM were determined with 4 solid-phase systems in a case-control study population including 381 APS patients and 727 controls. Interval-specific LRs (IS-LR) were calculated for ranges determined by prespecified specificity and sensitivity levels. Three methods were used for determining thresholds that separated low, moderate, and high positive antibody levels. Interassay agreement was checked with Cohen's kappa statistics., Results: Assay- and antibody-specific thresholds demonstrated increasing IS-LR, reflecting different clinical significance for low, moderate, and high levels, especially for IgG aCL and aβ2GPI and in thrombotic APS. IS-LRs per antibody and unit range were comparable across solid-phase platforms resulting in enhanced harmonization of result interpretation. Agreement between assays for identifying high levels was improved by semiquantitative interpretation compared with that by quantitative reporting., Conclusion: aCL and aβ2GPI IgG/IgM moderate and high thresholds were determined for 4 analytical platforms. Thresholds improve harmonized interpretation of aCL/aβ2GPI levels across platforms. The proposed thresholds should be verified in an independent case-control study to check interlaboratory transferability., Competing Interests: Declaration of competing interests G.W.M. was employed at Guy’s and St. Thomas’ Hospitals at the time of sample collection and reports consultancy fees from Technoclone. The other authors have no competing interests to disclose., (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Checklists are a common tool used in order to mitigate risks caused by human factors and can facilitate the safe induction of anesthesia as well as handovers. SBAR (Situation, Background, Assessment, Recommendation) is a checklist recommended by the WHO and DGAI for handovers, while SOAP-M (Suction, Oxygen, Airway, Pharmaceuticals, Monitoring) is a checklist for the induction of anesthesia. This study investigates the implementation and adoption of these two checklists., Methods: We conducted a single-center online survey one year after the implementation of SOAP-M and SBAR at a university hospital's anesthesiology department, using scales from three validated questionnaires to assess safety attitudes as well as the behavior of staff and the perceived usefulness of the checklists., Results: Staff with a high score in general attitude towards patient safety, as determined by the safety attitudes questionnaire, considered both checklists useful additions to their work environment. Nurses and physicians (p = 0.102) as well as groups divided according to work experience (p = 0.077) showed no significant differences in using SOAP-M and SBAR. Perceived usefulness was significantly higher (p < 0.001) among users of the checklists, and the same goes for positive reinforcement (p < 0.001), social cues (p = 0.0215) and goal cues (p = 0.0252)., Conclusion: SOAP-M and SBAR are perceived as useful checklists for patient handovers and anesthesia induction by tertiary referral hospital's employees with high score in general safety attitude and were therefore commonly used one year after their introduction. No significant difference in checklist adoption between occupations as well as groups divided according to work experience could be found. Perceived usefulness is significantly higher among users of the checklist, who feel using the checklists provides more support., (© 2024. The Author(s).)

This study examined the effects of three external verbal cues on countermovement rebound jump (CMRJ) performance. Twenty-five recreational athletes completed nine jumps with distinct height, velocity and combined cue focus. A general linear model analysis of variance was used to evaluate systematic bias between conditions ( p  < 0.05). The height and velocity cues significantly altered jump height and contact times in both jumps during the CMRJ, respectively ( p  ≤ 0.002). The combined cue significantly reduced contact time while increasing leg stiffness compared to the height cue ( p ≤ 0.038). It also increased jump height compared to the velocity cue ( p  ≤ 0.005) in both jumps, resulting in the highest explosive power and reactive strength values among all conditions. Furthermore, the combined cue enhanced the positive ankle contribution compared to the height cue ( p  = 0.020) and increased positive hip and negative knee joint work compared to the velocity cue ( p  ≤ 0.040) in the second jump of the CMRJ. These findings advise practitioners to use the height cue to maximise jump height, the velocity cue to minimise contact times and the combined cue to maximise explosive power and reactive strength.

Abstract: Mainer-Pardos, E, Bishop, C, and Gonzalo-Skok, O. Seasonal variations in performance and asymmetry data for jump and change of direction abilities in female soccer players. J Strength Cond Res XX(X): 000-000, 2024-The study aimed to evaluate the progression of the percentage-based change of direction (COD) deficit (%CODD) over a competitive season, along with its correlation with performance tests and to examine the impact of the magnitude and direction of asymmetry at 4 stages of the season. Forty-seven (U-16, U-18, and U-20), highly trained, female soccer players performed unilateral vertical jumping (countermovement jump [CMJ]) and horizontal jumping (HJ), 10-m sprint, and 180° change of direction (COD180) tests. The %CODD was also calculated. Significant group and time effects (p < 0.05) were observed in CMJ, HJ, 10-m sprint, and COD180 tests, with U-20 players generally outperforming the U-18 and U-16 groups. Nonsignificant differences were reported in the %CODD between any time point or groups throughout the season. Moderate or large significant (r = 0.44-0.64; p < 0.05) relationships were found between %CODD and 10 m. The direction of asymmetry within and between tests at all time points was slight to moderate (k = -0.29 to 0.57). Notwithstanding, 51% of the players showed the best performance in the horizontal jump with the same leg throughout the season, whereas only 36% in %CODD. This study highlights the importance of developing strategies to improve %CODD depending on the player's position demands. Finally, individually monitoring the magnitude and direction of asymmetry can help practitioners monitor the effects of training and competition throughout the season., (Copyright © 2024 National Strength and Conditioning Association.)

This study aimed to determine, through the use of a highly sensitive statistical tool, whether real changes in performance were present; and compare the rates of meaningful variations in strength, speed, and power parameters at different time-points during the competitive season in national team rugby players. Thirty-two players were assessed 5 times across the season using the following tests: squat jump and countermovement jump tests; 30-m sprint velocity; and one-repetition maximum (1RM) in the half-squat and bench-press exercises. A repeated-measures analysis of variance was conducted to test for differences between successive time-points. Individual coefficients of variation values were used to set target scores for post-measurements and examine whether changes in performance parameters were greater than the natural test variance, thus providing an indication of whether "true changes" occurred. No significant changes were detected in the vertical jump height, 1RM measures, and sprint velocity and momentum throughout the 11-month period ( P > 0.05). True changes occurred much more frequently for strength-power measures than for sprint velocity and momentum. Elite rugby union players did not exhibit significant variations in neuromuscular performance across the competitive period, when a group-based analysis was conducted. However, at the individual level, "true changes" in strength-power-(but not in speed-) related qualities were consistently observed over the competitive season., Competing Interests: The authors declare no conflict of interest., (Copyright © Institute of Sport – National Research Instutite.)

Conduct disorder (CD) is characterised by persistent antisocial and aggressive behaviour and typically emerges in childhood or adolescence. Although several authors have proposed that CD is a neurodevelopmental disorder, very little evidence is available about brain development in this condition. Structural brain alterations have been observed in CD, and some indirect evidence for delayed brain maturation has been reported. However, no detailed analysis of age-related changes in brain structure in youth with CD has been conducted. Using cross-sectional MRI data, this study aimed to explore differences in brain maturation in youth with CD versus healthy controls to provide further understanding of the neurodevelopmental processes underlying CD. 291 CD cases (153 males) and 379 healthy controls (160 males) aged 9-18 years (M age  = 14.4) were selected from the European multisite FemNAT-CD study. Structural MRI scans were analysed using surface-based morphometry followed by application of the ENIGMA quality control protocols. An atlas-based approach was used to investigate group differences and test for group-by-age and group-by-age-by-sex interactions in cortical thickness, surface area and subcortical volumes. Relative to healthy controls, the CD group showed lower surface area across frontal, temporal and parietal regions as well as lower total surface area. No significant group-by-age or group-by-age-by-sex interactions were observed on any brain structure measure. These findings suggest that CD is associated with lower surface area across multiple cortical regions, but do not support the idea that CD is associated with delayed brain maturation, at least within the age bracket considered here., (© 2024. The Author(s).)

Background: Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief accessible stress workshop programme for 16-18-year-olds. We aimed to investigate the clinical effectiveness and cost-effectiveness of the DISCOVER cognitive behavioural therapy (CBT) workshop on symptoms of depression in 16-18-year-olds at 6 months compared with treatment-as-usual., Methods: We conducted a multicentre, cluster randomised controlled trial in UK schools or colleges with sixth forms to evaluate clinical effectiveness and cost-effectiveness of a brief CBT workshop (DISCOVER) compared with treatment-as-usual. We planned to enrol 60 schools and 900 adolescents, using a self-referral system to recruit participants. Schools were randomised in a 1:1 ratio for participants to receive either the DISCOVER workshop or treatment-as-usual, stratified by site and balanced on school size and index of multiple deprivation. Participants were included if they were 16-18 years old, attending for the full school year, seeking help for stress, and fluent in English and able to provide written informed consent. The outcome assessors, senior health economist, senior statistician, and chief investigator were masked. People with lived experience were involved in the study. The primary outcome was depression symptoms measured with the Mood and Feelings Questionnaire (MFQ) at 6-month follow-up, in the intention-to-treat population of all participants with full covariate data. The trial was registered with the ISRCTN registry (ISRCTN90912799)., Findings: 111 schools were invited to participate in the study, seven were deemed ineligible, and 47 did not provide consent. Between Oct 4, 2021, and Nov 10, 2022, 933 students at 57 schools were screened for eligibility, seven were not eligible for inclusion, and 26 did not attend the baseline meeting and assessment, resulting in 900 adolescents participating in the study. The DISCOVER group included 443 participants (295 [67%] female and 136 [31%] male) and the treatment-as-usual group included 457 participants (346 [76%] female and 92 [20%] male). 468 (52%) of the 900 participants were White, and the overall age of the participants was 17·2 years (SD 0·6). 873 (97%) adolescents were followed up in the intention-to-treat population. The primary intention-to-treat analysis (n=854) found an adjusted mean difference in MFQ of -2·06 (95% CI -3·35 to -0·76; Cohen's d=-0·17; p=0·0019) at the 6-month follow-up, indicating a clinical improvement in the DISCOVER group. The probability that DISCOVER is cost- effective compared with treatment-as-usual ranged from 61% to 78% at a £20 000 to £30 000 per quality-adjusted life-year threshold. Nine adverse events (two of which were classified as serious) were reported in the DISCOVER group and 14 (two of which were classified as serious) were reported in the treatment-as-usual group., Interpretation: Our findings indicate that the DISCOVER intervention is modestly clinically effective and economically viable and could be a promising early intervention in schools. Given the importance of addressing mental health needs early in this adolescent population, additional research is warranted to explore this intervention., Funding: National Institute for Health and Care Research Health Technology Assessment Programme., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)