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This study aimed to determine whether caffeine gum influenced perceptual-cognitive and physical performance during the extra-time period of simulated soccer match-play. Semiprofessional male soccer players (n = 12, age: 22 ± 3 years, stature: 1.78 ± 0.06 m, mass: 75 ± 9 kg) performed 120-min soccer-specific exercise on two occasions. In a triple-blind, randomized, crossover design, players chewed caffeinated (200 mg; caffeine) or control (0 mg; placebo) gum for 5 min following 90 min of soccer-specific exercise. Perceptual-cognitive skills (i.e., passing accuracy, reaction time, composure, and adaptability) were assessed using a soccer-specific virtual reality simulator, collected pre- and posttrial. Neuromuscular performance (reactive-strength index, vertical jump height, absolute and relative peak power output, and negative vertical displacement) and sprint performance (15 and 30 m) were measured at pretrial, half-time, 90 min, and posttrial. Caffeine gum attenuated declines in reaction time (pre: 90.8 ± 0.8 AU to post: 90.7 ± 0.8 AU) by a further 4.2% than placebo (pre: 92.1 ± 0.8 AU to post: 88.2 ± 0.8 AU; p <.01). Caffeine gum reduced composure by 4.7% (pre: 69.1 ± 0.8 AU to post: 65.9 ± 0.8 AU) versus placebo (pre: 68.8 ± 0.8 AU to post: 68.3 ± 0.8 AU; p <.01). Caffeine gum did not influence any other variables (p >.05). Where caffeine gum is consumed by players prior to extra-time, reaction time increases but composure may be compromised, and neuromuscular and sprint performance remain unchanged. Future work should assess caffeine gum mixes with substances like L-theanine that promote a relaxed state under stressful conditions. [ABSTRACT FROM AUTHOR]

Oestrogen receptor (ER)-positive breast cancer (BC) is generally well responsive to endocrine therapy. Neoadjuvant endocrine therapy (NAET) is increasingly being used for downstaging ER-positive tumours. This study aims to analyse the effect of NAET on a well-characterised cohort of ER-positive BC with particular emphasis on receptor expression. This is a retrospective United Kingdom (UK) multicentre study of 391 patients who received NAET between October 2012 and October 2020. Detailed analyses of the paired pre- and post-NAET morphological changes and hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) expression were performed. The median duration of NAET was 86 days, with median survival and overall survival rates of 380 days and 93.4%, respectively. A total of 90.3% of cases achieved a pathological partial response, with a significantly higher rate of response in the HER2-low cancers. Following NAET, BC displayed some pathological changes involving the tumour stroma including central scarring and an increase in tumour infiltrating lymphocytes (TILs) and tumour cell morphology. Significant changes associated with the duration of NAET were observed in tumour grade (30.6% of cases), with downgrading identified in 19.3% of tumours (p < 0.001). The conversion of ER status from positive to low or negative was insignificant. The conversion of progesterone receptor (PR) and HER2 status to negative status was observed in 31.3% and 38.1% of cases, respectively (p < 0.001). HER2-low breast cancer decreased from 63% to 37% following NAET in the paired samples. Significant morphological and biomarker changes involving PR and HER2 expression occurred following NAET. The findings support biomarker testing on pre-treatment core biopsies and post-treatment residual carcinoma. [ABSTRACT FROM AUTHOR]

Background/Aims: The growing prevalence of sedentary behaviour across the life course is linked to an increased risk of chronic venous disease and related mortality, warranting the need for non-invasive interventions to improve blood flow and lower extremity function. The aim of this study was to investigate the change in venous blood flow, heart rate and blood pressure after 8 minutes of using the Leeper device, Circulation Booster and light intensity walking. Methods: A quasi-experimental crossover study involving 11 participants (eight women, three men, mean age 23.91 years, standard deviation 1.04 years) was conducted using Leeper and Circulation Booster devices and light intensity walking. During each intervention, participants exercised for 8 minutes, and blood flow was recorded at 0, 4 and 8 minutes. Heart rate and blood pressure were recorded at 0 and 8 minutes. Blood flow was the primary outcome measure, and heart rate and blood pressure were secondary outcomes. Participants rested for 10 minutes between exercise. A two-way repeated measures analysis of variance was used to analyse the effect of intervention and time on blood flow, blood pressure and heart rate. Results: There was no significant interaction between intervention and time on blood flow (P=0.180) indicating that blood flow did not change over time depending on intervention. There was no significant main effect of time on blood flow (P=0.206), indicating that no intervention caused a significant increase or decrease in blood flow after 8 minutes of exercise. Conclusions: The interventions involving the Leeper and Circulation Booster devices and light intensity walking did not appear to significantly increase blood flow in young adults. Further studies involving participants from older age groups and those with pathological interventions are warranted to examine the potential effectiveness of these interventions. Implications for practice: The findings may assist with the advice that allied health professionals provide regarding the use of seated exercise trainers and EMS devices and their ability to influence changes in blood flow. [ABSTRACT FROM AUTHOR]

Purpose: A temporal reduction in the cardiovascular autonomic responses predisposes patients to cardiovascular instability after a viral infection and therefore increases the risk of associated complications. These findings have not been replicated in a bacterial infection. This pilot study will explore the prevalence of cardiovascular autonomic dysfunction (CAD) in hospitalized patients with a bacterial infection. Methods: A longitudinal observational pilot study was conducted. Fifty participants were included: 13 and 37 participants in the infection group and healthy group, respectively. Recruitment and data collection were carried out during a two-year period. Participants were followed up for 6 weeks: all participants' cardiovascular function was assessed at baseline (week 1) and reassessed subsequently at week 6 so that the progression of the autonomic function could be evaluated over that period of time. The collected data were thereafter analyzed using STATA/SE version 16.1 (StataCorp). The Fisher Exact test, McNemar exact test, Mann–Whitney test and Wilcoxon test were used for data analysis. Results: 32.4% of the participants in the healthy group were males (n = 12) and 67.6% were females (n = 25). Participants' age ranged from 33 years old to 76 years old with the majority being 40–60 years of age (62.1%) (Mean age 52.4 SD = 11.4). Heart rate variability (HRV) in response to Valsalva Maneuver, metronome breathing, standing and sustained handgrip in the infection group was lower than in the healthy group throughout the weeks. Moreover, both the HRV in response to metronome breathing and standing up showed a statistically significant difference when the mean values were compared between both groups in week 1 (p = 0.03 and p = 0.013). The prevalence of CAD was significantly higher in the infection group compared to healthy volunteers, both at the beginning of the study (p = 0.018) and at the end of follow up (p = 0.057), when all patients had been discharged. Conclusions: CAD, as assessed by the HRV, is a common finding during the recovery period of a bacterial infection, even after 6 weeks post-hospital admission. This may increase the risk of complications and cardiovascular instability. It may therefore be of value to conduct a wider scale study to further evaluate this aspect so recommendations can be made for the cardiovascular autonomic assessment of patients while they are recovering from a bacterial infectious process. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyze and investigate the SARS‐CoV‐2 (SC‐2) transmission with effect of heart attack in United Kingdom with advanced mathematical tools. Mathematical model is converted into fractional order with the help of fractal fractional operator (FFO). The proposed fractional order system is investigated qualitatively as well as quantitatively to identify its stable position. Local stability of the SC‐2 system is verified and test the proposed system with flip bifurcation. Also system is investigated for global stability using Lyponove first and second derivative functions. The existence, boundedness, and positivity of the SC‐2 is checked which are the key properties for such of type of epidemic problem to identify reliable findings. Effect of global derivative is demonstrated to verify its rate of effects of heart attack in united kingdom. Solutions for fractional order system are derived with the help of advanced tool FFO for different fractional values to verify the combine effect of COVID‐19 and heart patients. Simulation are carried out to see symptomatic as well as a symptomatic effects of SC‐2 in the United Kingdom as well as its global effects, also show the actual behavior of SC‐2 which will be helpful to understand the outbreak of SC‐2 for heart attack patients and to see its real behavior globally as well as helpful for future prediction and control strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Offshore wind technicians (WTs) have been identified as having an occupation with high physical demands. OBJECTIVE: To characterise the physical demands of WTs, during the working day and when performing casualty rescues. METHODS: Data collection consisted of two components. Component A, 14 WTs (n = 13 male, 1 female) were monitored over three consecutive working days. The data collected consisted of: a questionnaire; heart rate and movement data; and accelerometer data. Component B, 5 WTs (n = 5 male) were assessed undertaking two simulated casualty evacuations. Heart rate and metabolic data were collected. RESULTS: A working day lasted 7.5 hrs to 9 hrs, with WTs covering, on average, 4.7 km on the turbine. WTs spent 28% of their time undertaking "light activity", 69% "moderate activity" and 3% working "vigorously". The greatest amount of time in a day was spent working on manual handling tasks such as torque and tensioning (up to 4 hours in total). Both rescues were performed largely aerobically, with similar cardiac and metabolic demands (14.56 (4.84) mL.kg–1.min–1 vs. 17.07 (3.54) mL.kg–1.min–1). Higher RPE values were reported for the rescue from within the Hub (median (range), 13 (12–14)) compared to down the ladder (11 (7–12)), likely due to a greater requirement to manoeuvre the casualty in tight spaces. CONCLUSION: The results presented characterise the physical requirements of WTs during the working day and two casualty evacuations. These data play an important role in supporting the job task analysis for WTs working in the offshore wind industry. [ABSTRACT FROM AUTHOR]

Video gamers can play to negate the psychological impact of stress, which may become problematic when users over-rely on the stress relief potential of gaming. This study used a repeated measures experimental design to investigate the relationships between stress, video gaming, and problematic video gaming behaviours in a convenience sample of 40 students at a UK university. The results indicated that positive affect increased and negative affect decreased, whilst a biological stress measure (instantaneous pulse rate) also decreased after a short video gaming session (t(36) = 4.82, p < 0.001, d = 0.79). The results also suggested that video gaming can act as a short-term buffer against the physiological impact of stress. Further research should focus on testing individuals who have been tested for gaming disorder, as opposed to the general population. Research could also utilise variations of the methodological framework used in this study to examine the intensity of a stress relief effect under different social situations. The study's findings in relation to published works are also discussed. [ABSTRACT FROM AUTHOR]

Introduction Combat-related traumatic injury (CRTI) adversely affects heart rate variability (HRV). The mediating effect of mental and physical health factors on the relationship between CRTI, its severity and HRV has not been previously studied and investigated. Materials and Methods A cross-sectional mediation analysis of the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study was performed. The sample consisted of injured and uninjured British male servicemen who were frequency-matched based on their age, rank, role-in-theater, and deployment to Afghanistan (2003-2014). CRTI and injury severity (the New Injury Severity Scores [NISS] [NISS < 25 and NISS ≥ 25]) were included as exposure variables. HRV was quantified using the root mean square of successive differences (RMSSD) obtained using pulse waveform analysis. Depression and anxiety mediators were quantified using the Patient Health Questionnaire and Generalized Anxiety Disorder, respectively. Body mass index and the 6-minute walk test (6MWT) represented physical health measures. Two mediation pathways between exposure and outcome variables were examined in comparison with the uninjured group using structural equation modeling. Results Of 862 servicemen, 428 were injured and 434 were uninjured with the mean age at assessment of 33.9 ± 5.4 (range 23-59) years. Structural equation modeling revealed that depression, anxiety, and body mass index did not significantly mediate the relationship between injury/injury severity and RMSSD. However, the 6MWT significantly mediated the relationship between CRTI and RMSSD (27% mediation). The indirect effect of 6MWT on the relationship between injury severity (NISS ≥ 25 vs. uninjured) and RMSSD was −0.06 (95% CI: −0.12, −0.00, P  < .05). Conclusions The findings suggest that greater physical function may improve HRV following CRTI. Longitudinal studies are warranted to further validate these findings. [ABSTRACT FROM AUTHOR]

The article discusses the benefits regular physical activity during menopause. Topics include types of physical activities to maintain or improve muscle strength, bone health and balance, study finding on a dose-response relationship between increased physical activity and decreased occurrence rate of cardiovascular health (CVD), and link between being physically active and reduction in breast cancer risk.

Background: Observational studies have demonstrated that a higher resting heart rate (RHR) is associated with an increased risk of dementia. However, it is not clear whether the association is causal. This study aimed to determine the causal effects of higher genetically predicted RHR on the risk of dementia. Methods: We performed a two-sample Mendelian randomization analysis to investigate the causal effect of higher genetically predicted RHR on Alzheimer's disease (AD) using summary statistics from genome-wide association studies. The generalized summary Mendelian randomization (GSMR) analysis was used to analyze the corresponding effects of RHR on following different outcomes: 1) diagnosis of AD (International Genomics of Alzheimer's Project), 2) family history (maternal and paternal) of AD from UK Biobank, 3) combined meta-analysis including these three GWAS results. Further analyses were conducted to determine the possibility of reverse causal association by adjusting for RHR modifying medication. Results: The results of GSMR showed no significant causal effect of higher genetically predicted RHR on the risk of AD (βGSMR = 0.12, P = 0.30). GSMR applied to the maternal family history of AD (βGSMR = -0.18, P = 0.13) and to the paternal family history of AD (βGSMR = -0.14, P = 0.39) showed the same results. Furthermore, the results were robust after adjusting for RHR modifying drugs (βGSMR = -0.03, P = 0.72). Conclusion: Our study did not find any evidence that supports a causal effect of RHR on dementia. Previous observational associations between RHR and dementia are likely attributed to the correlation between RHR and other cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Identifying causal factors to intervene on to delay age‐related declines in cognitive function is urgently needed. We examined associations between non‐exercise testing cardiorespiratory fitness (NETCRF; estimated using sex, age, body mass index, resting heart rate, and physical activity) at 45 years and cognitive function outcomes (immediate and delayed verbal memory; verbal fluency; visual processing speed) at 50 years in 8130 participants from the 1958 British birth cohort. In unadjusted models, higher NETCRF was associated with better cognitive function across all outcomes. When adjusted for confounding factors, associations disappeared. In this cohort, associations between 45 years NETCRF and 50 years cognitive function likely result from confounding factors. [ABSTRACT FROM AUTHOR]

Introduction: Experiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real‐world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real‐world clinical practice. Methods: In this within‐subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real‐world emergencies in a 6‐month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (SD) participant age was 33 (8) years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20 min after simulated and real‐world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State‐Trait Anxiety Inventory, respectively. High‐frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings. Results: Simulation was associated with greater likelihood of threat appraisal and higher state anxiety. High‐frequency HRV reduced from baseline in simulated and real‐world emergencies but recovered further towards baseline 20 min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post‐simulation debrief and feedback. Discussion: This study identifies important differences in psychophysiological stress responses to simulated and real‐world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real‐world clinical practice. Do simulated emergencies recreate the psychological experience of real‐world clinical practice? They are certainly stressful, but perhaps in a different way. [ABSTRACT FROM AUTHOR]

Epilepsy and Long-Term Risk of Arrhythmias Wang J, Huang P, Yu Q, Lu J, Liu P, Yang Y, Feng Z, Cai J, Yang G, Yuan H, Tang H, Lu Y. Eur Heart J. 2023;44(35):3374-3382. doi:10.1093/eurheartj/ehad523. PMID: 37602368; PMCID: PMC10499547 Background and aims: Previous evidence has mainly supported transient changes in cardiac function during interictal or peri-ictal phases in people with epilepsy, but the long-term risk of cardiac arrhythmias is poorly described. This study aimed to assess the long-term association of epilepsy with cardiac arrhythmias, considering the potential role of genetic predisposition and antiseizure medications (ASMs) in any associations observed. Methods: This population-based study evaluated UK Biobank data for individuals recruited between 2006 and 2010. Cox proportional hazards models and competing risk models were used to examine the association of epilepsy history with the long-term incidence risk of cardiac arrhythmias and arrhythmias subtypes. Polygenic risk scores (PRS) were calculated to investigate the effect of genetic susceptibility. The role of ASMs was also evaluated by integrating observational and drug target Mendelian randomization (MR) evidence. Results: The study included 329 432 individuals, including 2699 people with epilepsy. Compared with those without epilepsy, people with epilepsy experienced an increased risk of all cardiac arrhythmias [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.21-1.53], atrial fibrillation (HR 1.26, 95% CI 1.08-1.46), and other cardiac arrhythmias (HR 1.56, 95% CI 1.34-1.81). The associations were not modified by genetic predisposition as indicated by PRS. Competing and sensitivity analyses corroborated these results. Individuals with epilepsy using ASMs, especially carbamazepine and valproic acid, were at a higher risk for cardiac arrhythmias. This observation was further supported by drug target MR results (PSMR <.05 and PHEIDI >.05). Conclusion: This study revealed the higher risk of cardiac arrhythmias persists long term in people with epilepsy, especially among those using carbamazepine and valproic acid. These findings highlight the need for regular heart rhythm monitoring and management in people with epilepsy in order to reduce the risk of further cardiovascular complications. [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV) is a cardiac autonomic marker with predictive value in cardiac patients. Ultra-short HRV (usHRV) can be measured at scale using standard and wearable ECGs, but its association with cardiovascular events in the general population is undetermined. We aimed to validate usHRV measured using ≤ 15-s ECGs (using RMSSD, SDSD and PHF indices) and investigate its association with atrial fibrillation, major adverse cardiac events, stroke and mortality in individuals without cardiovascular disease. In the National Survey for Health and Development (n = 1337 participants), agreement between 15-s and 6-min HRV, assessed with correlation analysis and Bland–Altman plots, was very good for RMSSD and SDSD and good for PHF. In the UK Biobank (n = 51,628 participants, 64% male, median age 58), after a median follow-up of 11.5 (11.4–11.7) years, incidence of outcomes ranged between 1.7% and 4.3%. Non-linear Cox regression analysis showed that reduced usHRV from 15-, 10- and 5-s ECGs was associated with all outcomes. Individuals with low usHRV (< 20th percentile) had hazard ratios for outcomes between 1.16 and 1.29, p < 0.05, with respect to the reference group. In conclusion, usHRV from ≤ 15-s ECGs correlates with standard short-term HRV and predicts increased risk of cardiovascular events in a large population-representative cohort. [ABSTRACT FROM AUTHOR]

Medical records from a single UK-based referral hospital were retrospectively reviewed to identify brachycephalic dogs who had undergone corrective airway surgery and were nebulised with adrenaline in the post-operative period. Ninety dogs were identified between August 2014 and March 2020. Agitation following nebulisation with adrenaline was uncommon, with 86/90 (96%) dogs remaining calm, and overall outcome was reported as satisfactory in 68 of 73 (89%) dogs for which this information was available. Median respiratory rate at T0 (prior to first nebulisation) and T60 (1 hour following nebulisation) were both 20 breaths/minute with a median difference of 0 (95% CI = 0–0) breaths/minute (p = 0.657). Median heart rate at T0 and T60 were both 80 beats/minute with a median difference of 3 (95% CI = −10 to 7) beats/minute (p = 0.948). Two dogs experienced tachycardia, but this was not associated with the timing of administration of adrenaline. Complications reported in the 24 hours following surgery included regurgitation (n = 36), increased respiratory noise and effort (n = 10), aspiration pneumonia (n = 4), and inappetence (n = 3). A temporary tracheostomy tube was placed in 13 (14.4%) dogs. Nebulisation with adrenaline is feasible, results in minimal increases in respiratory rate and heart rate and is associated with agitation in only a small number of dogs. [ABSTRACT FROM AUTHOR]

Arterial stiffness, measured by arterial stiffness index (ASI), could be considered a main denominator in target organ damage among hypertensive subjects. Currently, no reported ASI normal references have been reported. The index of arterial stiffness is evaluated by calculation of a stiffness index. Predicted ASI can be estimated regardless to age, sex, mean blood pressure, and heart rate, to compose an individual stiffness index [(measured ASI–predicted ASI)/predicted ASI]. A stiffness index greater than zero defines arterial stiffness. Thus, the purpose of this study was 1) to determine determinants of stiffness index 2) to perform threshold values to discriminate stiffness index and then 3) to determine hierarchical associations of the determinants by performing a decision tree model among hypertensive participants without CV diseases. A study was conducted from 53,363 healthy participants in the UK Biobank survey to determine predicted ASI. Stiffness index was applied on 49,452 hypertensives without CV diseases to discriminate determinants of positive stiffness index (N = 22,453) from negative index (N = 26,999). The input variables for the models were clinical and biological parameters. The independent classifiers were ranked from the most sensitives: HDL cholesterol≤1.425 mmol/L, smoking pack years≥9.2pack-years, Phosphate≥1.172 mmol/L, to the most specifics: Cystatin c≤0.901 mg/L, Triglycerides≥1.487 mmol/L, Urate≥291.9 μmol/L, ALT≥22.13 U/L, AST≤32.5 U/L, Albumin≤45.92 g/L, Testosterone≥5.181 nmol/L. A decision tree model was performed to determine rules to highlight the different hierarchization and interactions between these classifiers with a higher performance than multiple logistic regression (p<0.001). The stiffness index could be an integrator of CV risk factors and participate in future CV risk management evaluations for preventive strategies. Decision trees can provide accurate and useful classification for clinicians. [ABSTRACT FROM AUTHOR]

Higher cardiorespiratory fitness is associated with lower risk of type 2 diabetes. However, the causality of this relationship and the biological mechanisms that underlie it are unclear. Here, we examine genetic determinants of cardiorespiratory fitness in 450k European-ancestry individuals in UK Biobank, by leveraging the genetic overlap between fitness measured by an exercise test and resting heart rate. We identified 160 fitness-associated loci which we validated in an independent cohort, the Fenland study. Gene-based analyses prioritised candidate genes, such as CACNA1C, SCN10A, MYH11 and MYH6, that are enriched in biological processes related to cardiac muscle development and muscle contractility. In a Mendelian Randomisation framework, we demonstrate that higher genetically predicted fitness is causally associated with lower risk of type 2 diabetes independent of adiposity. Integration with proteomic data identified N-terminal pro B-type natriuretic peptide, hepatocyte growth factor-like protein and sex hormone-binding globulin as potential mediators of this relationship. Collectively, our findings provide insights into the biological mechanisms underpinning cardiorespiratory fitness and highlight the importance of improving fitness for diabetes prevention. Being fit has been linked to a lower risk of type 2 diabetes, but it is unclear whether this relationship is causal. Using large scale studies with genetic data and measurements of cardiorespiratory fitness, the authors show evidence that higher genetically predicted fitness is causally associated with lower risk of type 2 diabetes independent of adiposity. [ABSTRACT FROM AUTHOR]

Background and Aims: Growing evidence supports an association between fatty liver disease (FLD) and cardiac dysfunction and remodelling, leading to cardiovascular disease and heart failure. Herein, we investigated the independent contribution of FLD to cardiac dysfunction and remodelling in participants from the UK Biobank with cardiac magnetic resonance (CMR) data available. Methods: A total of 18 848 Europeans without chronic viral hepatitis and valvular heart diseases, with liver magnetic resonance imaging and CMR data were included in the analyses. Clinical, laboratory and imaging data were collected using standardized procedures. Multivariable regression models were used to test the association between FLD and CMR endpoints, after adjusting for several cardiometabolic risk factors. Linear regression models with regularization (Least Absolute Shrinkage and Selection Operator [LASSO], Ridge and Elastic Net) were used to generate predictive models for heart‐related endpoints. Results: FLD was independently associated with higher average heart rate, higher cardiac remodelling (higher eccentricity ratio and lower remodelling index), lower left and right ventricular volumes (end‐systolic, end‐diastolic and stroke volumes) as well as with lower left and right atrial maximal volumes (p < 0.001). FLD was the strongest positive predictor for average heart rate, followed by age, hypertension and type 2 diabetes. Male sex was the strongest positive predictor for eccentricity ratio followed by FLD, age, hypertension and BMI. For LV volumes, FLD was the strongest negative predictor along with age. Conclusions: FLD is an independent predictor of higher heart rate and early cardiac remodelling associated with reduced ventricular volumes. [ABSTRACT FROM AUTHOR]

As the largest conduit vessel, the aorta is responsible for the conversion of phasic systolic inflow from ventricular ejection into more continuous peripheral blood delivery. Systolic distention and diastolic recoil conserve energy and are enabled by the specialized composition of the aortic extracellular matrix. Aortic distensibility decreases with age and vascular disease. In this study, we sought to discover epidemiologic correlates and genetic determinants of aortic distensibility and strain. We trained a deep learning model to quantify thoracic aortic area throughout the cardiac cycle from cardiac magnetic resonance images and calculated aortic distensibility and strain in 42,342 UK Biobank participants. Descending aortic distensibility was inversely associated with future incidence of cardiovascular diseases, such as stroke (HR: 0.59 per SD; P = 0.00031). The heritabilities of aortic distensibility and strain were 22% to 25% and 30% to 33%, respectively. Common variant analyses identified 12 and 26 loci for ascending and 11 and 21 loci for descending aortic distensibility and strain, respectively. Of the newly identified loci, 22 were not significantly associated with thoracic aortic diameter. Nearby genes were involved in elastogenesis and atherosclerosis. Aortic strain and distensibility polygenic scores had modest effect sizes for predicting cardiovascular outcomes (delaying or accelerating disease onset by 2%-18% per SD change in scores) and remained statistically significant predictors after accounting for aortic diameter polygenic scores. Genetic determinants of aortic function influence risk for stroke and coronary artery disease and may lead to novel targets for medical intervention. [Display omitted] [ABSTRACT FROM AUTHOR]

BACKGROUND: Myalgic encephalomyelitis (ME) is a complex, multi-system neurological condition. The defining feature of ME is post-exertional malaise (PEM) with over 30 symptoms triggered by physical, cognitive, emotional and social activity. The cause of PEM is unclear but one area of research using cardio-pulmonary exercise tests show a reduced ventilatory anaerobic threshold (VAT) with repeated tests leading to PEM. Pacing with heart rate monitoring (HRM) provides feedback to maintain activity intensity below the VAT. There is only one piece of research investigating the use of HRM although a number of guidelines recommend it. OBJECTIVE: To identify the experiences and attitudes of people with ME towards HRM. METHODS: A 40 question online survey was devised and released on ME websites, Twitter and Facebook pages. People with ME read the information sheet and followed an online link to the survey. The survey was open for three weeks and all answers were anonymous. RESULTS: 488 people with ME completed the survey. Most participants were female, 35-50 years and with a reported illness of greater than 5 years. Over 100 types of HR monitor used. Over 30 benefits and over 30 negatives identified. HRM reduced severity of ME and severity and duration of PEM. CONCLUSION: Although there are limitations, HRM has many benefits including helping PwME to understand and manage their PEM and support them to increase their activities, including work. There is a need for more research and education of healthcare professionals in the safe use of HRM. [ABSTRACT FROM AUTHOR]

We aimed to assess the frequency of value preferences in recording of vital signs in electronic healthcare records (EHRs) and associated patient and hospital factors. We used EHR data from Oxford University Hospitals, UK, between 01-January-2016 and 30-June-2019 and a maximum likelihood estimator to determine the prevalence of value preferences in measurements of systolic and diastolic blood pressure (SBP/DBP), heart rate (HR) (readings ending in zero), respiratory rate (multiples of 2 or 4), and temperature (readings of 36.0 °C). We used multivariable logistic regression to investigate associations between value preferences and patient age, sex, ethnicity, deprivation, comorbidities, calendar time, hour of day, days into admission, hospital, day of week and speciality. In 4,375,654 records from 135,173 patients, there was an excess of temperature readings of 36.0 °C above that expected from the underlying distribution that affected 11.3% (95% CI 10.6–12.1%) of measurements, i.e. these observations were likely inappropriately recorded as 36.0 °C instead of the true value. SBP, DBP and HR were rounded to the nearest 10 in 2.2% (1.4–2.8%) and 2.0% (1.3–5.1%) and 2.4% (1.7–3.1%) of measurements. RR was also more commonly recorded as multiples of 2. BP digit preference and an excess of temperature recordings of 36.0 °C were more common in older and male patients, as length of stay increased, following a previous normal set of vital signs and typically more common in medical vs. surgical specialities. Differences were seen between hospitals, however, digit preference reduced over calendar time. Vital signs may not always be accurately documented, and this may vary by patient groups and hospital settings. Allowances and adjustments may be needed in delivering care to patients and in observational analyses and predictive tools using these factors as outcomes or exposures. [ABSTRACT FROM AUTHOR]

Aim: High heart and respiratory rates are key indicators in many published guidelines to identify and treat serious bacterial infection and sepsis in children, but the credibility of evidence underpinning what is considered abnormal is questionable. This study established the distribution of heart and respiratory rates of children using a large data set to inform debate on what the 'normal' range of these should look like. The primary aim was to compare the distribution of heart and respiratory rates measured in children recruited from non‐tertiary emergency care settings with those published by Advanced Paediatric Life Support (APLS). The secondary aim was to compare the distribution of this study's data set to other national guidance on what constitutes a severe (high‐risk) measurement and previously published data sets. Method: Prospective study using anonymised patient data, extracted from electronic patient records of children and young people 0–16 years, recruited from three Emergency Departments and one Urgent Care Centre in Northwest England, UK. Results: Heart and respiratory rates, including the reporting of values at certain centiles and comparisons of averages. Distribution of heart and respiratory rate were consistently higher than those used by the APLS guidance, resulting in a large proportion exceeding the 'severe' cut‐offs proposed. This varied greatly by age. Conclusions: This study's data set suggests normal heart rate ranges proposed by the APLS and others is too low and therefore 'abnormal' measurements encompass too large a proportion. The respiratory rate of this data set was more consistent with the guidelines and other published data sets. [ABSTRACT FROM AUTHOR]

Background: Remote ischemic conditioning (RIC), exposure of body parts to brief periods of circulatory occlusion and reperfusion, has been shown to improve cardiovascular responses to exercise in healthy individuals but its effects in people with MS are unknown. Objective: This study aimed to assess the effect of RIC on heart rate responses to walking in people with MS. Design: Double blind randomized controlled trial Setting: Multiple sclerosis clinic of tertiary care center teaching hospital in the United Kingdom. Methods: Three cycles of RIC were delivered by occluding the upper arm with a blood pressure cuff inflated to a pressure of 30 mmHg above the systolic blood pressure. In the sham group, the blood pressure cuff was inflated to 30 mmHg below diastolic blood pressure. Heart rate responses to the 6-minute walk test (6MWT), the tolerability of RIC using a numerical rating scale for discomfort (0-10), and adverse events were studied. Results: Seventy-five participants (RIC -38 and Sham-37) completed the study. RIC was well tolerated. Compared to sham, RIC significantly decreased the rise in heart rate (P = 0.04) and percentage of predicted maximum heart rate (P = 0.016) after the 6MWT. Conclusion: RIC was well tolerated and improved the heart rate response to walking in people with MS. Further studies on RIC in the management of MS are needed. [ABSTRACT FROM AUTHOR]

Background: The evidence base for the benefits of β-blockers in heart failure with reduced ejection fraction (HFrEF) suggests that higher doses are associated with better outcomes. Objectives: The aim of this study was to report the proportion of patients receiving optimized doses of β-blockers, outcomes, and factors associated with suboptimal dosing. Methods: This was a prospective cohort study of 390 patients with HFrEF undergoing clinical and echocardiography assessment at baseline and at 1 year. Results: Two hundred thirty-seven patients (61%) were receiving optimized doses (≥5-mg/d bisoprolol equivalent), 72 (18%) could not be up-titrated (because of heart rate < 60 beats/min or systolic blood pressure <100 mm Hg), and the remaining 81 (21%) should have been. Survival was similarly reduced in those who could not and should have been receiving 5 mg/d or greater, and patient factors did not explain the failure to attain optimized dosing. Conclusions: Many patients with HFrEF are not receiving optimal dosing of β-blockers, and in around half, there was no clear contraindication in terms of heart rate or blood pressure. [ABSTRACT FROM AUTHOR]

Background: Resting heart rate (RHR) has been linked with an increased risk of dementia. However, evidence characterizing the associations of RHR with different dementia subtypes and their underlying mechanisms remains scarce. This study aims to investigate the relationships of RHR with different dementia types, cognitive function, and brain structural abnormalities. Methods: Three hundred thirty-nine thousand nine hundred one participants with no prior diagnosis of dementia from the UK biobank were analyzed. Cox regression and restricted cubic spline models examined the associations between RHR with all-cause dementia (ACD) and its major subtypes—Alzheimer's disease (AD) and vascular dementia (VaD). Logistic regression models assessed the associations of RHR with cognitive function, and linear regression models estimated the associations with hippocampal subfield volume and white matter tract integrity indexed by magnetic resonance imaging data. Results: During an average of 3148 (± 941.08) days of follow-up, 4177 individuals were diagnosed with dementia, including 2354 AD and 989 VaD cases. RHR ≥ 80bpm was associated with ACD (HR: 1.18, 95% CI: 1.08–1.28, P < 0.001) and VaD (HR: 1.29, 95% CI: 1.08–1.54, P = 0.005) but not AD in multi-adjusted models. A 10-bpm increment of RHR demonstrated non-linear effects in VaD, consisting of J-shape relationships. Several heterogeneities were indicated in stratified analysis, in which RHR measures only showed associations with dementia incidents in relatively younger populations (age ≤ 65) and females. Apart from dementia analysis, elevated RHR was associated with worsening performance in fluid intelligence and reaction time of cognitive tasks, decreased hippocampal subfields volume, and poor white matter tract integrity. Conclusions: RHR is associated with increased risks of ACD and VaD but also presented with few heterogeneities across different sex and age groups. Elevated RHR also appears to have deleterious effects on cognitive function and is distinctively associated with volume reduction in hippocampal subfields and impaired white matter tract integrity. [ABSTRACT FROM AUTHOR]

This study examines whether twelve sessions of heart rate variability biofeedback training would improve vagally mediated heart rate variability. If so, it would go some way in explaining why breathing-based interventions reduce clinical symptoms and improve non-clinical performance outcomes. Methods: Thirty participants (N = 30, Nfemale = 13) aged 14–13-year-old, all talented athletes, from a sport specialist school in SE London UK, were randomly divided into three groups, a control group, a psychology skills training combined with heart rate variability biofeedback training group, and a heart rate variability biofeedback only group. For the combined group, a variety of typical psychological skill training techniques were also used. Results: Paired participant t-test and the Wilcoxon Signed Rank test found non-significant differences between pre- and post-intervention measurements of heart rate variability. Non-significant results remained even after pooling the biofeedback training groups (n = 19). Conclusions: Our results do not indicate that beneficial effects associated with focused breathing training can be attributed to improved vagal tone. Further investigation into the underlying mechanisms of the benefits of focused breathing techniques is necessary to maximize clinical and non-clinical outcomes. [ABSTRACT FROM AUTHOR]

We developed a novel interpretable biological heart age estimation model using cardiovascular magnetic resonance radiomics measures of ventricular shape and myocardial character. We included 29,996 UK Biobank participants without cardiovascular disease. Images were segmented using an automated analysis pipeline. We extracted 254 radiomics features from the left ventricle, right ventricle, and myocardium of each study. We then used Bayesian ridge regression with tenfold cross-validation to develop a heart age estimation model using the radiomics features as the model input and chronological age as the model output. We examined associations of radiomics features with heart age in men and women, observing sex-differential patterns. We subtracted actual age from model estimated heart age to calculate a "heart age delta", which we considered as a measure of heart aging. We performed a phenome-wide association study of 701 exposures with heart age delta. The strongest correlates of heart aging were measures of obesity, adverse serum lipid markers, hypertension, diabetes, heart rate, income, multimorbidity, musculoskeletal health, and respiratory health. This technique provides a new method for phenotypic assessment relating to cardiovascular aging; further studies are required to assess whether it provides incremental risk information over current approaches. [ABSTRACT FROM AUTHOR]

Background: Continuous vital sign monitoring may identify changes sooner than current standard monitoring. Objective: To investigate if the use of real-time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis. Design: A prospective cohort study design. Setting: West Middlesex University Hospital, UK. Participants: Fifty acutely unwell surgical patients admitted to hospital. Intervention: Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 min whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated. Results: There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts, there were 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts, there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 min (2.6 h). There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway. Conclusion: This study demonstrates the evaluation of digital alerts to nurses in real time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathway and escalation to senior clinicians occurred. Further research is required to review why only some alerts were acknowledged and the effects of digital alerting on patient outcomes. Trial registration: ClinicalTrials.gov, NCT04638738 [ABSTRACT FROM AUTHOR]

The phencyclidine derivative 3-methoxyphencyclidine (3-MeO-PCP) is a potent dissociative hallucinogen. Sought for recreational use as a novel psychoactive substance, it can also induce acute psychological agitation and pathophysiological cardiorespiratory effects. Due to the harms associated with its use, 3-MeO-PCP was added to the "Green List" of materials covered by the 1971 Convention on Psychotropic Substances as a Schedule II substance by the United Nations Commission on Narcotic Drugs in April 2021. There have been 15 previous reports of fatal intoxications following 3-MeO-PCP use, but only one was attributable to 3-MeO-PCP intoxication alone. In this report, we detail the first fatality due to 3-MeO-PCP intoxication to be reported in the UK, along with a review of the surrounding literature. While the blood concentrations associated with 3-MeO-PCP toxicity and fatality remain unclear, by providing details of sample collection and storage conditions, this case will aid in future interpretations. Furthermore, this case suggests that 3-MeO-PCP toxicity may be exacerbated by exercise. Users of 3-MeO-PCP should be cautioned against its use as a "club drug" or in a similar setting where elevations in heart rate, body temperature and blood pressure may occur. [ABSTRACT FROM AUTHOR]

The article discusses research which found that ambulatory electrocardiogram (ECG) could provide signals for ventricular arrhythmia (VA) risk stratification when analyzed using VA-ResNet-50, an open-source ResNet-50-based deep neural network, referencing a study by J. Barker et al, published in a 2024 issue of the "European Heart Journal."

Various non-electrocardiogram (ECG) based methods are considered reliable sources of heart rate variability (HRV) measurement. However, the ultra-short recording of a femoral arterial waveform has never been validated against the gold-standard ECG-based 300s HRV and was the aim of this study.A validity study was conducted using a sample from the first follow-up of the longitudinal ADVANCE study UK. The participants were adult servicemen (n = 100); similar in age, rank, and deployment period (Afghanistan 2003–2014). The femoral arterial waveforms (14s) from the pulse wave velocity (PWV) assessment, and ECG (300s) were recorded at rest in the supine position using the Vicorder™ and Bittium Faros™ devices, respectively, in the same session. HRV analysis was performed using Kubios Premium. Resting heart rate (HR) and root mean square of successive differences (RMSSD) were reported. The Bland-Altman %plots were constructed to explore the PWV-ECG agreement in HRV measurement. A further exploratory analysis was conducted across methods and durations.The participants’ mean age was 38.0 ± 5.3 years. Both PWV-derived HR (r = 0.85) and RMSSD (rs=0.84) showed strong correlations with their 300s-ECG counterparts (p < 0.001). Mean HR was significantly higher with ECG than PWV (mean bias: -12.71 ± 7.73%, 95%CI: -14.25%, -11.18%). In contrast, the difference in RMSSD between the two methods was non-significant [mean bias: -2.90 ± 37.82% (95%CI: -10.40%, 4.60%)] indicating good agreement. An exploratory analysis of 14s ECG-vs-300s ECG measurement revealed strong agreement in both RMSSD and HR.The 14s PWV-derived RMSSD strongly agrees with the gold-standard (300s-ECG-based) RMSSD at rest. Conversely, HR appears method sensitive. [ABSTRACT FROM AUTHOR]

Experience is positively related to performance, but it is less clear whether experience might also minimise the deleterious effects of anxiety and arousal in stressful situations. One hundred and twenty-seven UK firearms officers of different experience levels participated in an experiment examining the extent to which anxiety affects performance during a bi-annual qualification shoot. Performance and anxiety were compared on a low-arousal development shoot and a high-arousal qualification shoot; qualification shoot failure would result in removal from operational duties. Heart rate and responses to the State-Trait Anxiety questionnaire were examined in relation to shooting performance. Less experienced officers demonstrated significantly higher baseline corrected mean heart rates, higher anxiety levels and lower accuracy than their more experienced counterparts, who maintained accuracy, despite a significant increase in heart rate during the qualification compared to the development shoot. The results, some of the first to examine British firearms officers in their natural training environment, suggest experience reduces the physiological impact of arousal on performance in pressurised situations. We discuss options for reducing the impact on performance in less experienced officers. [ABSTRACT FROM AUTHOR]

Background: International newborn resuscitation guidelines recommend electrocardiogram (ECG) heart rate (HR) monitoring at birth. We evaluated the application time of pre-set ECG electrodes fixed to a polyethene patch allowing adhesive-free attachment to the wet skin of the newborn chest. Objectives: Using a three-electrode pre-set ECG patch configuration, application success was calculated using video analysis and measured at three time points, the time to (1) apply electrodes; (2) detect recognizable QRS complexes after application; and (3) display a HR after application. Method: A prospective observational study in two UK tertiary maternity units was undertaken with 71 newborns including 23 who required resuscitation. Results: The median (IQR) time for ECG patch application was 8 (6–10) seconds, detection of recognizable QRS complexes 8 (2–12) seconds, and time to output HR was 23 (15–37) seconds. Conclusion: Pre-set ECG chest electrodes allow rapid HR information at birth without electrode detachment or compromising skin integrity. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to use a compositional analysis approach to account for the inherent co‐dependencies between behaviors and to explore how daily movement behaviors influence cardiovascular health in children with and without T1D. Research Design and Methods: Augmentation index, pulse wave velocity (PWV) and heart rate variability were measured in 20 children with (11.9 ± 1.6 years) and 17 children without T1D (11.6 ± 2.2 years). Subsequently, physical activity and sleep were assessed at 20 Hz for 28 consecutive days using a wrist‐worn accelerometer. Compositional analyses were utilized to explore the relative effects of each movement behavior and the overall movement complex on cardiovascular parameters, with predictive modeling used to explore the effects of reallocating 20 min between behaviors. Results: Arterial stiffness markers were most influenced by the total movement composition, whereas autonomic function was most influenced by sedentary time and sleep relative to all other behaviors. Reallocation of time from moderate‐to‐vigorous physical activity (MVPA) to any other behavior was predicted to negatively affect all cardiovascular measures, independent of disease status, whereas reallocating time to MVPA was consistently predicted to improve all outcome measures. Additionally, the same intensity of physical activity appeared to be more potent for cardiovascular health in T1D children compared to nondiabetic peers. Conclusions: Intensity, rather than volume, of physical activity may be key in reducing risk of premature adverse changes in cardiovascular health, whereas increasing time in MVPA could potentially the slow progression of cardiovascular aging in children with diabetes. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) represents a critical public health problem around the world. To date, there are no accurate therapeutic approaches for the management of cardiovascular impairments induce by TBI. In this regard, hydrogen sulfide (H2S), a novel gasotransmitter, has been proposed as a neuro- and cardioprotective molecule. This study was designed to determine the effect of subchronic management with sodium hydrosulfide (NaHS) on hemodynamic, vasopressor sympathetic outflow and sensorimotor alterations produced by TBI. Animals underwent a lateral fluid percussion injury, and changes in hemodynamic variables were measured by pletismographic methods. In addition, vasopressor sympathetic outflow was assessed by a pithed rat model. Last, sensorimotor impairments were evaluated by neuroscore test and beam-walking test. At seven, 14, 21, and 28 days after moderate-severe TBI, the animals showed: (1) a decrease on sensorimotor function in the neuroscore test and beam-walking test; (2) an increase in heart rate, systolic, diastolic, and mean blood pressure; (3) progressive sympathetic hyperactivity; and (4) a decrease in vasopressor responses induced by noradrenaline (α1/2-adrenoceptors agonist) and UK 14,304 (selective α2-adrenoceptor agonist). Interestingly, intraperitoneal daily injections of NaHS, an H2S donor (3.1 and 5.6 mg/kg), during seven days after TBI prevented the development of the impairments in hemodynamic variables, which were similar to those obtained in sham animals. Moreover, NaHS treatment prevented the sympathetic hyperactivity and decreased noradrenaline-induced vasopressor responses. No effects on sensorimotor dysfunction were observed, however. Taken together, our results suggest that H2S ameliorates the hemodynamic and sympathetic system impairments observed after TBI. [ABSTRACT FROM AUTHOR]

Increasing 24‐h demand for products, services and health care is resulting in a substantial portion of the workforce engaging in shift work. Observational studies suggest an association between shift work exposure and increased incidence of cardiometabolic disease. Shift workers report less healthy diets compared to day workers. As diet is a modifiable behaviour, it is important to understand how it might mediate the relationship between shift work and health. We reviewed online dietary advice for shift workers by searching for existing guidelines for shift workers published by websites of credible sources, for example institutions or government agencies. Based on the 26 guidelines retrieved, the most common categories of advice were eating patterns (n = 25), general healthy eating and/or specific food groups (n = 22), control of caffeine intake (n = 23) and maintaining hydration/fluid intake (n = 17). Although the majority of publicly available advice for shift workers follows general healthy eating guidelines, there are inconsistencies in the recommendations around the frequency of eating and snacking. Few studies have investigated modification of diet quality in shift workers. With the goal of adding to the evidence base, the Shift‐eat study is a feasibility trial designed to test whether dietary intakes in line with UK healthy eating recommendations during night work improve markers of health (interstitial glucose and heart rate variability) in free‐living shift‐working employees. Shift work is unavoidable and necessary for many industries. With an increasing section of the population employed in jobs requiring shift work, consistent dietary guidance based on evidence from shift‐working populations is urgently needed to support maintenance of health and wellbeing in employees working outside standard daytime hours. [ABSTRACT FROM AUTHOR]

Introduction: Defining current inpatient management of cervicofacial infections is key to identifying strategies to optimise care. Steroid use is beneficial in peritonsillar and orbital abscess, but there are few studies of steroid use in odontogenic cervicofacial infections. Our previous research identified widespread variation in practice, necessitating a national audit to define current practice. Methods: A multicentre, trainee-led snapshot audit was carried out across 25 hospitals in the UK. Information recorded included demographic features, presentation, surgical and medical management, and steroid administration. Results: One thousand two admissions were recorded. Fifty-five percent were male, with mean age 37.3 years (range 0–94 years). Steroids were administered to 357 patients (36%), 159 of whom received steroids on admission, and 254 peri-operatively. Patients who were prescribed steroids had significantly higher white cell count (12.4 vs 11.5), CRP (79.5 vs 57) and heart rate (94 vs 88) on admission. Justifications given for administration included swelling (74), dysphagia (21), and airway compromise (7). Three patients (0.8%) reported steroid-related side effects. Conclusions: This study uses the largest recorded cohort of cervicofacial infections to define current inpatient steroid administration. Our results suggest that steroids are targeted towards the most compromised 1/3 of patients. The incidence of steroid-related side effects was low. Defining the characteristics of patients currently receiving steroids will aid in determining whether steroid administration is an effective adjunct in treating odontogenic cervicofacial infection. [ABSTRACT FROM AUTHOR]

Differences in understanding emotion in autism are well-documented, although far more research has considered how being autistic impacts an understanding of other people's emotions, compared to their own. In neurotypical adults and children, many emotions are associated with distinct bodily maps of experienced sensation, and the ability to report these maps is significantly related to the awareness of interoceptive signals. Here, in 100 children who either carry a clinical diagnosis of autism (n = 45) or who have no history of autism (n = 55), we investigated potential differences in differentiation across autistic children's bodily maps of emotion, as well as how such differentiation relates to the processing of interoceptive signals. As such, we measured objective interoceptive performance using the heartbeat-counting task, and participants' subjective experience of interoceptive signals using the child version of the Body Perception Questionnaire. We found less differentiation in the bodily maps of emotion in autistic children, but no association with either objective or subjective interoceptive processing. These findings suggest that, in addition to previously reported differences in detecting others' emotional states, autistic children have a less differentiated bodily experience of emotion. This does not, however, relate to differences in interoceptive perception as measured here. More research has been conducted on how autistic people understand and interpret other people's emotions, than on how autistic people experience their own emotions. The experience of emotion is important however, because it can relate to difficulties like anxiety and depression, which are common in autism. In neurotypical adults and children, different emotions have been associated with unique maps of activity patterns in the body. Whether these maps of emotion are comparable in autism is currently unknown. Here, we asked 100 children and adolescents, 45 of whom were autistic, to color in outlines of the body to indicate how they experienced seven emotions. Autistic adults and children sometimes report differences in how they experience their internal bodily states, termed interoception, and so we also investigated how this related to the bodily maps of emotion. In this study, the autistic children and adolescents had comparable interoception to the non-autistic children and adolescents, but there was less variability in their maps of emotion. In other words, they showed more similar patterns of activity across the different emotions. This was not related to interoception, however. This work suggests that there are differences in how autistic people experience emotion that are not explained by differences in interoception. In neurotypical people, less variability in emotional experiences is linked to anxiety and depression, and future work should seek to understand if this is a contributing factor to the increased prevalence of these difficulties in autism. [ABSTRACT FROM AUTHOR]

The elderly are the most at-risk population for heat-related illness and mortality during the periods of hot weather. However, evidence-based elderly-specific cooling strategies to prevent heat-illness are limited. The aim of this investigation was to quantify the elderly's physiological and perceptual responses to cooling through cold water ingestion (COLD) or an L-menthol mouth rinse (MENT) during simulated activities of daily living in UK summer climatic conditions. Randomised, controlled repeated measures research design. A total of ten participants (men n = 7, women n = 3: age; 69 ± 3 yrs, height; 168 ± 10 cm, body mass; 68.88 ± 13.72 kg) completed one preliminary and three experimental trials; control (CON), COLD and MENT. Experimental trials consisted of 40 min rest followed by 30 min of cycling exercise at 6 metabolic equivalents and a 6-min walk test (6MWT), within a 35 °C, 50% relative humidity environment. Experimental interventions (every 10 min); cold water (4 °C) ingestion (total of 1.5L) or menthol (5 ml mouth swill for 5 s, menthol concentration of 0.01%). Peak rectal temperature (T re) was significantly (P < 0.05) lower in COLD compared with CON (−0.34 ± 0.16 °C) and MENT (−0.36 ± 0.20 °C). End exercise heart rate (HR) decreased in COLD compared with CON (−7 ± 9 b min−1) and MENT (−6 ± 7 b min−1). There was no difference in end exercise thermal sensation (TS) (CON; 6.1 ± 0.4, COLD; 6.0 ± 0.4, MENT; 6.4 ± 0.6) or thermal comfort (TC) (CON; 4 ± 1, COLD; 4 ± 1, MENT; 4 ± 1) between trials. The participants walked significantly further during the COLD 6MWT compared with CON (40 m ± 40 m) and MENT (40 m ± 30 m). There was reduced physiological strain in the COLD 6MWT compared with CON (T re ; −0.21 ± 0.24 °C, HR; −7 ± 8 b min−1) and MENT (T re ; −0.23 ± 0.24 °C, HR; −4 ± 7 b min−1). The elderly have reduced physiological strain (T re and HR) during activities of daily living and a 6MWT in hot UK climatic conditions, when they drink cold water. Furthermore, the elderly's perception (TS and TC) of the hot environment did not differ from CON at the end of exercise with COLD or MENT interventions. Menthol provided neither perceptual benefit to exercise in the heat nor functional gain. The TS data indicate that elderly may be at increased risk of heat illness, due to not feeling hot and uncomfortable enough to implement physiological strain reducing strategies such as cold-water ingestion. Article in a Tweet: [ABSTRACT FROM AUTHOR]

Intimate partner violence is predominantly viewed as a social problem of men's violence against women. However, a growing evidence base suggests an equal prevalence rate for male and female perpetrated intimate partner physical aggression. Moreover, female perpetrated intimate partner violence is often assumed to be reactive, yet there is limited evidence to support this notion. In this article, we describe the results of two studies that investigated the prevalence of female perpetrated intimate partner physical aggression, and its correlates in heterosexual female university students. The relationships of personality traits, resting heart rate, and heart rate variability (a correlate of vagal activity) were compared between females who did and did not report having engaged in intimate partner physical aggression. In Study 1, we found that 30.9% of participants reported enacting intimate partner physical aggression during the preceding 12 months. This finding suggests that a considerable number of undergraduate females aggress against their intimate partners. Perpetrators, relative to nonperpetrators, scored higher on secondary psychopathic traits. In Study 2, female intimate partner violence was shown to be associated with low resting heart rate and high heart rate variability. Perpetrators, relative to nonperpetrators, scored higher on psychopathic traits that index emotional resilience and unempathic tendencies, and reported increased proactive and reactive aggression. This raises the possibility that some incidences of female intimate partner physical aggression represent proactive aggressive acts. These findings also support the frequently found association between low resting heart rate and aggression, but raise the prospect that the reported aggressive acts reflect high heart rate variability and strong parasympathetic nervous system activity. [ABSTRACT FROM AUTHOR]

Background: Reduced heart rate (HR) increase (HRI), recovery (HRR), and higher resting HR are associated with cardiovascular (CV) disease, but causal inferences have not been deduced. We investigated causal effects of HRI, HRR, and resting HR on CV risk, all-cause mortality (ACM), atrial fibrillation (AF), coronary artery disease (CAD), and ischemic stroke (IS) using Mendelian Randomization. Methods: 11 variants for HRI, 11 for HRR, and two sets of 46 and 414 variants for resting HR were obtained from four genome-wide association studies (GWASs) on UK Biobank. We performed a lookup on GWASs for CV risk and ACM in UK Biobank (N = 375,367, 5.4% cases and N = 393,165, 4.4% cases, respectively). For CAD, AF, and IS, we used publicly available summary statistics. We used a random-effects inverse-variance weighted (IVW) method and sensitivity analyses to estimate causality. Results: IVW showed a nominally significant effect of HRI on CV events (odds ratio [OR] = 1.0012, P = 4.11 × 10–2) and on CAD and AF. Regarding HRR, IVW was not significant for any outcome. The IVW method indicated statistically significant associations of resting HR with AF (OR = 0.9825, P = 9.8 × 10–6), supported by all sensitivity analyses, and a nominally significant association with IS (OR = 0.9926, P = 9.82 × 10–3). Conclusion: Our findings suggest no strong evidence of an association between HRI and HRR and any outcome and confirm prior work reporting a highly significant effect of resting HR on AF. Future research is required to explore HRI and HRR associations further using more powerful predictors, when available. [ABSTRACT FROM AUTHOR]

BACKGROUND: Limited research exists into extraterrestrial CPR, despite the drive for interplanetary travel. This study investigated whether the terrestrial CPR method can provide quality external chest compressions (ECCs) in line with the 2015 UK resuscitation guidelines during ground-based hypogravity simulation. It also explored whether gender, weight, and fatigue influence CPR quality. METHODS: There were 21 subjects who performed continuous ECCs for 5 min during ground-based hypogravity simulations of Mars (0.38 G) and the Moon (0.16 G), with Earth's gravity (1 G) as the control. Subjects were unloaded using a body suspension device (BSD). ECC depth and rate, heart rate (HR), ventilation (...E), oxygen uptake (...o2), and Borg scores were measured. RESULTS: ECC depth was lower in 0.38 G (42.9 ± 9 mm) and 0.16 G (40.8 ± 9 mm) compared to 1 G and did not meet current resuscitation guidelines. ECC rate was adequate in all gravity conditions. There were no differences in ECC depth and rate when comparing gender or weight. ECC depth trend showed a decrease by min 5 in 0.38 G and by min 2 in 0.16 G. Increases in HR, ...E, and ...o2 were observed from CPR min 1 to min 5. DISCUSSION: The terrestrial method of CPR provides a consistent ECC rate but does not provide adequate ECC depths in simulated hypogravities. The results suggest that a mixed-gender space crew of varying bodyweights may not influence ECC quality. Extraterrestrial-specific CPR guidelines are warranted. With a move to increasing ECC rate, permitting lower ECC depths and substituting rescuers after 1 min in lunar gravity and 4 min in Martian gravity is recommended. [ABSTRACT FROM AUTHOR]

Objective: To describe maternal haemodynamic differences in gestational hypertension with small-for-gestational-age babies (HDP + SGA), gestational hypertension with appropriate-for-gestational-age babies (HDP-only) and control pregnancies.Design: Prospective cohort study.Setting: Tertiary Hospital, UK.Population: Women with gestational hypertension and healthy pregnant women.Methods: Maternal haemodynamic indices were measured using a non-invasive Ultrasound Cardiac Output Monitor (USCOM-1A® ) and corrected for gestational age and maternal characteristics using device-specific reference ranges.Main Outcome Measures: Maternal cardiac output, stroke volume, systemic vascular resistance.Results: We included 114 HDP + SGA, 202 HDP-only and 401 control pregnancies at 26-41 weeks of gestation. There was no significant difference in the mean arterial blood pressure (110 versus 107 mmHg, P = 0.445) between the two HDP groups at presentation. Pregnancies complicated by HDP + SGA had significantly lower median heart rate (76 versus 85 bpm versus 83 bpm), lower cardiac output (0.85 versus 0.98 versus 0.97 MoM) and higher systemic vascular resistance (1.4 versus 1.0 versus 1.2 MoM) compared with control and HDP-only pregnancies, respectively (all P < 0.05).Conclusion: Women with HDP + SGA present with more severe haemodynamic dysfunction than HDP-only. Even HDP-only pregnancies exhibit impaired haemodynamic indices compared with normal pregnancies, supporting a role of the maternal cardiovascular system in gestational hypertension irrespective of fetal size. Central haemodynamic changes may play a role in the pathogenesis of pre-eclampsia and should be considered alongside placental aetiology.Tweetable Abstract: Hypertensive disorders of pregnancy are associated with worse maternal haemodynamic function when associated with small-for-gestational-age birth. [ABSTRACT FROM AUTHOR]

Objectives: This article presents two studies assessing the impact of mindfulness in prison (prisoners and staff) and non-custodial settings.Method: Study 1-prisoners (n = 17) and staff (n = 15) in a UK prison completed a mindfulness program; 16 individuals acted as a single time point comparison. Data were collected using self-report, computer based and physiological measurement. Study 2-men under community probation supervision were allocated to mindfulness (completed, n = 28) or TAU (n = 27). Data were collected using self-report mindfulness measures.Results: Study 1-statistically significant (increases in mindfulness skills (η2p = .234 to η2p = .388), cognitive control (η2p = .28), and heart rate variability (SDNN; η2p = .41) along with significant decreases in stress (η2p = .398) were found. In study 2, the mindfulness group showed non-significant improvements in mindfulness skills.Conclusion: The findings suggest brief mindfulness interventions could make an important contribution to offender rehabilitation and custodial staff wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to quantify changes in heart rate (HR) and movement speeds in interchanged and whole-match players during 35 elite rugby league performances. Methods: Performances were separated into whole match, interchange bout 1, and interchange bout 2 and further subdivided into match quartiles. Mean percentages of peak HR (%HRpeak) and total and high-intensity running (> 14 km/h) meters per minute (m/ min) were recorded. Results: For whole-match players, a decline in high-intensity m/min and %HRpeakwas observed between successive quartiles (P < .05). High-intensity m/min during interchange 1 also progressively declined, although initial m/min was higher than whole match (24.2 ± 7.9 m/min vs 18.3 ± 4.7 m/min, P = .018), and %HRpe3k did not change over match quartiles (P > .05). During interchange 2, there was a decline in high-intensity m/min from quartile 1 toquartile3 (18 ±4.1 vs 13.4 ±5 m/min, P= .048) before increasing in quartile 4. Quartiles 1 and 2 also showed an increase in %HRpeak (85.2 ± 6.5 vs 87.3 ± 4.2%, P = .022). Conclusions: Replacement players adopted a high initial intensity in their first match quartile before a severe decline thereafter. However, in a second bout, lower exercise intensity at the outset enabled a higher physiological exertion for later periods. These findings inform interchange strategy and conditioning for coaches while also providing preliminary evidence of pacing in team sport. [ABSTRACT FROM AUTHOR]

Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39–70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC75%). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC75%, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62–0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56–0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62–1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55–0.94) than women (HR 0.99, 95% CI 0.71–1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study. [ABSTRACT FROM AUTHOR]

Sudden cardiac death is responsible for half of all deaths from cardiovascular disease. The analysis of the electrophysiological substrate for arrhythmias is crucial for optimal risk stratification. A prolonged T-peak-to-Tend (Tpe) interval on the electrocardiogram is an independent predictor of increased arrhythmic risk, and Tpe changes with heart rate are even stronger predictors. However, our understanding of the electrophysiological mechanisms supporting these risk factors is limited. We conducted genome-wide association studies (GWASs) for resting Tpe and Tpe response to exercise and recovery in ∼30,000 individuals, followed by replication in independent samples (∼42,000 for resting Tpe and ∼22,000 for Tpe response to exercise and recovery), all from UK Biobank. Fifteen and one single-nucleotide variants for resting Tpe and Tpe response to exercise, respectively, were formally replicated. In a full dataset GWAS, 13 further loci for resting Tpe, 1 for Tpe response to exercise and 1 for Tpe response to exercise were genome-wide significant (p ≤ 5 × 10−8). Sex-specific analyses indicated seven additional loci. In total, we identify 32 loci for resting Tpe, 3 for Tpe response to exercise and 3 for Tpe response to recovery modulating ventricular repolarization, as well as cardiac conduction and contraction. Our findings shed light on the genetic basis of resting Tpe and Tpe response to exercise and recovery, unveiling plausible candidate genes and biological mechanisms underlying ventricular excitability. [ABSTRACT FROM AUTHOR]

Objective: To define the sex, age, and disease-specific associations of resting heart rate (RHR) with cardiovascular and mortality outcomes in 502,534 individuals from the UK Biobank over 7–12 years of prospective follow-up. Methods: The main outcomes were all-cause, cardiovascular, and ischaemic heart disease mortality. Additional outcomes included incident acute myocardial infarction (AMI), fatal AMI, and cancer mortality. We considered a wide range of confounders and the effects of competing hazards. Results are reported as hazard ratios (HR) for all-cause mortality and sub-distribution hazard ratios (SHR) for other outcomes with corresponding 95% confidence intervals (CI) per 10bpm increment of RHR. Results: In men, for every 10bpm increase of RHR there was 22% (HR 1.22, CI 1.20 to 1.24, p = 3×10−123) greater hazard of all-cause and 17% (SHR 1.17, CI 1.13 to 1.21, p = 5.6×10−18) greater hazard of cardiovascular mortality; for women, corresponding figures were 19% (HR 1.19, CI 1.16 to 1.22, p = 8.9×10−45) and 14% (SHR 1.14, CI 1.07 to 1.22, p = 0.00008). Associations between RHR and ischaemic outcomes were of greater magnitude amongst men than women, but with similar magnitude of association for non-cardiovascular cancer mortality [men (SHR 1.18, CI 1.15–1.21, p = 5.2×10−46); women 15% (SHR 1.15, CI 1.11–1.18, p = 3.1×10−18)]. Associations with all-cause, incident AMI, and cancer mortality were of greater magnitude at younger than older ages. Conclusions: RHR is an independent predictor of mortality, with variation by sex, age, and disease. Ischaemic disease appeared a more important driver of this relationship in men, and associations were more pronounced at younger ages. [ABSTRACT FROM AUTHOR]

Introduction: In the UK, approximately 70,000 appendicectomies (one of the most common surgical procedures) are performed yearly. There is a wide variation in length of stay following Laparoscopic Appendicectomy (LA). Aim: To review the feasibility of safe same day discharge following LA for patients with acute appendicitis. Materials and Methods: This was a retrospective review of 92 consecutive adults (≥18 years) who underwent emergency appendicectomy in a District General Hospital (DGH), between April and July 2018. The patients were divided into two groups. Group A comprised all patients not discharged on day of operation while Group B comprised all patients discharged on same day of operation. Data collected and analysed included demographics, clinical diagnosis, WBC, CRP, operative details, complications and length of stay. Outcomes were compared using Fisher's exact test. Results: Group A: Total 86 (93%), included male: female of 38:48, age 36 (median), range (18-81) years, heart rate 78(median), range (51-162)/minute, temperature 36.8°C (median), range (35.7-40.2) C, WBC 13.5 (median), range (3.8-25.6), CRP 36 (median), range (2-498) and PO stay 1 (median), range (1-11) days. Group B: Total 6(7%), included male:female of 2: 4 with age of 27 (median), range (18-49) years, temperature 36.8°C (median), range (36.5-39.2) C, WBC 10.5 (median), range (7-15.6), CRP 5.5 (median), range (1-94) and PO stay of 0 day. Four had uncomplicated appendicitis, 1 had pus and 1 had appendicular mass with pus. Five out of six patients had LA and were operated before noon. Group B had no complications including no re-admissions. Conclusion: Selective approach to same day discharge, for medically fit patients undergoing emergency laparoscopic appendicectomy, is safe. Complicated appendicitis is not an absolute contraindication to same day discharge. [ABSTRACT FROM AUTHOR]