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Rapid weight loss (RWL) practices are common among athletes to "make weight" for a chosen bodyweight class. This study's purpose was to investigate RWL prevalence, magnitude, and methods within Olympic weightlifters from Great Britain. Subjects (n 5 39, male 5 22, female 5 17) were recruited from International Weightlifting Federation lifting populations (mandatory two-hour competition weigh-in). Subjects were categorized into competitive groups based on Sinclair coefficient total (high, mid, low) and also gender (male, female). The validated Rapid Weight Loss Questionnaire was used to establish RWL magnitude and practices. Of respondents, 33 of 39 (84.6%) had purposely acutely reduced body mass to compete, a higher proportion present within females (94.1%) than males (77.3%). The cohort's mean habitual precompetition acute body mass loss was 3.8 6 1.7% and the "rapid weight loss score" (RWLS) was 23.6 6 9.5. Across competitive groups there were no significant differences in habitual or highest precompetition body mass loss, postcompetition body mass gain or RWLS (p . 0.05). However, females attributed a significantly greater "highest" relative precompetition body mass loss compared with males (7.4 vs 4.9%, p 5 0.045). For RWL methods used, frequencies of "always" and "sometimes" were reported highest for "restricting fluid ingestion" (81.8%), "gradual dieting" (81.8%), and "water loading" (54.5%). The prevalence of RWL is high among competitive Olympic weightlifters, and especially within the sampled female athletes. Magnitude of RWL was similar across different standards of athlete; however, female lifters demonstrated a higher maximum precompetition RWL. [ABSTRACT FROM AUTHOR]

Scholars from the psychology and mental health professions have previously identified the value of self-care for enhancing practitioners personal and professional well-being, and fitness to practice. Despite these advances, self-care in sport psychology practitioners has received limited attention from scholars, with the few extant studies investigating senior practitioners' self-care. As such, there currently exists little understanding of how neophyte practitioners understand, experience and enact self-care. In the current study, we aimed to better understand SPP self-care early in individuals' professional development. Grounded in ontological relativism, we recruited 18 self-identified white neophyte SPPs residing in the United Kingdom (12 females and 6 males), aged between 24 and 52 years (Mage = 31.94, SDage = 7.81), to take part in semi-structured interviews in which we explored their experiences of enacting self-care during their training. Five main themes were constructed following a reflexive thematic analysis of data. These themes were: (a) What self-care means to neophyte SPPs, (b) The cornerstones of self-care, (c) What facilitates neophyte's self-care, (d) The self-care hurdles that neophytes face and (e) The self-care actions that neophytes implement. These findings contribute to the nascent body of literature exploring self-care within SPP populations and serve to better illuminate neophyte SPPs' understanding of self-care and how they perceive their interactions with the profession to impact their ability to enact self-care. The current lack of emphasis on self-care in SPP training pathways and employment settings as well as key considerations for the development of greater self-care awareness within current and future neophyte cohorts is discussed. Lay summary: In this study we explored the self-care experiences of 18 neophyte Sport Psychology Practitioners (SPPs). Analysis of interview data identified the meaning of self-care to neophyte SPPs, the key mechanisms, such as self-awareness, that underpin self-care as well as the facilitating and challenging aspects related to engaging in self-care. Neophyte sport psychology practitioners perceive engaging in self-care to be of benefit to a positive work-life balance and their holistic development. The development of mechanisms such as self-awareness and psychological flexibility in one's self-care practices may be beneficial to promoting effective self-care for neophytes. Greater efforts from employing organizations, regulatory bodies and educational institutions are needed to better communicate the importance of self-care during training. [ABSTRACT FROM AUTHOR]

Flat jockeys in Great Britain (GB) are classified as apprentices if they are aged less than 26 years and/or have ridden less than 95 winners. To gain experience, apprentices are allocated a weight allowance of up to 7 lb (3.2 kg). Given that there is no off-season in GB flat horseracing, jockeys are required to maintain their racing weight all year round. In light of recent work determining that current apprentices are considerably heavier than previous generations and that smaller increases have been made in the minimum weight, the aim of this study was to assess if the minimum weight in GB was achievable. To make the minimum weight (50.8 kg) with the maximal weight allowance requires a body mass of ∼46.6 kg while maintaining a fat mass >2.5 kg (the lowest fat mass previously reported in weight-restricted males). Thirty-two male apprentice jockeys were assessed for body composition using dual-energy X-ray absorptiometry. The mean (SD) total mass and fat mass were 56 (2.9) kg and 7.2 (1.8) kg, respectively. Given that the lowest theoretical body mass for this group was 51.2 (2.3) kg, only one of 32 jockeys was deemed feasible to achieve the minimum weight with their current weight allowance and maintaining fat mass >2.5 kg. Furthermore, urine osmolality of 780 (260) mOsmol/L was seen, with 22 (out of 32) jockeys classed as dehydrated (>700 mOsmols/L), indicating that body mass would be higher when euhydrated. Additionally, we observed that within new apprentice jockeys licensed during this study (N = 41), only one jockey was able to achieve the minimum weight. To facilitate the goal of achieving race weight with minimal disruptions to well-being, the authors' data suggest that the minimum weight for GB apprentices should be raised. [ABSTRACT FROM AUTHOR]

Background: Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection. Methods: We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from health records using a standardised template. We used multivariable logistic regression to analyse the factors associated with ICU survival. Results: Of the 156 patients included, 112 (72%) were male, 89 (57%) were overweight or obese, 68 (44%) were from ethnic minorities, and 89 (57%) were aged over 60 years of age. 136 (87%) received mechanical ventilation, 77 (57% of those intubated) were placed in the prone position and 95 (70% of those intubated) received neuromuscular blockade. 154 (99%) patients required cardiovascular support and 44 (28%) required renal replacement therapy. Of the 130 patients with completed ICU episodes, 38 (29%) died and 92 (71%) were discharged alive from ICU. In multivariable models, age (OR 1.13 [95% CI 1.07–1.21]), obesity (OR 3.06 [95% CI 1.16–8.74]), lowest P/F ratio on the first day of admission (OR 0.82 [95% CI 0.67–0.98]) and PaCO2 (OR 1.52 [95% CI 1.01–2.39]) were independently associated with ICU death. Conclusions: Age, obesity and severity of respiratory failure were key determinants of survival in this cohort. Multiorgan failure was prevalent. These findings are important for guiding future research and should be taken into consideration during future healthcare planning in the UK. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy dose and target volume prescriptions for anal squamous cell carcinoma (ASCC) vary considerably in daily practice and guidelines, including those from NCCN, UK, Australasian, and ESMO. We conducted a pattern-of-care survey to assess the patient management in German speaking countries.Methods: We developed an anonymous questionnaire comprising 18 questions on diagnosis and treatment of ASCC. The survey was sent to 361 DEGRO-associated institutions, including 41 university hospitals, 118 non-university institutions, and 202 private practices.Results: We received a total of 101 (28%) surveys, including 20 (19.8%) from university, 36 (35.6%) from non-university clinics, and 45 (44.6%) from private practices. A total of 28 (27.8%) institutions reported to treat more than 5 patients with early-stage ASCC and 42 (41.6%) institutions treat more than 5 patients with locoregionally-advanced ASCC per year. Biopsy of suspicious inguinal nodes was advocated in only 12 (11.8%) centers. Screening for human immunodeficiency virus (HIV) is done in 28 (27.7%). Intensity modulated radiotherapy or similar techniques are used in 97%. The elective lymph node dose ranged from 30.6 Gy to 52.8 Gy, whereas 87% prescribed 50.4-55. 8 Gy (range: 30.6 to 59.4 Gy) to the involved lymph nodes. The dose to gross disease of cT1 or cT2 ASCC ranged from 50 to ≥60 Gy. For cT3 or cT4 tumors the target dose ranged from 54 Gy to more than 60 Gy, with 76 (75.2%) institutions prescribing 59.4 Gy. The preferred concurrent chemotherapy regimen was 5-FU/Mitomycin C, whereas 6 (6%) prescribed Capecitabine/Mitomycin C. HIV-positive patients are treated with full-dose CRT in 87 (86.1%) institutions. First assessment for clinical response is reported to be performed at 4-6 weeks after completion of CRT in 2 (2%) institutions, at 6-8 weeks in 20 (19.8%), and 79 (78%) institutions wait up to 5 months.Conclusions: We observed marked differences in radiotherapy doses and treatment technique in patients with ASCC, and also variable approaches for patients with HIV. These data underline the need for an consensus treatment guideline for ASCC. [ABSTRACT FROM AUTHOR]

This essay explores Charles Dickens’s railway journalism of the 1850s and 1860s and its differences from his more well-known fictional accounts of the British railway network. While fictional works such asDombey and Sonand ‘The Signalman’ emphasize the catastrophic aspects of railway accidents, Dickens’s journalism inHousehold WordsandAll the Year Roundexamines the modern systematicity of the railway network, which by its nature as system, necessitated accidents on the lines. The essay incorporates theoretical readings of risk by Ulrich Beck and Paul Virilio into its critical assessment of Dickens’s railway journalism. Fundamentally, it aims to demonstrate that Dickens’s railway journalism illuminates the complexity of Victorian narratives of technological and bureaucratic industrial and transport systems by prioritizing the global dimensions of systematic accidents over the period’s tendencies to focus merely on local accidental events. [ABSTRACT FROM PUBLISHER]

Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia-related entries in patients' records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds of patients (n = 475, 64.5%, 95%CI 60.9-67.8%) received no physician-documented pain assessment during the 24-h study period. Just under one-third (n = 215, 28.6%, 95%CI 25.5-32.0%) received no nursing-documented pain assessment, and over one-fifth (n = 159, 21.2%, 95%CI 19.2-23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed. [ABSTRACT FROM AUTHOR]

Background Chronic pain has a strong association with major depressive disorder (MDD), but there is a relative paucity of studies on the association between chronic multisite pain and bipolar disorder (BD). Such studies are required to help elucidate the complex biological and psychological overlap between pain and mood disorders. The aim of this study is to investigate the relationship between chronic multisite pain and mood disorder across the unipolar-bipolar spectrum. Methods We conducted a cross-sectional study of 149,611 UK Biobank participants. Self-reported depressive and bipolar features were used to categorise participants into MDD and BD groups and a non-mood disordered comparison group. Multinomial logistic regression was used to establish whether there was an association between extent of chronic pain (independent variable) and mood disorder category (dependent variable), using no pain as the referent category, and adjusting for a wide range of potential sociodemographic, lifestyle and comorbidity confounders. Results Multisite pain was significantly more prevalent in participants with BD and MDD, for example, 4-7 pain sites: BD 5.8%, MDD 4.5%, and comparison group 1.8% (p < 0.001). A relationship was observed between extent of chronic pain and risk of BD and persisted after adjusting for confounders (relative to individuals with no chronic pain): 2-3 sites RRR of BD 1.84 (95% CI 1.61, 2.11); 4-7 sites RRR of BD 2.39 (95%CI 1.88, 3.03) and widespread pain RRR of BD 2.37 (95%CI 1.73, 3.23). A similar relationship was observed between chronic pain and MDD: 2-3 sites RRR of MDD 1.59 (95%CI 1.54, 1.65); 4-7 sites RRR of MDD 2.13 (95%CI 1.98, 2.30); widespread pain RRR of MDD 1.86 (95%CI 1.66, 2.08). Conclusions Individuals who report chronic pain and multiple sites of pain are more likely to have MDD and are at higher risk of BD. These findings highlight an important aspect of comorbidity in MDD and BD and may have implications for understanding the shared neurobiology of chronic pain and mood disorders. [ABSTRACT FROM AUTHOR]

Background Previous studies on the association between adiposity and mood disorder have produced contradictory results, and few have used measurements other than body mass index (BMI). We examined the association between probable major depression and several measurements of adiposity: BMI, waist circumference (WC), waist-hip-ratio (WHR), and body fat percentage (BF%). Methods We conducted a cross-sectional study using baseline data on the sub-group of UK Biobank participants who were assessed for mood disorder. Multivariate logistic regression models were used, adjusting for potential confounders including: demographic and life-style factors, comorbidity and psychotropic medication. Results Of the 140,564 eligible participants, evidence of probable major depression was reported by 30,145 (21.5%). The fully adjusted odds ratios (OR) for obese participants were 1.16 (95% confidence interval (CI) 1.12, 1.20) using BMI, 1.15 (95% CI 1.11, 1.19) using WC, 1.09 (95% CI 1.05, 1.13) using WHR and 1.18 (95% CI 1.12, 1.25) using BF% (all p < 0.001). There was a significant interaction between adiposity and gender (p = 0.001). Overweight women were at increased risk of depression with a dose response relationship across the overweight (25.0-29.9 kg/m²), obese I (30.0-34.9 kg/m²), II (35.0-39.9 kg/m²) and III (≥40.0 kg/m²) categories; fully adjusted ORs 1.14, 1.20, 1.29 and 1.48, respectively (all p < 0.001). In contrast, only obese III men had significantly increased risk of depression (OR 1.29, 95% CI 1.08, 1.54, p = 0.006). Conclusion Adiposity was associated with probable major depression, irrespective of the measurement used. The association was stronger in women than men. Physicians managing overweight and obese women should be alert to this increased risk. [ABSTRACT FROM AUTHOR]

Background Obesity is known to increase the risk of many diseases and reduce overall quality of life. This study examines the relationship with self-reported health (SRH) and happiness. Methods We conducted a cross-sectional study of the 163 066 UK Biobank participants who completed the happiness rating. The association between adiposity and SRH and happiness was examined using logistic regression. SRH was defined as good (excellent, good), or poor (fair, poor). Self-reported happiness was defined as happy (extremely, very, moderately) or unhappy (moderately, very, extremely). Results Poor health was reported by 44 457 (27.3%) participants. The adjusted ORs for poor health were 3.86, 2.92, 2.60 and 6.41 for the highest, compared with lowest, deciles of Body Mass Index, waist circumference, waist to hip ratio and body fat percent, respectively. The associations were stronger in men (p<0.001). Overall, 7511 (4.6%) participants felt unhappy, and only class III obese participants were more likely to feel unhappy (adjusted OR 1.33, 95% CI 1.15 to 1.53, p<0.001) but the associations differed by sex (p<0.001). Among women, there was a significant association between unhappiness and all levels of obesity. By contrast, only class III obese men had significantly increased risk and overweight and class I obese men were less likely to be unhappy. Conclusions Obesity impacts adversely on happiness as well as health, but the association with unhappiness disappeared after adjustment for self-reported health, indicating this may be mediated by health. Compared with obese men, obese women are less likely to report poor health, but more likely to feel unhappy. [ABSTRACT FROM AUTHOR]

Objectives: UK Biobank is a landmark cohort of over 500,000 participants which will be used to investigate genetic and non-genetic risk factors for a wide range of adverse health outcomes. This is the first study to systematically assess the prevalence and validity of proposed criteria for probable mood disorders within the cohort (major depression and bipolar disorder). Methods: This was a descriptive epidemiological study of 172,751 individuals assessed for a lifetime history of mood disorder in relation to a range of demographic, social, lifestyle, personality and health-related factors. The main outcomes were prevalence of a probable lifetime (single) episode of major depression, probable recurrent major depressive disorder (moderate), probable recurrent major depressive disorder (severe), probable bipolar disorder and no history of mood disorder (comparison group). Outcomes were compared on age, gender, ethnicity, socioeconomic status, educational attainment, functioning, self-reported health status, current depressive symptoms, neuroticism score, smoking status and alcohol use. Results: Prevalence rates for probable single lifetime episode of major depression (6.4%), probable recurrent major depression (moderate) (12.2%), probable recurrent major depression (severe) (7.2%) and probable bipolar disorder (1.3%) were comparable to those found in other population studies. The proposed diagnostic criteria have promising validity, with a gradient in evidence from no mood disorder through major depression and probable bipolar disorder in terms of gender distribution, socioeconomic status, self-reported health rating, current depressive symptoms and smoking. Significance: The validity of our proposed criteria for probable major depression and probable bipolar disorder within this cohort are supported by these cross-sectional analyses. Our findings are likely to prove useful as a framework for a wide range of future genetic and non-genetic studies. [ABSTRACT FROM AUTHOR]

Bipolar disorder is a complex condition characterised by both manic and depressive episodes. Here the authors discuss the challenges faced in both diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The article discusses the marketing strategies employed by filmmakers in China to sell Johnnie To's films in Great Britain and the U.S. It notes that To was able to re-brand his personality to become more suitable with those of international art cinema filmmakers in an effort to match the dominant associations of Hong Kong cinema with gangster films. It mentions that critics were able to recognize the changes in the country's motion picture industry particularly the effort of To in re-energizing and reinventing the genre in his film "Fulltime Killer."

This essay examines the British critical reception of the Japanese horror film Ring. Critics claimed that Ring was representative of a non-graphic, suggestive tradition in horror, and used the film rhetorically to present a sense of difference from teen horror films such as Scream. [ABSTRACT FROM AUTHOR]

Guidance regarding appropriate use of personal protective equipment in hospitals is in constant flux as research into SARS-COV-2 transmission continues to develop our understanding of the virus. The risk associated with procedures classed as 'aerosol generating' is under constant debate. Current guidance is largely based on pragmatic and cautious logic, as there is little scientific evidence of aerosolization and transmission of respiratory viruses associated with procedures. The physical properties of aerosol particles which may contain viable virus have implications for the safe use of personal protective equipment and infection control protocols. As elective work in the NHS is reinstated, it is important that the implications of the possibility of airborne transmission of the virus in hospitals are more widely understood. This will facilitate appropriate use of personal protective equipment and help direct further research into the true risks of aerosolization during these procedures to allow safe streamlining of services for staff and patients.

Introduction: Oxygen is the most commonly administered drug to mechanically ventilated critically ill adults, yet little is known about the optimum oxygen saturation (SpO 2 ) target for these patients; the current standard of care is an SpO 2 of 96% or above. Small pilot studies have demonstrated that permissive hypoxaemia (aiming for a lower SpO 2 than normal by using a lower fractional inspired oxygen concentration (FIO 2 )) can be achieved in the critically ill and appears to be safe. This approach has not been evaluated in a National Health Service setting. It is possible that permissive hypoxaemia may be beneficial to critically ill patients thus it requires robust evaluation., Methods and Analysis: Targeted OXygen therapY in Critical illness (TOXYC) is a feasibility randomised controlled trial (RCT) to evaluate whether recruiting patients to a study of permissive hypoxaemia is possible in the UK. It will also investigate biological mechanisms that may underlie the links between oxygenation and patient outcomes. Mechanically ventilated patients with respiratory failure will be recruited from critical care units at two sites and randomised (1:1 ratio) to an SpO 2 target of either 88%-92% or ≥96% while intubated with an endotracheal tube. Clinical teams can adjust FIO 2 and ventilator settings as they wish to achieve these targets. Clinical information will be collected before, during and after the intervention and blood samples taken to measure markers of systemic oxidative stress. The primary outcome of this study is feasibility, which will be assessed by recruitment rate, protocol adherence and withdrawal rates. Secondary outcomes will include a comparison of standard critical care outcome measures between the two intervention groups, and the measurement of biomarkers of systemic oxidative stress. The results will be used to calculate a sample size, likely number of sites and overall length of time required for a subsequent large multicentre RCT., Ethics and Dissemination: This study was approved by the London - Harrow Research Ethics Committee on 2 November 2017 (REC Reference 17/LO/1334) and received HRA approval on 13 November 2017. Results from this study will be disseminated in peer-reviewed journals, at medical and scientific meetings, in the NIHR Journals Library and patient information websites., Trial Registration Number: NCT03287466; Pre-results., Competing Interests: Competing interests: DSM, MM and MPWG are directors of a company developing an oxygen delivery device (Oxygen Control Ltd). DSM has received honoraria and consultancy fees from Siemens Healthcare, Masimo, Deltex and Edwards Lifesciences. MPWG is the National Specialty Lead for Anaesthesia, Perioperative Medicine and Pain within the UK National Institute of Heath Research Clinical Research Network, an elected council member of the Royal College of Anaesthetists and serves on the board of the Evidence Based Perioperative Medicine (EBPOM) social enterprise and the medical advisory board of Sphere Medical Ltd. MPWG has received honoraria for speaking and/or travel expenses from Edwards Lifesciences, Fresenius-Kabi, BOC Medical (Linde Group), Ely-Lilly Critical Care, and Cortex GmBH. MPWG is executive chair of the Xtreme-Everest Oxygen Research Consortium and joint Editor-in-Chief of the journal Perioperative Medicine. MM is a consultant for Baxter, Edwards Lifesciences and Deltex; his University Chair is supported by Smiths Medical; Elected Council Member Royal College of Anaesthetsists; Editorial Board BJA and Critical Care; Founding Editor-in-Chief Perioperative Medicine., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)