Search

Importance: An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. Objective: To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. Design, Setting, and Participants: Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. Interventions: Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. Main Outcomes and Measures: The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with Spo2 ≤92% for >1 minute). Results: Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3% [95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P =.23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6% [95% CI, -11.1% to 6.1%]; P

Talent selection has become an integral part of many nations’ athlete development systems. In this context, a coach often serves as a decision-maker, selecting or deselecting athletes based on their intuition, a phenomenon that has generally come to be referred to as “coach’s eye”. However, there is no consistent operational definition of this term. To this end, we reviewed prior work using the term “coach’s eye” as reflecting the process of coaches assessing and selecting athletes during talent selection scenarios. Based on previous research, four main characteristics of the coaches’ eye were identified: intuitive, subjective, experience-based and holistic. Results emphasize the underlying mechanisms of the coach’s eye are still unknown and links to theoretical models are missing. In the final section of this paper, we describe a model from decision-making research, the iCodes model (integrated coherence-based decision and search model) by Jekel, Glockner, and Broder (2018), and apply it to talent selection scenarios. We believe this model provides a useful starting point for investigating the decision process and the underlying mechanisms of the coach’s eye.

Objetivou-se avaliar o fornecimento de náuplios de Artemia congelada, ração comercial e coalimentação com náuplios de Artemia congelada e ração comercial no desempenho produtivo e qualidade da água na larvicultura de curimatã-pacu Prochilodus argenteus. As larvas foram cultivadas durante 21 dias sob os seguintes tratamentos alimentares: 100F (100% ração comercial); 67F33A (67% de ração comercial e 33% de náuplios de Artemia congelada); 34F66A (34% de ração comercial e 66% de náuplios de Artemia congelada); e 100A (100% de náuplios de Artemia congelada). As larvas submetidas aos tratamentos alimentares não diferiram no desempenho, sobrevivência, peso, comprimentos total e padrão, fator de condição de Fulton e taxa de crescimento especí­­fico. O fornecimento de ração comercial aumentou as concentrações de amônia, prejudicando a qualidade da água, enquanto que o fornecimento de Artemia proporcionou baixas concentrações de amônia, parcialmente devido í­Â fácil limpeza. Portanto, pode-se empregar náuplios de Artemia congelados na larvicultura do curimatã-pacu.

The past few decades have seen a significant change in the delivery of sport and in trends related to athlete development. However, the notion of talent continues to play a critical role in most athlete development models. In this brief review, we highlight concerns with the notion of talent and how it is conceptualized in high performance sport systems. These include: the assumption that talent is a fixed capacity that can be identified early, the influence of talent beliefs on athlete development, the different levels of risk for talent selection decisions, biases evident in approaches to athlete selection, the inadequacy of current statistical approaches, the problems with using current performance to predict future outcomes, and how short-term priorities and competition between sports for talented athletes undermine the overall efficiency of athlete development systems. These concerns form the basis for more focused discussion of avenues for future work in this field.

The community size effect (or birthplace effect) suggests that high-performance athletes are less likely to emerge from regions with population sizes that are very small or very large. However, previous research on elite Canadian ice hockey players has not considered the influence of intra-national regional variation of population distributions with respect to community size effects. Therefore, the purpose of the current study was to test the heterogeneity of the community size effect between Canadian National Hockey League draftees (2000-2014: n = 1505), from 7 provincial regions within Canada (i.e., British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and the Atlantic Provinces). The proportion of athletes in the 9 census population categories were compared to the national and regional general population distributions in the census categories. Results suggest variability of community size effects between the 7 provincial regions within Canada, with only the province of Ontario demonstrating a community size effect congruent with effects reported in previous research. Using regional general population distributions as the comparator to athlete populations changed the direction, meaningfulness and magnitude of community size effects. In conclusion, elite ice hockey player community size effects may not be generalisable to all regions within Canada.

Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications.Patients with operable lung cancer were randomly assigned to usual care (UC) (n = 77) or preoperative rehabilitation based on HIIT (Rehab) (n = 74). Maximal cardiopulmonary exercise testing and the 6-minute walk test were performed twice before surgery. The primary outcome measure was a composite of death and in-hospital postoperative complications.The groups were well balanced in terms of patient characteristics. During the preoperative waiting period (median 25 days), the peak oxygen consumption and the 6-minute walking distance increased (median +15%, interquartile range, 25th to 75 percentile [IQR25%-75%, %] = +9% to +22%, p = 0.003 and +15%, IQR25%-75% = +8% to +28%, p0.001, respectively) in the Rehab group, whereas peak oxygen consumption declined in the UC group (median -8%, IQR25%-75% = -16% to 0%], p = 0.005). The primary end point did not differ significantly between the two groups: at least one postoperative complication developed in 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group (p = 0.080). Notably, the incidence of pulmonary complications was lower in the Rehab compared with in the UC group (23% versus 44%, p = 0.018), owing to a significant reduction in atelectasis (12.2% versus 36.4%, p0.001), and this decrease was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQR25%-75% = -4 to -10).In this randomized controlled trial, preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.

Introduction Although experimental studies strongly support the cardioprotective effects of glucose—insulin—potassium (GIK) infusion, clinical trials have yielded mixed results due to the heterogeneity of patient populations as well as varying GIK administration patterns. An updated systematic review and meta-analysis were conducted to assess the impact of GIK treatment on postoperative complications in patients undergoing on- or off-pump cardiac surgery. Methods We searched MEDLINE, Embase and the Cochrane Central Register without language restrictions for studies from inception to March, 2020. We included randomized controlled trials that compared GIK infusion as cardioprotective measure to conventional treatment or placebo in adults undergoing on- or off-pump cardiac surgery. Postoperative myocardial infarct (PMI) was the main study endpoint; secondary outcomes were in-hospital mortality, postoperative complications, as well as duration of mechanical ventilation, intensive care stay and hospital stay. Postoperative glycemia and cardiac index were also examined. The study was registered with PROSPERO (N°CRD42019117728). We computed risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) and heterogeneity was estimated using I2 statistic. Results From 47 studies, 5’872 participants were pooled for meta-analysis. The incidence of PMI was 5.9% and 8.3% in the GIK and Control groups, respectively (n = 20, RR [95% CI] = 0.83 [0.65 to 1.04] I2 = 0). Compared to control treatment, GIK infusion was associated with lower hospital mortality (n = 19, RR [95%CI] = 0.64 [0.43 to 0.97], I2 = 0), reduced acute kidney injury (n = 6, RR [95%CI] = 0.59 [0.4 to 0.87, I2 = 0), fewer atrial fibrillation (n = 23, RR [95%CI] = 0.75 [0.6 to 0.94], I2 = 0.58), as well as a shorter duration of mechanical ventilation (n = 14, MD [95%CI] = -1.77 [-3.04 to -0.49] hours, I2 = 0.96), shorter stay in intensive care (n = 20, MD [95%CI] = -5.39 [-9.34 to -1.44] hours, I2 = 0.99) and faster hospital discharge (n = 19, MD [95%CI] = -0.84 [-1.6 to -0.08] days, I2 = 0.95). Discussion A recent systematic review and meta-analysis restricted to part of the literature published on the topic since 2000 concluded to a strong effect of GIK on PMI [1]. While the analysis of our augmented corpus of literature did not find any such association in patients undergoing cardiac surgery, perioperative administration of GIK was associated with improved postoperative clinical outcomes as reflected by lower in-hospital mortality and morbidity as well as lesser utilization of hospital resources. Further clinical studies are warranted to ascertain the effectiveness of GIK in minimizing myocardial injuries and to explore the specific dosage and timing of GIK infusion.

Normes de genre dans les interventions en santé sexuelle : analyse des discours observés au sein des écoles publiques du secondaire"

CD4

The spatio-temporal demands of many high performance sport contexts require a strategic interplay between anticipation from early kinematic cues and the appropriate movement strategy. Despite the importance of the interaction between observer and deceiver in these contexts, this dyad is usually considered separately (i.e., from perceptual-cognitive or kinematic perspectives). The present approach proposes a consolidation of perceptual-cognitive and kinematic perspectives into a dyad of deception that focuses on the interplay between opposing actors within antagonistic contexts. A framework is proposed for analyzing movement deception within this dyad. Applying a functional approach, the deceptive act is positioned as a means of optimally solving an antagonistic performance task with high spatio-temporal demands. The framework involves three elements: first, the context of the movement deception is evaluated relative to the constraints imposed by the athlete, object, and deceptive content. Together, these constraints generate a range of potential kinematic options for movement deception. Second, movement deception is determined by the spatio-temporal constraints of the original context. More simply, misleading information is only useful if it mimics elements of the genuine movement. Third, the framework emphasizes targeting the spatio-temporal interplay as well as differentiating between active and co(ntra)-active movement deception. Our goal with this framework is to supplement movement deception research by providing a conceptional context that can be applied across sports.

Referees in sports games have a high level of responsibility as they have to make correct and appropriate decisions at any point during a match. Regarding referees’ decision-making (RDM) as a perceptual-cognitive process, evidence suggests that physical load might reduce cognitive performance and thus might reduce RDM performance as well. In consideration of increasing game dynamics, referees have to cope with high physical load, but they have to make correct and appropriate decisions further on. Here, we review the current state of research on the relationship between physical load and RDM. A scoping review was performed, in accordance with the PRISMA guidelines, using the following databases: Scopus, PubMed, Web of Science (all databases), SURF and SPONET (both with an English and German search). Only primary studies written in English or German that investigated the relationship between physical load and RDM in sports games were included. Eleven studies included in the review investigated six physical parameters and RDM: match period, velocity, blood lactate, running time, heart rate, distance covered. Most findings of the studies showed no relationship between physical load and RDM (n = 18). Thirteen findings suggest a negative relationship and three findings indicate a positive relationship between physical load and RDM. Results of the scoping review show contradictory evidence across and within investigated different physical parameters. As RDM consists of multi-factorial components, it is recommended to conduct systematic research programs – field as well as experimental studies – to resolve the missing control of potential confounding variables and to consider the difference of internal and external load.

Investigations of the association of focus of attention and quiet eye duration have shown mixed results. It is possible that when focusing on visuo-motor learning a more sensitive category system of instructions might be useful. The aim of this study was to investigate the interaction of focus of attention and quiet eye duration in darts. In addition to locus-directed foci (external, internal), perception-directed (visual, kinesthetic) foci of attention were considered. Participants were divided into four groups and had to perform a pre- and post-test with a 1-week training intervention in between. Throwing accuracy (TA) and quiet eye duration (QED) were measured using the SMI eye tracking glasses. An analysis of covariance (2x2) showed no significant group differences or interactions for TA. For QED, an analysis of variance (2x2x2) showed quiet eye duration was increased with the intervention but there were significant differences between the tests. A significant interaction of test and perception-directed focus was observed. Visually instructed groups increased QED whereas the kinesthetic group decreased the QED, suggesting perceptual and motor learning may be asynchronous. One possible explanation for the trends might be the common-coding theory of perception and action.

The development of the field of sport expertise over the past 20 years has been remarkable, and our understanding of the varying factors affecting athlete development and motor skill acquisition has expanded considerably. Recently, there has been a push toward more sophisticated research designs to continue the advancement of our understanding of sport expertise. Even in a population of performers at the highest levels of performance and competition (e.g., participants in professional sports or those who compete at Olympic Games), there are those with obvious superiority compared to others in the cohort, such as those who win “most valuable player” awards or who are elected to the Hall of Fame. This paper builds a case that athletes who reach this level of achievement possess a more advanced level of skill than those at the elite or expert stage and we refer to this stage of development as “eminence.” This paper explores the notion of eminence and provides converging forms of evidence for the division between expertise and eminence. Moreover, it explores the implications of this division for the further examination of skill acquisition across the lifespan.

Objectives: This study is set to analyze clinicopathological factors predicting the recovery of unilateral vocal fold paralysis (UVP) in patients after thyroid gland surgery. The quality of voice was additionally assessed in these patients. Methods: The charts and videolaryngostroboscopy (VLS) examinations of 84 consecutive patients with a complete UVP after surgery of the thyroid gland were retrospectively reviewed. Patients were divided into 2 groups: patients who fully recovered from vocal fold paralysis and those who failed to recover after a follow-up of 12 months. The quality of voice was analyzed among other things by determining the Voice Handicap Index (VHI). Results: The UVP fully recovered in 52 of 84 (61.9%) patients. Positive mucosal waves (pMWs) on the paralyzed side, a minimal glottic gap Conclusions: For patients with a poor prognosis of a UVP, early intervention may be beneficial. Thus, predicting factors for a full recovery of vocal fold motion would be a valuable tool. In our cohort, about 60% of recoveries could have been predicted using the above-mentioned parameters. Good quality of voice was independently reached in 90% of the cases.

Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting.Electronic databases were searched for pertinent studies up to January 2019. We included randomized controlled trials on the use of hemoperfusion, hemofiltration without a renal replacement purpose, and plasmapheresis as a blood purification technique in comparison to conventional therapy in adult patients with sepsis and septic shock. The primary outcome was mortality at the longest follow-up available. We calculated relative risks and 95% CIs. The grading of recommendations assessment, development and evaluation methodology for the certainty of evidence was used.Thirty-seven trials with 2,499 patients were included in the meta-analysis. Hemoperfusion was associated with lower mortality compared to conventional therapy (relative risk = 0.88 [95% CI, 0.78 to 0.98], P = 0.02, very low certainty evidence). Low risk of bias trials on polymyxin B immobilized filter hemoperfusion showed no mortality difference versus control (relative risk = 1.14 [95% CI, 0.96 to 1.36], P = 0.12, moderate certainty evidence), while recent trials found an increased mortality (relative risk = 1.22 [95% CI, 1.03 to 1.45], P = 0.02, low certainty evidence); trials performed in the United States and Europe had no significant difference in mortality (relative risk = 1.13 [95% CI, 0.96 to 1.34], P = 0.15), while trials performed in Asia had a positive treatment effect (relative risk = 0.57 [95% CI, 0.47 to 0.69], P0.001). Hemofiltration (relative risk = 0.79 [95% CI, 0.63 to 1.00], P = 0.05, very low certainty evidence) and plasmapheresis (relative risk = 0.63 [95% CI, 0.42 to 0.96], P = 0.03, very low certainty evidence) were associated with a lower mortality.Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.

The objective of the study was to verify the combination of live and frozen Artemia nauplii, in different salinized water, and its influence in growth and survival of the catfish Lophiosilurus alexandri (Steindachner, 1876) larvae. Larvae were exposed to a combination of two feeds and two different salinities: live Artemia nauplii + 0‰ salinity in the water; live Artemia nauplii + 2‰ salinity in the water; frozen Artemia nauplii + 0‰ salinity in the water; and frozen Artemia nauplii + 2‰ salinity in the water. The experiment was conducted in a randomized design, in a 2 × 2 factorial scheme, 5 replicates, during 15 days. The larvae final weight, weight gain, food conversion, standard and total length, biomass, survival, body width, intestinal quotient, Fulton’s condition factor, and water quality were evaluated. The use of Artemia nauplii and 2 ppm salinized water for L. alexandri larviculture proved to be adequate providing greater growth. This was due to Artemia nauplii being kept alive and attractive for the cultivation of larvae in salinized water, even though salt was a stress factor. Already, the frozen Artemia nauplii was a viable food but should be used preferably in times of lack of live nauplii and without salinization of the water.

The aim of the present study was to perform comparative histological analyses of the ontogenetic development of two fish species endemic to the Sao Francisco River in Brazil: Prochilodus argenteus and Lophiosilurus alexandri. Histological analyses were performed every 24 h from the moment of hatching until 14 days post-hatching (dph) for the observation of larval development and until 39 dph for the observation of gonadal development. Whole larvae were fixed in Bouin's solution and the histological slides were stained with haematoxylin-eosin. Lophiosilurus alexandri larvae had a larger body size compared with P. argenteus larvae since hatching. Lophiosilurus alexandri larvae had mouth opening and pigmentation of the eyes upon hatching, whereas these events were observed at 1 dph in P. argenteus larvae. The visualisation and the inflation of the swim bladder occurred at 1 and 3 dph, respectively, in the P. argenteus, whereas these events occurred at 2 and 8 dph, respectively, in L. alexandri. Yolk granules were absorbed at 4 dph in P. argenteus and the 10 dph in L. alexandri. At 7 dph, the digestive tube was more differentiated in L. alexandri than P. argenteus and at 14 dph, the digestive system of both species had features of their eating habits: broad stomach and short intestine in L. alexandri, typical of carnivorous habits; stomach with a mechanical function and long intestine in P. argenteus, typical of detritivorous habits. The epithelial lining tissue, formed by a single layer of cells in the newly hatched larvae (0 dph), differentiated throughout the study, exhibiting scales in P. argenteus and numerous club cells in the middle epithelial region of L. alexandri at 39 dph. Undifferentiated gonads with somatic cells and primordial germ cells were observed at 39 dph, with caudal-cranial migration since 1 dph in both species. The anatomic changes during the ontogeny of P. argenteus and L. alexandri larvae are directly associated with the evolutionary history of each species, which explains their feeding habits, behaviour and distribution in the environment: Prochilodus argenteus is detritivorous and actively swims in the water column, whereas L. alexandri is carnivorous and inhabits bottom regions. At 39 dph neither species exhibited sexual differentiation.

A hydrogen purification system based on the technology of the electrochemical hydrogen compression and purification is introduced. This system is developed within the scope of the project MEMPHYS. Therefore, the project, its targets and the different work stages are presented. The technology of the electrochemical purification and the state of the art of hydrogen purification are described. Early measurements in the project have been carried out and the results are shown and discussed. The ability of the technology to recover hydrogen from a gas mixture can be recognized and an outlook into further optimizations shows the future potential. A big advantage is the simultaneous compression of the purified hydrogen up to 200bar, therefore facilitating the transportation and storage.

In this commentary on Joan Vicker’s target article (2016), we first recognize the work she has done in the last 35 years. We then provide examples of differentiations of the Quiet Eye (QE) that might be necessary to fully understand the multifacetedness of the phenomenon. Here we propose, as in our current review (Rienhoff, Tirp, Strauss, Baker, & Schorer, 2016), for the QE a differentiation by the mechanisms behind it. We suggest another categorization in the research on training the QE. Additionally, we provide further areas of research that are interesting for the future, namely the QE across life-span and the (in)dependence of the perceptual-motor processes.