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Suicidality is common in youth care and has a major impact on young people, parents and professionals. The number of suicides among young people (10-25 years) in the Netherlands has risen in recent years from 103 suicides in 2008 to 159 suicides in 2019, with a high of 169 suicides in 2017. Many youth care professionals experience timidity in dealing with suicidal behaviour.To investigate whether suicide prevention training leads to an improvement in knowledge, skills and self-confidence in dealing with suicidal behavior in young people.Professionals working at a national youth care institution participated in suicide prevention training. Before and immediately after the training they completed questionnaires to measure their knowledge, skills and self-confidence in the field of suicide prevention.There was an improvement in knowledge, skills and self-confidence of youth care professionals after the training. In particular, more knowledge about suicide prevention led to more self-confidence. The change was equal in the different forms of care. Scientifically trained and higher educated professionals showed a less strong change in their competencies than secondary educated professionals. The change in knowledge and skills was less pronounced the older the professionals were.Participation in suicide prevention training led to more knowledge, skills and self-confidence of youth care professionals in dealing with suicidal behaviour.

The use of IRIS to determine 13C enrichment in expired breath samples captured during exercise to determine exogenous glucose oxidation during exercise has excellent validity and reliability when compared with the gold standard IRMS.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

Elliptical trainers and steppers are proposed as useful exercise modalities in the rehabilitation of injured runners due to the reduced stress on muscles and joints when compared to running. This study compared the physiological responses to submaximal running (treadmill) with exercise on the elliptical trainer and stepper devices at three submaximal but identical workloads. Authors had 18 trained runners (male/female: N = 9/9, age: mean ± SD = 23 ± 3 years) complete randomized maximal oxygen consumption tests on all three modalities. Submaximal tests of 3 min were performed at 60%, 70%, and 80% of peak workload individually established for each modality. Breath-by-breath oxygen consumption, heart rate, fuel utilization, and energy expenditure were determined. The value of maximal oxygen consumption was not different between treadmill, elliptical, and stepper (49.3 ± 5.3, 48.0 ± 6.6, and 46.7 ± 6.2 ml·min−1·kg−1, respectively). Both physiological measures (oxygen consumption and heart rate) as well as carbohydrate and fat oxidation differed significantly between the different exercise intensities (60%, 70%, and 80%) but did not differ between the treadmill, elliptical trainer, and stepper. Therefore, the elliptical trainer and stepper are suitable substitutes for running during periods when a reduced running load is required, such as during rehabilitation from running-induced injury.

Every women’s and men’s world records from 5 km to the marathon has been broken since the introduction of carbon fibre plate (CFP) shoes in 2016. This step-wise increase in performance coincides with recent advancements in shoe technology that increase the elastic properties of the shoe thereby reducing the energy cost of running. The latest CFP shoes are acknowledged to increase running economy by more than 4%, corresponding to a greater than 2% improvement in performance/run time. The recently modified rules governing competition shoes for elite athletes, announced by World Athletics, that includes sole thickness must not exceed 40 mm and must not contain more than one rigid embedded plate, appear contrary to the true essence and credibility of sport as access to this performance-defining technology becomes the primary differentiator of sporting performance in elite athletes. This is a particular problem in sports such as athletics where the primary sponsor of the athlete is very often a footwear manufacturing company. The postponement of the 2020 Summer Olympics provides a unique opportunity for reflection by the world of sport and time to commission an independent review to evaluate the impact of technology on the integrity of sporting competition. A potential solution to solve this issue can involve the reduction of the stack height of a shoe to 20 mm. This simple and practical solution would prevent shoe technology from having too large an impact on the energy cost of running and, therefore, determining the performance outcome. Electronic supplementary material The online version of this article (10.1007/s40279-020-01420-7) contains supplementary material, which is available to authorized users.

Oosthuyse, T, Bosch, AN, Kariem, N, and Millen, AME. Mountain bike racing stimulates osteogenic bone signaling and ingesting carbohydrate-protein compared with carbohydrate-only prevents acute recovery bone resorption dominance. J Strength Cond Res 35(2): 292-299, 2021-Mountain biking, unlike road cycling, includes vibrational accelerations but whether it stimulates osteogenic signaling remains unknown. Furthermore, exercise nutrition influences bone turnover, and the effect of ingesting protein during multiday racing was investigated. We measured plasma bone turnover markers, C-terminal telopeptide of type1-collagen (β-CTX) and N-terminal propeptides of type1-procollagen (P1NP), and osteocyte mechanosensory signaling factor, sclerostin (SOST), corrected for plasma volume change, before (pre-day 1) and 20-60 minutes after (post-day 3) a multiday mountain bike race in 18 male cyclists randomly assigned to ingest carbohydrate-only (CHO-only) or carbohydrate-with-casein protein hydrolysate (CHO-PRO) during racing. Fourteen cyclists (n = 7 per group) completed the race, and data were analyzed with p < 0.05 accepted as significant. Plasma SOST decreased similarly in both groups (mean ± SD, CHO-only: 877 ± 451 to 628 ± 473 pg·ml-1, p = 0.004; CHO-PRO: 888 ± 411 to 650 ± 443 pg·ml-1, p = 0.003), suggesting that osteocytes sense mountain biking as mechanical loading. However, the bone formation marker, P1NP, remained unchanged in both groups, whereas the bone resorption marker, β-CTX, increased in CHO-only (0.19 ± 0.034 to 0.31 ± 0.074 ng·ml-1, p = 0.0036) but remained unchanged in CHO-PRO (0.25 ± 0.079 to 0.26 ± 0.074 ng·ml-1, p = 0.95). Mountain bike racing does stimulate osteogenic bone signaling but bone formation is not increased acutely after multiday mountain biking; investigation for a delayed effect is warranted. The acute recovery increase in bone resorption with CHO-only is prevented by ingesting CHO-PRO during racing.

Purpose This study aimed to examine the effect of altering osmolality or adding sodium alginate and pectin to a concentrated carbohydrate (CHO) beverage on gastric-emptying (GE) rate. Methods Boluses (500 mL) of three drinks were instilled double blind in eight healthy men while seated, GE was measured using the double sampling method for 90 min, and blood samples were collected regularly. Drinks consisted of glucose and fructose (MON; 1392 mOsmol·kg), maltodextrin and fructose (POLY; 727 mOsmol·kg), and maltodextrin, fructose, sodium alginate, and pectin (ENCAP; 732 mOsmol·kg) with each providing 180 g·L CHO (CHO ratio of 1:0.7 maltodextrin or glucose/fructose). Results Time to empty half of the ingested bolus was faster for ENCAP (21 ± 9 min) than for POLY (37 ± 8 min); both were faster than MON (51 ± 15 min). There were main effects for time and drink in addition to an interaction effect for the volume of test drink remaining in the stomach over the 90 min period, but there were no differences between MON and POLY at any time point. ENCAP had a smaller volume of the test drink in the stomach than MON at 30 min (193 ± 62 vs 323 ± 54 mL), which remained less up to 60 min (93 ± 37 vs 210 ± 88 mL). There was a smaller volume of the drink remaining in the stomach in ENCAP compared with POLY 20 min (242 ± 73 vs 318 ± 47 mL) and 30 min (193 ± 62 vs 304 ± 40 mL) after ingestion. Although there was a main effect of time, there was no effect of drink or an interaction effect on serum glucose, insulin or nonesterified fatty acid concentrations. Conclusion The addition of sodium alginate and pectin to a CHO beverage enhances early GE rate but did not affect serum glucose, insulin, or nonesterified fatty acid concentration at rest.

In the general population we recently reported a consistent association between plasma sodium and volume markers, suggesting that individuals with higher plasma sodium have higher extracellular fluid volume (ECFV). To test this hypothesis, we analyzed the association between plasma sodium and directly measured ECFV (iothalamate distribution volume) in healthy men. Second, we studied whether plasma sodium is associated with blood pressure. We analyzed data from 70 men (age 24 ± 7 years) at the end of two 7‐day periods on a low‐sodium diet (LS, 50 mmol Na/24 h) and a high‐sodium diet (HS, 200 mmol Na/24 h), respectively. The association of plasma sodium with blood pressure was assessed in the combined data of the different sodium intakes by linear mixed effects models. A positive univariable association between plasma sodium and ECFV was found during HS (β = 0.24, p = 0.042) and LS (β = 0.23, p = 0.058), respectively. Individual values of plasma sodium on LS and HS diet were strongly correlated (β = 0.68, p, Plasma sodium concentration is positively associated with ECFV on both LS and HS intake. Our data confirm and extend prior data on individual regulation of plasma sodium and suggest that this is associated with individuality of the regulation of ECFV. Finally, plasma sodium level is associated with SBP, independent of ECFV and diet.

Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.

Background: Compression garment utilization is very popular among runners despite a lack of consensus in the literature regarding a beneficial impact. The aim of the study was to investigate the impact of training and competing with compression garments on exercise-induced muscle damage and performance in ultramarathon runners. Hypothesis: Compression garments will reduce the severity of exercise-induced muscle damage and improve performance in long-distance runners compared with control conditions. Study Design: Prospective, randomized controlled trial. Level of Evidence: Level 1. Methods: The study was conducted in healthy, uninjured endurance runners (n = 41) participating in a 56-km ultramarathon. The experimental group (n = 20; 14 males, 6 females) trained for 6 weeks and participated in the race wearing below-knee compression garments while the control group (n = 21; 15 males, 6 females) did not. Participants were tested on 4 occasions for various markers of exercise-induced muscle damage and running performance. Results: Ankle circumference measurements increased significantly less ( P = 0.01, Cohen d = 0.9) in the experimental group from immediately after until 2 days post-race compared with the control group. No further statistically significant changes were detected over time in midcalf circumferences, muscle architecture, or race performance. Selected pain ratings were statistically significant and worse in the experimental group. Conclusion: There are limited indications of a beneficial impact of compression garments with improvements in ankle circumference measurements. No ergogenic impact was detected. Clinical Relevance: There is limited evidence to support the continued utilization of commercially available below-knee compression garments during running for the purpose of muscle recovery or as a performance aid.

The benefit of training at altitude to enhance exercise performance remains equivocal although the most widely accepted approach is one where the athletes live and perform lower-intensity running at approximately 2300 m with high-intensity training at approximately 1250 m. The idea is that this method maintains maximal augmentations in total hemoglobin mass while reducing the performance impairment of high-intensity sessions performed at moderate altitude and thus preventing any detraining that can occur when athletes live and train at moderate altitude. This training regimen, however, is not universally accepted and some argue that the performance enhancement is due to placebo and training camp effects. Altitude training may affect an athlete's hematological parameters in ways similar to those observed following blood doping. Current methods of detection appear insufficient to differentiate between altitude training and blood doping making the interpretation of an athlete's biological passport difficult. Further research is required to determine the optimal method for altitude training and to enhance current detection methods to be able to differentiate better blood doping and altitude exposure.

Multiday racing causes mild left ventricular (LV) dysfunction from day 1 that persists on successive days. We evaluated ingesting casein protein hydrolysate–carbohydrate (PRO) compared with carbohydrate-only (CHO) during a 3-day mountain bike race. Eighteen male cyclists were randomly assigned to ingest 6.7% carbohydrate without (CHO) or with 1.3% casein hydrolysate (PRO) during racing (~ 4–5 h/day; 68/71/71 km). Conventional LV echocardiography, plasma albumin content, plasma volume (PV) and blood biomarkers were measured before day 1 and post race on day 3. Fourteen cyclists (n = 7 per group) completed the race. PV increased in CHO (mean increase (95% CI), 10.2% (0.1 to 20.2)%, p = 0.045) but not in PRO (0.4% (− 6.1 to 6.9)%). Early diastolic transmitral blood flow (E) was unchanged but deceleration time from peak E increased post race (CHO: 46.7 (11.8 to 81.6) ms, p = 0.019; PRO: 24.2 (− 0.5 to 48.9) ms, p = 0.054), suggesting impaired LV relaxation. Tissue Doppler mitral annular velocity was unchanged in CHO, but in PRO septal early-to-late diastolic ratio decreased (p = 0.016) and was compensated by increased lateral early (p = 0.034) and late (p = 0.012) velocities. Systolic function was preserved in both groups; with increased systolic lateral wall velocity in PRO (p = 0.002). Effect size increase in serum creatine kinase (CK) activity, CK-MB and C-reactive protein concentrations was less in PRO than CHO (Cohen’s d mean ± SD, PRO: 2.91 ± 2.07; CHO: 7.56 ± 4.81, p = 0.046). Ingesting casein hydrolysate with carbohydrate during a 3-day race prevented secondary hypervolemia and failed to curb impaired LV relaxation despite reducing tissue damage and inflammatory biomarkers. Without PV expansion, systolic function was preserved by lateral wall compensating for septal wall dysfunction.

Running economy, known as the steady-state oxygen consumption at a given submaximal intensity, has been proposed as one of the key factors differentiating East African runners from other running communities around the world. Kenyan runners have dominated middle- and long-distance running events and this phenomenon has been attributed, in part at least, to their exceptional running economy. Despite such speculation, there are no data on running mechanics during real-life situations such as during training or competition. The use of innovative wearable devices together with real-time analysis of data will represent a paradigm shift in the study of running biomechanics and could potentially help explain the outstanding performances of certain athletes. For example, the integration of foot worn inertial sensors into the training and racing of athletes will enable coaches and researchers to investigate foot mechanics (e.g., an accurate set of variables such as pitch and eversion angles, cadence, symmetry, contact and flight times or swing times) during real-life activities and facilitate feedback in real-time. The same technological approach also can be used to help the athlete, coach, sports physician, and sport scientist make better informed decisions in terms of performance and efficacy of interventions, treatments or injury prevention; a kind of "telesport" equivalent to "telemedicine." There also is the opportunity to use this real-time technology to advance broadcasting of sporting events with the transmission of real-time performance metrics and in doing so enhance the level of entertainment, interest, and engagement of enthusiasts in the broadcast and the sport. Such technological advances that are able to unobtrusively augment personal experience and interaction, represent an unprecedented opportunity to transform the world of sport for participants, spectators, and all relevant stakeholders.

Oosthuyse, T, Florence, GE, Correia, A, Smyth, C, and Bosch, AN. Carbohydrate-restricted exercise with protein increases self-selected training intensity in female cyclists but not male runners and cyclists. J Strength Cond Res 35(6): 1547-1558, 2021-Carbohydrate-restricted training challenges preservation of euglycemia and exercise intensity that precludes ergogenic gains, necessitating countering strategies. We investigated the efficacy of ingesting casein protein hydrolysate in overnight-fasted male runners, male cyclists, and female cyclists. Twenty-four overnight-fasted athletes ingested 15.8 g·h-1 casein hydrolysate or placebo-water during exercise (60-80 minutes) comprising an incremental test to exhaustion, steady-state exercise (70% Vmax or 60% peak power output, 87 ± 4% HRmax), and 20-minute time trial (TT) in a double-blind randomized crossover design, with p < 0.05 accepted as significant. Ingesting protein vs. placebo increased metabolic demand {oxygen consumption, +4.7% (95% confidence interval [CI] ± 4%), p = 0.0297; +3.2% (95% CI ± 3.4%), p = 0.061}, heart rate (p = 0.0083; p = 0.007) and rating of perceived exertion (RPE) (p = 0.0266; p = 0.0163) in male cyclists and runners, respectively, but not female cyclists. Protein vs. placebo increased carbohydrate oxidation (+0.26 [95% CI ± 0.13] g·min-1, p = 0.0007) in female cyclists alone. Cyclists reported +2 ± 1 higher RPE than runners (p = 0.0062). Glycemia was maintained only in runners and increased with protein vs. placebo after 20 minutes of steady-state exercise (+0.63 [95% CI ± 0.56] mmol·L-1, p = 0.0285). TT performance with protein vs. placebo ingestion was modestly compromised in runners (-2.8% [95% CI ± 2.2%], p = 0.0018), unchanged in male cyclists (+1.9% [95% CI ± 5.6%], p = 0.5794), and modestly improved in female cyclists (+2.5% [95% CI ± 1.8%], p = 0.0164). Casein hydrolysate ingestion during moderate to hard carbohydrate-restricted exercise increases glycemia in runners, but not cyclists. Casein hydrolysate increases metabolic demand in male athletes and carbohydrate oxidation in female cyclists and is suitable for improving carbohydrate-restricted training intensity in female but not male endurance athletes.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Eken, MM, Withers, A, Flanagan, K, Burger, J, Bosch, A, and Lamberts, RP. Muscular activation patterns during exercise on the treadmill, stepper, and elliptical trainer. J Strength Cond Res 36(7): 1847-1852, 2022-Because of the low-impact, the stepper and elliptical trainer are popular alternatives to running when runners sustain running-related injuries. Muscular effort is expected to be lower during exercise on the stepper and elliptical trainer compared with running. The aim of this study was to quantify this by comparing muscular effort when exercising at similar moderate-to-high exercise intensities on a treadmill, stepper, and elliptical trainer. Seventeen well-trained runners (V̇o2max: 53.3 ml·min-1·kg-1 [male: n = 9], 44.8 ml·min-1·kg-1 [female: n = 8]; average peak treadmill running speed: 18.7 km·h-1 [male], 16.3 km·h-1 [female]) performed exercise at submaximal levels (60%-70%-80% of peak workload) on the treadmill, stepper, and elliptical trainer. Peak workload was determined during peak exercise tests on separate days. Surface electromyography was recorded from lower extremity muscles. Root-mean-squared (RMS) values were calculated and compared between exercise modalities and submaximal levels. Significance was set at p0.05. Root-mean-squared levels of lower extremity muscles were significantly reduced during exercise on the stepper and elliptical trainer compared with treadmill running (p0.05, except for quadriceps (p0.05). Overall, similar RMS levels were found on stepper and elliptical trainer (p0.05), whereas in several cases higher RMS levels were found on the stepper compared with elliptical trainer (p0.05). These findings support clinical expectations that exercise on the stepper and elliptical trainer reduces muscular effort up to 60% compared with (treadmill) running, and therefore can be effective training modalities during rehabilitation from running-related injuries by restricting impact on lower extremities.

While most semiconductor materials are susceptible to radiation damage, we report here an observation of enhancements in the conductivity of undoped composite amorphous/nanocrystalline silicon thin films after irradiation with high-energy protons. When a series of films for which the nanocrystal concentration is varied were irradiated with 16-MeV protons with fluences from $2\ifmmode\times\else\texttimes\fi{}{10}^{13}$ to ${10}^{15}\phantom{\rule{0.16em}{0ex}}\mathrm{protons}/\mathrm{c}{\mathrm{m}}^{2}$, the dark conductivity following irradiation is increased by up to a factor of 10. Unlike the persistent photoconductivity effect observed in amorphous semiconductors, this enhancement is permanent and is not removed by annealing. Various mechanisms are tested to explain this effect, but none are able to fully account for our observations.