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Background & aims: Anxiety can be related to reduced diet quality during pandemics such as COVID-19. However, it is not clear whether these relationships would be similar in inactive and physically active participants. The aim of this study was to analyze associations between anxiety and eating habits in physically active and inactive individuals during the COVID-19 pandemic. Methods: The sample consisted of 1826 adults (58.5% women) who were invited through social media to answer an online questionnaire. The instrument included questions related to physical activity, eating habits, health behavior, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Anxiety, food habits (high food habits consumption ≥5 times per week) and physical activity (≥150 min per week) were assessed during the COVID-19 pandemic. The relationship between anxiety and eating habits according to levels of physical activity (inactive vs. active) was assessed using binary logistic regression adjusted for sex, age, education level, social isolation, and body mass index. Results: Among the inactive participants, anxiety was related with high consumption of sweets (OR = 1.43; 95% CI = 1.11–1.83) and fast foods (OR = 2.23; 95% CI = 1.05–4.74) while quarantining during the COVID-19 pandemic. No relationship was observed between anxiety and food consumption among physically active participants in the final model. Conclusion: Anxiety was associated with less desirable eating habits among physically inactive adults during the COVID-19 pandemic.

Introduction\ud The COLO-COHORT study aims to produce a multi-factorial risk prediction model for colorectal neoplasia that will be able to be used to target colonoscopy to those at greatest risk of colorectal neoplasia, ensuring that people are not investigated unnecessarily and maximising the use of limited endoscopy resources. The study will also explore the link between neoplasia and the human gut microbiome. Additionally, the study aims to generate a cohort of colonoscopy patients who are ‘research ready’ through the development of a consent-for-contact platform (C4C), to facilitate a range of CRC prevention studies to be conducted at scale and speed.\ud \ud Methods and Analysis\ud This is a multi-centre observational study involving sites across the UK. Recruitment is over a 6-year period (2019 – 2025). Patients recruited to the study are those attending for colonoscopy. Patients are recruited into two groups, namely; observational Group A (10,000 patients) and C4C Group B (10,000 patients), known as COLO-SPEED (Colorectal Cancer Screening Prevention Endoscopy and Early Diagnosis; https://colospeed.uk).\ud \ud Patients complete a health questionnaire, provide anthropometric measurements and submit biosamples (blood and stool - depending on the part of the study they are recruited into). Patients’ colonoscopy and histology findings are also recorded. Models of factors associated with presence of neoplasia at colonoscopy will be developed using logistic or multinomial regression. For internal validation, model discrimination and calibration will be assessed and bootstrapping and cross-validation approaches used. To enable long-term follow up for outcomes related to CRC and polyps, patients are asked to consent to follow up through data linkage with national databases.\ud \ud Dissemination\ud In keeping with good research practice, following analysis by the study team the study investigators will make the anonymised dataset available to other researchers. The C4C platform will also be accessible to other researchers. The study findings will be submitted for publication in peer reviewed journals and lay summaries will be disseminated to participants and the wider public.

Background: The SARS-CoV-2 omicron variant (B.1.1.529) is highly transmissible, but disease severity appears to be reduced compared with previous variants such as alpha and delta. We investigated the risk of severe outcomes following infection in residents of long-term care facilities. Methods: We did a prospective cohort study in residents of long-term care facilities in England who were tested regularly for SARS-CoV-2 between Sept 1, 2021, and Feb 1, 2022, and who were participants of the VIVALDI study. Residents were eligible for inclusion if they had a positive PCR or lateral flow device test during the study period, which could be linked to a National Health Service (NHS) number, enabling linkage to hospital admissions and mortality datasets. PCR or lateral flow device test results were linked to national hospital admission and mortality records using the NHS-number-based pseudo-identifier. We compared the risk of hospital admission (within 14 days following a positive SARS-CoV-2 test) or death (within 28 days) in residents who had tested positive for SARS-CoV-2 in the period shortly before omicron emerged (delta-dominant) and in the omicron-dominant period, adjusting for age, sex, primary vaccine course, past infection, and booster vaccination. Variants were confirmed by sequencing or spike-gene status in a subset of samples. Results: 795 233 tests were done in 333 long-term care facilities, of which 159 084 (20·0%) could not be linked to a pseudo-identifier and 138 012 (17·4%) were done in residents. Eight residents had two episodes of infection (>28 days apart) and in these cases the second episode was excluded from the analysis. 2264 residents in 259 long-term care facilities (median age 84·5 years, IQR 77·9–90·0) were diagnosed with SARS-CoV-2, of whom 253 (11·2%) had a previous infection and 1468 (64·8%) had received a booster vaccination. About a third of participants were male. Risk of hospital admissions was markedly lower in the 1864 residents infected in the omicron-period (4·51%, 95% CI 3·65–5·55) than in the 400 residents infected in the pre-omicron period (10·50%, 7·87–13·94), as was risk of death (5·48% [4·52–6·64] vs 10·75% [8·09–14·22]). Adjusted hazard ratios (aHR) also indicated a reduction in hospital admissions (0·64, 95% CI 0·41–1·00; p=0·051) and mortality (aHR 0·68, 0·44–1·04; p=0·076) in the omicron versus the pre-omicron period. Findings were similar in residents with a confirmed variant. Interpretation: Observed reduced severity of the omicron variant compared with previous variants suggests that the wave of omicron infections is unlikely to lead to a major surge in severe disease in long-term care facility populations with high levels of vaccine coverage or natural immunity. Continued surveillance in this vulnerable population is important to protect residents from infection and monitor the public health effect of emerging variants. Funding: UK Department of Health and Social Care.

Purpose\ud To systematically map available evidence for school-based interventions led by allied health (i.e., occupational therapy, physiotherapy, and/or speech and language therapy).\ud \ud Materials and methods\ud We searched for studies in pre-school, primary, secondary, or post-secondary settings, published 2004–2020. We coded study, population, and intervention characteristics. Outcomes were coded inductively, categorised, and linked to the International Classification of Functioning, Disability, and Health.\ud \ud Results\ud We included 337 studies (33 countries) in an interactive evidence map. Participants were mainly pre-school and primary-aged, including individuals with neurodisability and whole-school populations. Interventions targeted wide-ranging outcomes, including educational participation (e.g., writing, reading) and characteristics of school environments (e.g., educators’ knowledge and skills, peer support). Universal, targeted, and intensive interventions were reported in 21.7%, 38.9%, and 60.2% of studies, respectively. Teachers and teaching assistants delivered interventions in 45.4% and 22.6% of studies, respectively. 43.9% of studies conducted early feasibility testing/piloting and 54.9% had ≤30 participants. Sixty-two randomised controlled trials focused on intervention evaluation or implementation.\ud \ud Conclusions\ud In the United Kingdom, future research should take forward school-based allied health interventions that relate directly to agreed research priorities. Internationally, future priorities include implementation of tiered (universal, targeted, intensive) intervention models and appropriate preparation and deployment of the education workforce.\ud \ud IMPLICATIONS FOR REHABILITATION\ud Allied health professionals (occupational therapists, physiotherapists, and speech and language therapists) work in schools supporting children and young people affected by neurodisability but the content, impact, and cost-effectiveness of their interventions are not well-understood.\ud \ud We systematically mapped the available evidence and identified that allied health school-based interventions target highly diverse health-related outcomes and wider determinants of children and young people’s health, including educational participation (e.g., literacy) and characteristics of the school environment (e.g., educators’ knowledge and skills).\ud \ud Our interactive evidence map can be used to help stakeholders prioritise the interventions most in need of further evaluation and implementation research, including tiered models of universal, targeted, and intensive allied health support.\ud \ud Teachers and teaching assistants play a central role in delivering allied health interventions in schools – appropriate preparation and deployment of the education workforce should therefore be a specific priority for future international allied health research.

Cherry juice has become a standard component of athlete recovery strategies. This review covers the history of cherry juice as a recovery drink to give context to its current use. Fifteen studies were identified that included a measure of muscle function, soreness, or inflammation on the days following exercise and had an exercise insult sufficient to assess the effectiveness of the tart cherry intervention. Eight studies used a concentrated juice, three used a juice from fresh-frozen cherries, two used a tart cherry concentrate gel, and two used a tart cherry powder. The effective juice dose was specific to the type of drink (fresh-frozen versus concentrate) but dose-response studies are lacking, and thus, the optimal dose for any specific type of cherry juice is not known. Timing of the dosing regimen is a critical factor. Studies have uniformly shown that muscle function will recover faster on the days after exercise if juice is provided for several days prior to exercise. Effects on soreness or systemic inflammation are more equivocal. The available evidence does not support a regimen that begins on the day of exercise or post-exercise. Tart cherry powder did not enhance any metric of recovery on the days after exercise. In conclusion, the term recovery implies an intervention that is introduced after an exercise insult. The term “precovery” may be preferable to describe interventions that should be introduced on the days prior to exercise to facilitate recovery on the days after exercise. The evidence supports cherry juice as a precovery intervention across a range of athletic activities.

Purpose:To provide a descriptive analysis of the warm-up (WU) strategies employed by cross-country skiers prior to distance and sprint competitions at a national championship and to compare the skiers’ planned and executed WUs prior to the respective competitions.Methods:Twenty-one national- and international-level skiers (11 women and 10 men) submitted WU plans prior to the distance and sprint competitions, and after the competitions, reported any deviations from the plans. Skiers used personal monitors to record heart rate (HR) during WU, races, and cooldown. Quantitative statistical analyses were conducted on WU durations, durations in HR-derived intensity zones, and WU loads. Qualitative analyses were conducted on skiers’ WU plans and their reasons for deviating from the plans.Results:Skiers’ planned WUs were similar in content and planned time in HR-derived intensity zones for both the distance and sprint competitions. However, 45% of the women and 20% of the men reported that their WU was not carried out as planned, with reasons detailed as being due to incorrect intensities and running out of time. WU activities including skiing across variable terrain, muscle-potentiating exercises, and heat-maintenance strategies were missing from the skiers’ planned routines.Conclusions:Skiers favored a long, traditional WU approach for both the sprint and distance events, performing less high-intensity and more moderate-intensity exercise during their WUs than planned. In addition, elements likely relevant to successful performance in cross-country skiing were missing from WU plans.

Background Although laboratory studies demonstrate that training programmes using auditory rhythmical cueing (ARC) may improve gait post-stroke, few studies have evaluated this intervention in the home and outdoors where deployment may be more appropriate. This manuscript reports stakeholder refinement of an ARC gait and balance training programme for use at home and outdoors, and a study which assessed acceptability and deliverability of this programme. Methods Programme design and content were refined during stakeholder workshops involving physiotherapists and stroke survivors. A two-group acceptability and deliverability study was then undertaken. Twelve patients post-stroke with a gait related mobility impairment received either the ARC gait and balance training programme or the gait and balance training programme without ARC. Programme provider written notes, participant exercise and fall diaries, adverse event monitoring and feedback questionnaires captured data about deliverability, safety and acceptability of the programmes. Results The training programme consisted of 18 sessions (six supervised, 12 self-managed) of exercises and ARC delivered by a low-cost commercially available metronome. All 12 participants completed the six supervised sessions and 10/12 completed the 12 self-managed sessions. Provider and participant session written records and feedback questionnaires confirmed programme deliverability and acceptability. Conclusion An ARC gait and balance training programme refined by key stakeholders was feasible to deliver and acceptable to participants and providers. Trial registration ISCTRN 12/03/2018.

Background\ud Advances in SARS-CoV-2 sequencing have enabled identification of new variants, tracking of its evolution, and monitoring of its spread. We aimed to use whole genome sequencing to describe the molecular epidemiology of the SARS-CoV-2 outbreak and to inform the implementation of effective public health interventions for control in Zimbabwe.\ud \ud Methods\ud We performed a retrospective study of nasopharyngeal samples collected from nine laboratories in Zimbabwe between March 20 and Oct 16, 2020. Samples were taken as a result of quarantine procedures for international arrivals or to test for infection in people who were symptomatic or close contacts of positive cases. Samples that had a cycle threshold of less than 30 in the diagnostic PCR test were processed for sequencing. We began our analysis in July, 2020 (120 days since the first case), with a follow-up in October, 2020 (at 210 days since the first case). The phylogenetic relationship of the genome sequences within Zimbabwe and global samples was established using maximum likelihood and Bayesian methods.\ud \ud Findings\ud Of 92 299 nasopharyngeal samples collected during the study period, 8099 were PCR-positive and 328 were available for sequencing, with 156 passing sequence quality control. 83 (53%) of 156 were from female participants. At least 26 independent introductions of SARS-CoV-2 into Zimbabwe in the first 210 days were associated with 12 global lineages. 151 (97%) of 156 had the Asp614Gly mutation in the spike protein. Most cases, 93 (60%), were imported from outside Zimbabwe. Community transmission was reported 6 days after the onset of the outbreak.\ud \ud Interpretation\ud Initial public health interventions delayed onset of SARS-CoV-2 community transmission after the introduction of the virus from international and regional migration in Zimbabwe. Global whole genome sequence data are essential to reveal major routes of spread and guide intervention strategies.\ud \ud Funding\ud WHO, Africa CDC, Biotechnology and Biological Sciences Research Council, Medical Research Council, National Institute for Health Research, and Genome Research Limited.

Background Sarcopenia is defined as the loss of muscle mass and strength. Despite the seriousness of this disease, a single diagnostic criterion has not yet been established. Few studies have reported the prevalence of sarcopenia globally, and there is a high level of heterogeneity between studies, stemmed from the diagnostic criteria of sarcopenia and the target population. The aims of this systematic review and meta‐analysis were (i) to identify and summarize the diagnostic criteria used to define sarcopenia and severe sarcopenia and (ii) to estimate the global and region‐specific prevalence of sarcopenia and severe sarcopenia by sociodemographic factors. Methods Embase, MEDLINE, and Web of Science Core Collections were searched using relevant MeSH terms. The inclusion criteria were cross‐sectional or cohort studies in individuals aged ≥18 years, published in English, and with muscle mass measured using dual‐energy x‐ray absorptiometry, bioelectrical impedance, or computed tomography (CT) scan. For the meta‐analysis, studies were stratified by diagnostic criteria (classifications), cut‐off points, and instruments to assess muscle mass. If at least three studies reported the same classification, cut‐off points, and instrument to measure muscle mass, they were considered suitable for meta‐analysis. Following this approach, 6 classifications and 23 subgroups were created. Overall pooled estimates with inverse‐variance weights obtained from a random‐effects model were estimated using the metaprop command in Stata. Results Out of 19 320 studies, 263 were eligible for the narrative synthesis and 151 for meta‐analysis (total n = 692 056, mean age: 68.5 years). Using different classifications and cut‐off points, the prevalence of sarcopenia varied between 10% and 27% in the studies included for meta‐analysis. The highest and lowest prevalence were observed in Oceania and Europe using the European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2, respectively. The prevalence ranged from 8% to 36% in individuals

Objectives: The benefits of increased physical activity for stroke survivors include improved function and mental health and wellbeing. However, less than 30% achieve recommended physical activity levels, and high levels of sedentary behaviour are reported. We developed a multifaceted behavioural intervention (and accompanying implementation plan) targeting physical activity and sedentary behaviour of stroke survivors.\ud Design: Intervention Mapping facilitated intervention development. Step 1 involved a systematic review, focus group discussions and a review of care pathways. Step 2 identified social cognitive determinants of behavioural change and behavioural outcomes. Step 3 linked determinants of behavioural outcomes with specific behaviour change techniques (BCTs) to target behaviours of interest. Step 4 involved intervention development informed by steps 1–3. Subsequently, an implementation plan was developed (Step 5) followed by an evaluation plan (Step 6).\ud Setting: Community and secondary care settings, North East England.\ud Participants: Stroke survivors and healthcare professionals (HCPs)\ud working in stroke services.\ud Results: Systematic review findings informed selection of nine ‘promising’ BCTs (e.g. problem-solving). Focus groups with stroke survivors (n = 18) and HCPs (n= 24) identified the need for an intervention delivered throughout the rehabilitation pathway, tailored to individual needs with training for HCPs delivering the intervention. Intervention delivery was considered feasible within\ud local stroke services. The target behaviours for the intervention were levels of physical activity and sedentary behaviour in adult stroke survivors. Assessment of acceptability and usability with 11 HCPs and 21 stroke survivors/relatives identified issues with self-monitoring tools and the need for a physical activity repository of local services’ and training for HCPs with feedback on intervention delivery. A feasibility study protocol was designed to evaluate the intervention.\ud Conclusions: A systematic development process using intervention mapping resulted in a multi-faceted evidence- and theory-informed intervention (Physical Activity Routines After Stroke – PARAS) for delivery by community stroke rehabilitation teams.

Background Dementia is a serious problem in old age, that impacts an individual’s ability to function and may threaten personal dignity. Given the variable features of the illness and the diversity of life experiences, many factors may contribute to the perception of dignity by men and women with dementia. The purpose of the study was to explore the factors that contribute to dignity and its domains in men and women with dementia. Methods This cross-sectional study involved 316 community-dwelling patients with early-stage dementia (aged ≥ 60) (PwD). We assessed the participants’ sociodemographic and social involvement characteristics, health-related variables (pain, depression, physical performance, visual and hearing impairments), attitude to aging, and self-sufficiency in the activities of daily living (ADL). These factors were investigated as independent variables for the perception of dignity and of its domains in men and women. Results Multivariate regression analysis showed that PwD experienced minor dignity problems in the early stages of dementia. In both men and women higher rates of depression, negative attitudes to aging, and pain were associated with reductions in the perception of dignity. In men, but not in women visual impairment had a negative effect on overall dignity, and on the associated domains of ‘Loss of Autonomy’ and ‘Loss of Confidence’. In women, lowered self-sufficiency in ADL contributed to reduced self-perception of dignity and in the associated domains of ‘Loss of Purpose of Life’, ‘Loss of Autonomy’, and ‘Loss of Confidence’. Sociodemographic and social involvement characteristics, hearing impairment, and physical performance did not influence the participants’ self-perception of dignity. Conclusion The results suggested that several common factors (depression, attitudes to aging, and pain) contribute to the perception of dignity in both men and women. Other factors, visual impairments in men, and self-sufficiency in ADL in women, appear to be more gender specific. These differences might relate to their specific gender roles and experiences. The self-perception of dignity in PwD can be helped by supporting the individual, to the extent that their illness allows, in maintaining activities that are important to their gender roles, and that preserve their gender identity. Trial registration NCT04443621.

Background As part of an ongoing service improvement project, a digital ‘joint school’ (DJS) was developed to provide education and support to patients undergoing total hip (THR) and total knee (TKR) replacement surgery. The DJS allowed patients to access personalised care plans and educational resources using web-enabled devices, from being listed for surgery until 12 months post-operation. The aim of this study was to compare a cohort of patients enrolled into the DJS with a cohort of patients from the same NHS trust who received a standard ‘non-digital’ package of education and support in terms of Health-Related Quality of Life (HRQoL), functional outcomes and hospital length of stay (LoS). Methods A retrospective comparative cohort study of all patients undergoing primary TKR/THR at a single NHS trust between 1st Jan 2018 and 31st Dec 2019 (n = 2406) was undertaken. The DJS was offered to all patients attending the clinics of early adopting surgeons and the remaining surgeons offered their patient’s standard written and verbal information. This allowed comparison between patients that received the DJS (n = 595) and those that received standard care (n = 1811). For each patient, demographic data, LoS and patient reported outcome measures (EQ-5D-3L, Oxford hip/knee scores (OKS/OHS)) were obtained. Polynomial regressions, adjusting for age, sex, Charlson Comorbidity Index (CCI) and pre-operative OKS/OHS or EQ-5D, were used to compare the outcomes for patients receiving DJS and those receiving standard care. Findings Patients that used the DJS had greater improvements in their EQ-5D, and OKS/OHS compared to patients receiving standard care for both TKR and THR (EQ-5D difference: TKR coefficient estimate (est) = 0.070 (95%CI 0.004 to 0.135); THR est = 0.114 (95%CI 0.061 to 0.166)) and OKS/OHS difference: TKR est = 5.016 (95%CI 2.211 to 7.820); THR est = 4.106 (95%CI 2.257 to 5.955)). The DJS had a statistically significant reduction on LoS for patients who underwent THR but not TKR. Conclusion The use of a DJS was associated with improved functional outcomes when compared to a standard ‘non-digital’ method. The improvements between pre-operative and post-operative outcomes in EQ-5D and OKS/OHS were higher for patients using the DJS. Furthermore, THR patients also had a shorter LoS.

Nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have severely affected bed capacity and patient flow. We utilized whole-genome sequencing (WGS) to identify outbreaks and focus infection control resources and intervention during the United Kingdom’s second pandemic wave in late 2020. Phylogenetic analysis of WGS and epidemiological data pinpointed an initial transmission event to an admission ward, with immediate prior community infection linkage documented. High incidence of asymptomatic staff infection with genetically identical viral sequences was also observed, which may have contributed to the propagation of the outbreak. WGS allowed timely nosocomial transmission intervention measures, including admissions ward point-of-care testing and introduction of portable HEPA14 filters. Conversely, WGS excluded nosocomial transmission in 2 instances with temporospatial linkage, conserving time and resources. In summary, WGS significantly enhanced understanding of SARS-CoV-2 clusters in a hospital setting, both identifying high-risk areas and conversely validating existing control measures in other units, maintaining clinical service overall.

Background. Gait impairments are common in Parkinsons disease (PD) and increase falls risk. Visual cues can improve gait in PD, particularly freezing of gait (FOG), but mechanisms involved in visual cue response are unknown. This study aimed to examine brain activity in response to visual cues in people with PD who do (PD+FOG) and do not report FOG (PD-FOG) and explore relationships between attention, brain activity and gait. Methods. Mobile EEG measured brain activity during gait in 20 healthy older adults and 43 PD participants (n=22 PD+FOG, n=21 PD-FOG). Participants walked for 2-minutes with and without visual cues (transverse lines to step over). We report power spectral density (PSD) in Delta (1-4Hz), Theta (4-7Hz), Alpha (8-12Hz), Beta (14-24Hz) and Gamma (30-50Hz) bands within clusters of similarly brain localized independent component sources. Results. PSDs within the parietal and occipital lobes were altered when walking with visual cues in PD, particularly in PD+FOG. Between group, differences suggested that parietal sources in PD, particularly with PD+FOG, had larger activity compared to healthy older adults when walking. Within group, visual cues altered brain activity in PD, particularly in PD+FOG, within visual processing brain regions. In PD participants, brain activity differences with cues correlated with gait improvements, and in PD+FOG those with worse attention required more visual attentional processing (reduced alpha PSD) in the occipital lobe. Conclusions. Visual cues improve gait and influence brain activity during walking in PD, particularly in PD+FOG. Findings may allow development of more effective therapeutics.

Currently, many countries are promoting B100 as the main fuel for diesel engines towards the transition to 100% renewable energy applications. However, due to its properties, B100 has both advantages and disadvantages to replace diesel oil. Therefore, a bibliometric analysis was carried out to evaluate the performance and emissions of a diesel engine with the B100 being tested on a multi-cylinder diesel engine for cars. Unfortunately, only 12 of the 127 selected articles are eligible to be reviewed in detail and none of them discusses all the key performance of diesel engines which include Brake Thermal Efficiency (BTE), Specific Fuel Consumption (SFC), Cylinder Pressure (CPs), Heat Release Rate (HRR), NOx, and smoke. Through data synthesis, we found that the use of B100 provides advantages in engine noise, thermal efficiency, specific fuel consumption, and emissions under certain engine loads. On the other hand, it also has the potential to result in poorer performance, if there is no modification to engine components and the addition of additives. As a recommendation, the results of this analysis provide a guide for further research to examine the use of B100 with all diesel engine performance variables. Research paths can be developed with the wider potential to provide new arguments on various diesel engine technologies, engine capacities, B100 raw materials, and test environments.

OBJECTIVE:\ud To describe physical activity habits and barriers for physical activity practice in patients with peripheral artery disease and claudication symptoms during Coronavirus 2019 (COVID-19) pandemic.\ud \ud METHODS:\ud In this cross-sectional survey study, 127 patients with peripheral artery disease (59.8% men; 68±9 years old; and 81.9% had the peripheral artery disease diagnosis ≥5 years old) were included. The physical activity habits and barriers for physical activity practice were assessed through telephone interview using a questionnaire with questions related to: (a) COVID-19 personal care; (b) overall health; (c) physical activity habits; (d) for those who were inactive, the barriers for physical activity practice.\ud \ud RESULTS:\ud Only 26.8% of patients reported practicing physical activity during the COVID-19 pandemic. Exercise characteristics more common among these patients include walking, performed at least 5 days a week, during 31–60 min at light intensity. In contrast, among physically inactive patients, pain, injury or disability (55%), the COVID-19 pandemic (50%), the need to rest due to leg pain (29%), and lack of energy (27%) were the most frequent barriers to physical activity practice.\ud \ud CONCLUSION:\ud The physical activity level of patients with peripheral artery disease is impacted by the COVID-19 pandemic.

Background Despite improvements in pulmonary function following lung transplantation (LTx), physical activity levels remain significantly lower than the general population. To date, there is little research investigating interventions to improve daily physical activity in LTx recipients. This study assessed the feasibility and acceptability of a novel, 12-weeks physical activity tele-coaching (TC) intervention in LTx recipients. Methods Lung transplant recipients within 2 months of hospital discharge were recruited and randomised (1:1) to TC or usual care (UC). TC consists of a pedometer and smartphone app, allowing transmission of activity data to a platform that provides feedback, activity goals, education, and contact with the researcher as required. Recruitment and retention, occurrence of adverse events, intervention acceptability and usage were used to assess feasibility. Results Key criteria for progressing to a larger study were met. Of the 15 patients eligible, 14 were recruited and randomised to TC or UC and 12 completed (67% male; mean ± SD age; 58 ± 7 years; COPD n = 4, ILD n = 6, CF n = 1, PH n = 1): TC ( n = 7) and UC ( n = 5). TC was well accepted by patients, with 86% indicating that they enjoyed taking part. Usage of the pedometer was excellent, with all patients wearing it for over 90% of days and rating the pedometer and telephone contact as the most vital aspects. There were no adverse events related to the intervention. After 12 weeks, only TC displayed improvements in accelerometry steps/day (by 3475 ± 3422; p = .036) and movement intensity (by 153 ± 166 VMU; p = .019), whereas both TC and UC groups exhibited clinically important changes in physical SF-36 scores (by 11 ± 14 and 7 ± 9 points, respectively). Conclusion TC appears to be a feasible, safe, and well-accepted intervention in LTx.

Vztah mezi somatotypovým tříčíslím atleta a jeho sportovním výkonem je dobře znám. Přímý vliv odlišného dominantního somatotypu na skokové a sprintové proměnné však dosud nebyl popsán. Cílem této studie bylo prozkoumat účinky dominantního somatotypu na sportovně specifické výbušné proměnné. Sto dvanáct fyzicky aktivních mladých dospělých (průměrný věk směrodatné odchylky: 21,82 3,18 let) bylo somatotypizováno pomocí Heath–Carterovy metody. Účastníci byli klasifikováni jako vyvážený ektomorf, vyrovnaný mezomorf, centrální, mezomorf-endomorf a mezomorfní ektomorf. Vertikální skok a testy lineárního sprintu byly provedeny za účelem měření špičkového výkonu v dolní části těla a proměnných sprintu (čas, rychlost a hybnost). Analýza odhalila, že vyvážený mezomorf měl významně vyšší vertikální skok (velikost účinku (ES) = 1,10, p = 0,005) a sílu k tělesné hmotnosti (ES = 1,04, p = 0,023) než mezomorf-endomorf. Kromě toho, vyvážený mezomorf vykazoval významně lepší výkon v čase a rychlosti sprintu na 30 m než centrální a mezomorf-endomorf (rozsah ES = 0,93–1, p < 0,05). Konečně, vyrovnaný ektomorf (ES = 1,12, p = 0,009) a mezomorfní ektomorf (ES = 1,10, p = 0,017) byly nižší ve sprintové hybnosti ve srovnání s vyrovnanými mezomorfy. Závěrem lze říci, že tato studie prokázala důležitost interakce mezi podtypy a sportovním výkonem. Získané znalosti mohou být důležité při identifikaci těch, kteří mají tendenci podávat dobré výkony ve sportech s výbušnou silou a při předepisování tréninkových programů. The relationship between an athlete’s somatotype three-numeral rating and his or her athletic performance is well known. However, a direct effect of the different dominant somatotype on jumping and sprinting variables has not yet been reported. The aim of this study was to investigate the effects of dominant somatotype on sport-specific explosive variables. One hundred and twelve physically active young adults (mean standard deviation age: 21.82 3.18 years) were somatotyperated using the Heath–Carter method. Participants were classified as balanced ectomorph, balanced mesomorph, central, mesomorph-endomorph, and mesomorphic ectomorph. Vertical jump and linear sprint tests were performed to measure peak lower body performance and sprint variables (time, speed, and momentum), respectively. The analysis revealed that balanced mesomorph had significantly higher vertical jump (effect size (ES) = 1.10, p = 0.005) and power to body mass (ES = 1.04, p = 0.023) than mesomorph-endomorph. In addition, balanced mesomorph showed significantly superior performance in 30-m sprint time and velocity than central and mesomorph-endomorph (ES range = 0.93–1, p < 0.05). Finally, balanced ectomorph (ES = 1.12, p = 0.009) and mesomorphic ectomorph (ES = 1.10, p = 0.017) were lower in sprint momentum compared to balanced mesomorphs. In conclusion, this study has shown the importance of the interaction between subtypes and athletic performance. The knowledge gained may be important in identifying those who tend to perform well in sports with explosive power and in prescribing training programs.

Postural instability is common in neurological diseases. Although transcranial direct current stimulation (tDCS) seems to be a promising complementary therapy, emerging evidence indicates mixed results and protocols' characteristics. We conducted a systematic review and meta-analysis on PubMed, EMBASE, Scopus, and Web of Science to synthesize key findings of the effectiveness of single and multiple sessions of tDCS alone and combined with other interventions on balance in adults with neurological disorders. Thirty-seven studies were included in the systematic review and 33 in the meta-analysis. The reviewed studies did not personalize the stimulation protocol to individual needs/characteristics. A random-effects meta-analysis indicated that tDCS alone (SMD = -0.44; 95%CI = -0.69/-0.19; p 0.001) and combined with another intervention (SMD = -0.31; 95%CI = -0.51/-0.11; p = 0.002) improved balance in adults with neurological disorders (small to moderate effect sizes). Balance improvements were evidenced regardless of the number of sessions and targeted area. In summary, tDCS is a promising therapy for balance rehabilitation in adults with neurological disorders. However, further clinical trials should identify factors that influence responsiveness to tDCS for a more tailored approach, which may optimize the clinical use of tDCS.

Background:Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings.Methods:We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data collection period, followed by intervention periods comprising 8 weeks of ‘rapid’ (Results:A total of 2170 HOCI cases were recorded from October 2020 to April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95% CI 0.85–3.01; p=0.14) or rapid (0.85, 0.48–1.50; p=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8 and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2 and 11.6% of cases where the report was returned. In a ‘per-protocol’ sensitivity analysis, there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources.Conclusions:While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days.Funding:COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) (grant code: MC_PC_19027), and Genome Research Limited, operating as the Wellcome Sanger Institute.Clinical trial number:NCT04405934.

Background Low levels of habitual physical activity and high levels of sedentary behaviour are commonly observed post-stroke. We aimed to assess the feasibility, acceptability and fidelity of a multifaceted, theory- and evidence-informed supported self-management intervention targeting physical activity and sedentary behaviour after stroke: Physical Activity Routines After Stroke (PARAS). Methods Adult stroke survivors and healthcare professionals were recruited from North East England stroke services. Stroke survivor physical activity and sedentary behaviour were targeted by a self-management behavioural intervention supported by healthcare professionals trained in intervention delivery. The main outcomes were protocol and intervention acceptability and feasibility and fidelity of intervention delivery. Results Eleven healthcare professionals (9 physiotherapists; 2 occupational therapists) participated in the study. Stroke survivor recruitment was lower than anticipated (19 versus target of up to 35). The healthcare professional training programme was feasible, with fidelity assessment of delivery supporting this finding. Data completeness was acceptable according to a priori criteria (>60%), except for stroke survivor questionnaire return rate (59%) and interview uptake (52%). No serious adverse events occurred. Healthcare professionals and stroke survivors perceived intervention delivery to be feasible and acceptable with minor modifications highlighted including the potential for earlier delivery in the stroke pathway. Conclusions The study protocol and intervention delivery were feasible and acceptable to stroke survivors and healthcare professionals with modifications required before large-scale evaluation. Trial registration ISRCTN35516780. Registered on October 24, 2018

Background: Muscle strength imbalance assessment (e.g., hamstring-to-quadriceps ratio, H:Q) using traditional peak torque isokinetic measurements has been shown to be a weak risk factor predictor of future lower-limb injuries (e.g., hamstring strain and anterior cruciate ligament tear). In soccer, power-related tasks are commonplace and injuries are most likely to occur during fatigued high-velocity actions. Thus, it is reasonable to that calculating H:Q using power output and may serve as an alternative to traditional peak torque-based H:Q. Aims: We aimed to investigate the relationship of isokinetic H:Q calculated from traditional peak torque and power output during non-fatigue and fatigue conditions. Methods: Seventy-nine professional soccer players (25.6 ± 4.9 years old; 78.7 ± 8.1 kg; 179.4 ± 6.7 cm) performed concentric knee extension-flexion contractions at 60°.s−1 (five repetitions) and 300°.s−1 (30 repetitions, fatigue trial). Traditional peak torque H:Q was calculated using the highest torque obtained during five repetitions at 60°.s−1. Power output H:Qnon-fatigued was calculated using the average from the 2nd, 3rd and 4th repetitions, and power output H:Qfatigued was obtained as the average of the power output of the last three repetitions of the fatigue trial. Results: Weak (rs = 0.27) and moderate (rs = 0.49) correlations were found between traditional peak torque and power output H:Qfatigued, and traditional peak torque and power output H:Qnon-fatigued, respectively. Conclusion: The present data suggested that power H:Q differs from traditional H:Q, particularly during fatigue in professional soccer players, which warrants further investigation on the potential use of power output H:Q ratios for injury prediction.

Elbow flexors (EFs) and knee extensors (KEs) have shown differences in performance fatigability and recovery of neuromuscular function after isometric and isotonic single-joint fatiguing contractions. However, dynamic multi-joint movements are more representative of real-world activities. The aim of the study was to assess central and peripheral mechanisms of fatigability after either arm-cranking or cycling. Ten physically active men performed maximal incremental arm-cranking and cycling until task failure. Maximal voluntary isometric contraction (MVIC) and electrically evoked forces of both EF and KE were assessed before (PRE) and 1 (POST) and 20 (POST20) min after exercise. At POST, MVIC decreased similarly to 76 ± 8% and 81 ± 7% (both P < 0.001) of PRE for EF and KE, respectively. MVIC force remained lower than PRE at POST20 for both EF and KE (85 ± 8% vs. 95 ± 3% of PRE, P ≤ 0.033), having recovered less in EF than in KE ( P = 0.003). Electrically evoked forces decreased similarly from PRE to POST in EF and KE (all P > 0.05). At POST20, the ratio of low-to-high frequency doublets was lower in EF than in KE (75 ± 13% vs. 85 ± 10% of PRE; P ≤ 0.034). Dynamic maximal incremental exercise acutely induced similar magnitudes of MVIC and evoked force loss in EF and KE. However, at POST20, impaired MVIC recovery and lower ratio of low-to-high frequency doublets in EF than in KE suggest the recovery of neuromuscular function after dynamic maximal exercises is specific to and dependent on changes within the muscles investigated.

Leukaemia cells re-program their microenvironment to provide proliferation support and protection from standard chemotherapy, molecularly targeted therapies, and immunotherapy. Although much is becoming known about molecules that drive niche-dependent treatment resistance; means of targeting these in the clinics has remained a key obstacle. To address this challenge, we have developed human induced pluripotent stem cell engineered niches ex vivo to reveal insights into druggable cancer-niche dependencies. We show that mesenchymal (iMSC) and vascular niche-like (iANG) cells support ex vivo proliferation of patient-derived leukaemia cells, impact dormancy and mediate therapy resistance. iMSC protected both non-cycling and cycling blasts against dexamethasone treatment while iANG protected only dormant blasts. Leukaemia proliferation and protection from dexamethasone induced-apoptosis was dependent on direct cell-cell contact and mediated by CDH2. To explore the therapeutic potential of disrupting this cell-cell interaction, we tested the CDH2 antagonist ADH-1 (previously in phase I / II for solid tumours) in a very aggressive patient-derived xenograft leukaemia mouse model. ADH-1 showed high in vivo efficacy. ADH-1/ dexamethasone combination therapy was superior to dexamethasone alone with no ADH1 conferred additional toxicity. These findings provide a proof-of-concept starting point to develop novel, potentially safer therapeutics that target niche-mediated cancer cell dependencies in haematological malignancies.Summary CDH2 mediated niche-dependent cancer proliferation and treatment resistance is clinically targetable via ADH-1, a low toxic agent that could be potentially repurposed for future clinical trials in acute leukaemia.Competing Interest StatementThe authors have declared no competing interest.

The objective was to verify whether the impact of COVID-19 on physical activity and screen time was associated with the impact on quality of life and symptoms of anxiety and depression in a sample of Brazilian adults. The invitation was made through social networks and the collection was carried out through electronic research. There was a decrease in quality of life and physical activity, and an increase in symptoms of anxiety and depression and screen time. These findings are important for new strategies that promote physically active habits during the pandemic .

PURPOSE: This study aimed to describe changes in laboratory-assessed anthropometric and physiological characteristics, training volumes, and competitive performance in national development-team cross-country skiers over a 25-month period, and to analyze whether changes in competitive performance could be predicted by changes in laboratory-assessed qualities and training volumes. METHODS: Data collected over 25 months from 30 national development-team cross-country skiers (14 women, 16 men; age, 18-23 yr) were analyzed retrospectively using multivariate statistics. Anthropometric and physiological characteristics were assessed via dual-energy x-ray absorptiometry and incremental roller-ski treadmill tests, respectively. Total training volumes and distributions of low- and high-intensity training were analyzed from online training diaries, and competitive performance was determined by International Ski Federation (FIS) distance and sprint points. RESULTS: Whole- and upper-body lean mass increased in the full cohort of skiers (n = 30; both P < 0.05), whereas lower-body lean mass, whole-body fat mass, speed and oxygen uptake (V˙O2) at a blood lactate concentration (BLa) of 2 and 4 mmol·L-1, as well as time-trial completion time, power output, and peak V˙O2, improved in the women only (all P < 0.05). Valid predictive models were identified for female skiers' best FIS distance points (R2 = 0.81/Q2 = 0.51) and changes in FIS distance points (R2 = 0.83/Q2 = 0.54), with body mass, fat mass, lean mass, V˙O2peak, and speed at a BLa of 4 mmol·L-1 identified as consistently important variables for projection. CONCLUSIONS: The valid prediction of competitive performance was achieved for women only in distance events. This study suggests that improvements in body composition and aerobic capacity may be more beneficial for elite female development-level skiers than for their male counterparts. These results have implications for athlete selection and performance development.

Aim: The aim was to investigate same‐sex mothers’ self‐assessed experiences of forming a family, and the association between heteronormative information, parental support and parenting stress. \ud \ud Design: A quantitative, cross‐sectional study. \ud \ud Methods: In a web survey conducted in Sweden in 2019, same‐sex mothers (N = 146) with a child aged 1–3 years answered questions about their experiences of forming a family through assisted reproduction and questions about parenting stress. Descriptive statistics describes the process of forming a family. Pearson's correlation analyses and independent sample t tests were used to test hypotheses about heteronormative information, parental support and parenting stress. \ud \ud Results: Same‐sex mothers experienced going through assisted reproduction treatment as stressful, and parental groups as not being supportive. Heteronormative information correlated with both lower perceived parental support and higher perceived parenting stress. Non‐birth mothers experienced less acknowledgement and support than birthmothers.

War and combat exposure pose great risks to the vision system. More recently, vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise in incidence of traumatic brain injury (TBI). Studies have looked at the effects of injury severity, aetiology of injury and the stage at which visual problems become apparent. There was little discrepancy found between the frequencies or types of visual dysfunctions across blast and non-blast related groups, however complete sight loss appeared to occur only in those who had a blast-related injury. Generally, the more severe the injury, the greater the likelihood of specific visual disturbances occurring, and a study found total sight loss to only occur in cases with greater severity. Diagnosis of mild TBI (mTBI) is challenging. Being able to identify a potential TBI via visual symptoms may offer a new avenue for diagnosis.