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Indoor spin cycling has gained popularity as a training modality for triathletes. Part of its appeal is that it can form a component of a structured periodised training program and provide an alternative to outdoor cycling. Indices of physiological components (i.e., the metabolic equivalent, caloric cost, perceived exertion) and changes in the body position can be inferred by wearable technology such as an accelerometer. This pilot study aimed to investigate the relationship between the rating of perceived exertion, heart rate reserve, and the metabolic equivalent between the whole body centre of mass acceleration using a sacrum mounted triaxial accelerometer during 20 minutes of 6 varied power conditions of indoor spin cycling. Compared with other conditions, cycling at a steady state (>152-205 W) resulted in extremely large effects (> 0.9) in mediolateral acceleration and the rating of perceived exertion (p < 0.0001). The relationship between the body position (aerodynamic to drops) induced significant changes in anteroposterior acceleration magnitude (p < 0.0001), although moving from drops to the aerodynamic position was not significant despite a large increase in heart rate reserve and extremely large effects of perceived exertion. The rating of perceived exertion scale and the metabolic equivalent comparative to the whole body centre of mass acceleration magnitude and power displayed a strong correlation (r = 0.865). An individually determined whole body centre of mass accelerations combined with perceived exertion, the metabolic equivalent and heart rate reserve could potentially contribute to improved indoor triathlete spin cycling performance.

A biomechanical variable of interest to cyclists and cycling coaches is postural stability. A cyclist’s position on a bicycle can be easily measured in a laboratory environment using motion capture software, but is difficult to measure in the field. The focus of this paper was to identify the legitimacy of a sacrum mounted triaxial accelerometer to identify temporal acceleration magnitudes of the centre of mass (CoM) whilst cycling against a motion analysis system. To provide validation of the sensor, data was collected at the torso as cyclists pedaled at varied cadences against a motion analysis system. The effects of cycling cadence and changes to torso angle via changes to hand position revealed that wearable technology (accelerometers) provide legitimacy in the assessment of torso accelerations during cycling. The minimal variation and change in agreement between the two systems during cycling indicates the adherence method of the accelerometer was suitable.

Research highlights a relationship between cognitive complexity and coping capacity. Narrative studies with psychiatric patients show that development of more complex ideas about self, others, and ...

Recent “Life as a film” (LAAF) studies demonstrate a relationship between themes of agency and communion in life stories and substance misuse recovery, contrasting with theme deficits in addicted p...

While the phenomenon has been researched for more than half a century, the vast majority of studies concentrate on manifestations of psychopathy in offenders already in the criminal justice system. However, both academics and practitioners in the field agree that psychopathic behaviors differ from those of the general population (Hare, 1996; O’Toole & Hakkanen‐Nyholm, 2012), ergo, crimes committed by psychopaths may reveal distinguishing features from those committed by nonpsychopaths. Despite the potentially rich source of data provided by crime scenes, the question of whether psychopathy can be deduced from offenders’ crime scene actions is underresearched, with most studies focusing on motive and victimology. Nonetheless, some recent studies have examined crime scene behaviors, suggesting certain indicators of psychopathy with implications for offense inquiry. The chapter reviews research efforts to establish offending patterns related to psychopathy, examining qualitative differences between psychopaths and nonpsychopaths in terms of violence, victim choice and other offense variables, arguing that since psychopathy is underpinned by a constellation of affective, interpersonal, and behavioral factors, key differences in crime scene actions should be discernible, serving value for police investigations and onward criminal justice protocols. Mindful of benefits crime scene insights bring to investigative procedures, the chapter presents an Investigative Psychology approach, with its focus on the relationship between specific offense actions and offender characteristics. Application of Investigative Psychology methodology and modeling are discussed with respect to advancing the literature on crime scene indicators of psychopathy, and associations between offenders’ interpersonal style and actions during offense commission are suggested with a view to more targeted future research.

The policing of peaceful public assembly during the Covid-19 pandemic has been one of the most central challenges to police legitimacy. This is arguably because mass gatherings are assumed to carry a high risk of contagion yet, at the same time, peaceful public assembly is a protected human right. In this article, we explore this issue by using a case study to provide a detailed chronological interactional analysis of the policing operation surrounding a highly controversial public assembly that took place on Clapham Common in March 2021 in London, England. We explore the utility of a research and theory-based model for public order policing in pandemics as a framework for understanding the way the event evolved and identifying what lessons can be learnt for policing assemblies, both in future pandemics and more generally. We contend that ambiguity in the application of emergency powers and the potential for heavy fines to be applied using the legislation created a divergence between stakeholders and culminated in a leadership vacuum among protesters. Moreover, the context of acute political sensitivity led to a highly centralized public order operation that limited the capacity of police to enact dialogue-based solutions when leadership (re)emerged during the event. We conclude by discussing the implications of our analysis for understanding the inherent dangers of regulatory frameworks that place too heavy a burden of discretionary power into the hands of police in determining whether public assemblies are ‘lawful’, and under what conditions they can occur.

Background: Research in the field of substance misuse shows that identity change is key to recovery. Theories typically focus on either personal or social factors in this process; however, a framew...

Background: Narrative research shows that identity change is key to recovery from substance misuse. Theories have focused on either personal or social factors in this process. A framework encompass...

ObjectiveWe aimed to determine the predictive capacity and diagnostic yield of a 10-fold increase in serum IgA antitissue transglutaminase (tTG) antibody levels for detecting small intestinal injury diagnostic of coeliac disease (CD) in adult patients.DesignThe study comprised three adult cohorts. Cohort 1: 740 patients assessed in the specialist CD clinic at a UK centre; cohort 2: 532 patients with low suspicion for CD referred for upper GI endoscopy at a UK centre; cohort 3: 145 patients with raised tTG titres from multiple international sites. Marsh 3 histology was used as a reference standard against which we determined the performance characteristics of an IgA tTG titre of ≥10×ULN for a diagnosis of CD.ResultsCohort 1: the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 54.0%, 90.0%, 98.7% and 12.5%, respectively. Cohort 2: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 50.0%, 100.0%, 100.0% and 98.3%, respectively. Cohort 3: the sensitivity, specificity, PPV and NPV for IgA tTG levels of ≥10×ULN at identifying individuals with Marsh 3 lesions were 30.0%, 83.0%, 95.2% and 9.5%, respectively.ConclusionOur results show that IgA tTG titres of ≥10×ULN have a strong predictive value at identifying adults with intestinal changes diagnostic of CD. This study supports the use of a no-biopsy approach for the diagnosis of adult CD.

Purpose There is a need to increase access to HIV testing in the UK in male migrant communities. The purpose of this paper is to assess the uptake and acceptability of a workplace HIV testing intervention aimed at increasing access to testing in non-clinical settings. Design/methodology/approach A total of 20 health check events were delivered at 11 UK organisations employing male migrant workers. Intervention included HIV testing, cholesterol, BMI, blood glucose, blood pressure; tailored health advice; take-away resources; optional post-event text reminders about HIV and general health. Mixed-methods evaluation included exit questionnaires (n=771), follow-up text messages (n=465) and qualitative interviews (n=35) to assess event acceptability. Qualitative data were analysed thematically. Findings Attendees were 776 employees from 50 countries (51 per cent male; 30 per cent migrant workers). A total of 52 per cent of attendees undertook an HIV test (75 per cent were first-time testers). In total, 96 per cent considered HIV testing to be an acceptable element of workplace health checks; 79 per cent reported new health-related knowledge; 60 per cent of attendees opted for follow-up text messaging; 26 per cent of text respondents reported independently taking HIV test post-event. High acceptability and uptake of HIV testing was associated with convenience, opportunity taking (through removal of deliberation and intentional test-seeking), and normalisation of HIV testing within a general health check. Originality/value This study is the first to demonstrate that opt-in HIV testing can be successfully delivered in the workplace within a multi-component health check. The workplace is an effective means of increasing access to HIV testing in groups at risk for HIV, including male migrant workers.

Current models of identity transformation in substance misuse recovery emphasise either communal or agentic growth processes. Building on life narrative studies of addicted males, the present study proposes that agency and communion themes distinguish the narrative identities of rehabilitated substance users from active users.The 'Life as a Film' (LAAF) task was used to record narratives in an opportunity sample of 32 participants (23 males, 9 females) with ongoing or substance misuse history. Transcripts were coded for agency and communion, and external measures of rehabilitation were assessed using a recovery inventory.Four types of narrative were revealed, according to the presence or absence of agency and communion themes in LAAF accounts. Analysis determined a significant correlation between descriptions of agency and communion and rehabilitation outcomes (0.91 - p 0.01), showing that both identity themes are important to recovery. Participants illustrating either theme showed moderate outcomes and those depicting neither theme showed poor outcomes. Case studies were used to illustrate the instrumentality of agentic and communal growth to behavioural change.The LAAF method demonstrated value in a narrative approach for expanding current perspectives, indicating that both agency and communion shape identity transformation in recovery from substance misuse. These findings highlight unique intervention needs corresponding with presenting narrative identity.

Obesity is having an increasingly significant impact on health care services across the developed world. Although initially laparoscopic surgery was thought to be contraindicated in cases of obesity, surgeons, including gynaecologists, are now routinely performing laparoscopic surgery on obese patients. Limited research has been conducted into the effect of obesity on outcomes of major laparoscopic pelvic surgery. Some authors report worsening outcomes in obese women having laparoscopic hysterectomies; others suggest that complication rates do not increase, but operating times are longer. Here, we report our experience from 250 total laparoscopic hysterectomies performed for benign, malignant and pre-malignant conditions, and we compare outcomes among normal, overweight, obese and morbidly obese patients. We used a composite score index calculated on the basis of operating and theatre times, estimated blood loss, length of stay and number and severity of complications for our comparisons. Our conclusions suggest that meticulous, consistent surgical technique may produce similar outcomes in normal and obese patients having total laparoscopic hysterectomy, with longer operating/theatre times noted only at BMI levels >40.

Since the 1960s, a single class of agent has been licensed targeting virus-encoded ion channels, or “viroporins”, contrasting the success of channel blocking drugs in other areas of medicine. Although resistance arose to these prototypic adamantane inhibitors of the influenza A virus (IAV) M2 proton channel, a growing number of clinically and economically important viruses are now recognised to encode essential viroporins providing potential targets for modern drug discovery.We describe the first rationally designed viroporin inhibitor with a comprehensive structure-activity relationship (SAR). This step-change in understanding not only revealed a second biological function for the p7 viroporin from hepatitis C virus (HCV) during virus entry, but also enabled the synthesis of a labelled tool compound that retained biological activity. Hence, p7 inhibitors (p7i) represent a unique class of HCV antiviral targeting both the spread and establishment of infection, as well as a precedent for future viroporin-targeted drug discovery.

The Certified Health Informatician Australasia (CHIA) program consists of an online exam, which aims to test whether a candidate has the knowledge and skills that are identified in the competencies framework to perform as a health informatics professional. The CHIA Health Informatics Competencies Framework provides the context in which the questions for the exam have been developed. The core competencies for health informatics that are tested in the exam have been developed with reference to similar programs by the American Medical Informatics Association, the International Medical Informatics Association and COACH, Canada's Health Informatics Association, and builds on the previous work done by the Australian Health Informatics Education Council. This paper shows how the development of this competency framework is helping to raise the profile of health informaticians in Australasia, contributing to a wider recognition of the profession, and defining more clearly the body of knowledge underpinning this discipline. This framework can also be used as a set of guidelines for recruiting purposes, definitions of career pathways, or the design of educational and training activities. We discuss here the current status of the program, its resultsandprospectsfor the future.

Surgical site infection can result in increased morbidity for the patient, prolonged hospital stay and hospital readmission. Preoperative antibiotics reduce the incidence of such infections, particularly in open surgery. Universal use of antibiotic prophylaxis, however, is not recommended due to the risks of adverse reactions, generation of resistant bacteria and additional cost. Endoscopic procedures carry low risk of wound contamination and infection. Limited data suggest wide variability in antibiotic prophylaxis in gynaecological surgery and potential overuse of antibiotics in gynaecological endoscopic surgery. Bringing together the existing evidence allows for a consensus proposal for the use of preoperative antibiotics in gynaecological endoscopy.

Key content Injury of the urinary tract is the most common major complication of gynaecological laparoscopic surgery. Injury to either bladder or ureter results in significant morbidity for the patient and may lead to litigation. Knowledge of pelvic anatomy, training and meticulous technique are of paramount importance in reducing the incidence of urinary tract injury. Ideally an injury should be identified and repaired during the primary operation, but vigilance in the immediate postoperative period may result in early recognition and intervention. Learning objectives To understand the common risk factors of urinary tract injury at laparoscopy. To learn strategies to prevent injury where possible. To learn strategies for intraoperative and postoperative recognition and repair of such injuries. To understand the significance of multi-disciplinary management of such injuries. Ethical issues Limited evidence shows that laparoscopic hysterectomy may carry a higher risk of urinary tract injury compared with abdominal hysterectomy. Should patients be counselled accordingly?

This article describes the development and validation of a novel thermoelastic stress analysis (TSA) system based on a low-cost microbolometer device. The use of a microbolometer for a highly synchronous and delicate temperature measurement breaks a longstanding and exclusive reliance on high performance, cooled photon detectors for thermoelastic applications. It is shown that despite markedly inferior noise equivalent temperature detectivity and dynamic response specifications, microbolometers are capable of achieving comparable levels of stress measurement performance. The practical implications for experimental stress analysis are significant. Microbolometers are relatively low in capital cost, small in size, have good tolerance to shock and vibration and consume less power than their photon counterparts, attributes that confer enormous practical advantages. It is argued that the emergence of TSA systems that are more affordable and better suited to in-service application could help to promote a much b...

We report a case of a woman with chronic right-sided pelvic pain with an unusual combination of broad ligament defects and associated terminal ileum and caecum herniation. Reduction of the hernia and closure of the defects at laparoscopy resulted in resolution of the patient’s painful symptoms. Review of the literature suggests that, although rare, such defects should be considered in the differential diagnosis of persistent pelvic pain. Where found incidentally, broad ligament defects should be repaired in order to prevent sinister complications such as bowel obstruction and strangulation.

The emergence recently of a thermoelastic stress analysis (TSA) capability exploiting low-cost, compact and rugged microbolometer detector technology provides a significant opportunity topromote a broader use of this powerful non-contact full-field stress analysis technique. An area whereit has considerable and hitherto unexplored potential is in in-situ structural health monitoring (SHM).The present paper outlines the case for a nexus between SHMand TSA in this new form. It is proposedthat the approach should yield diagnostic and prognostic capabilities surpassing those of some existingSHM modalities. An F/A-18 centre-fuselage full-scale structural fatigue test is employed as a casestudy to illustrate the practical feasibility of the approach and to underscore some of its potential.Although the case study focuses on an aircraft structure, the concept has potential application to awide variety of different engineering assets across the aerospace, civil and maritime sectors.

Objective Acute upper gastrointestinal bleeding (AUGIB) results in 25 000 hospital admissions annually. Patients admitted at weekends with AUGIB have increased mortality, and guidelines advise out-of-hours endoscopy. We present retrospective data from our service involving the interhospital transfer of patients. Design We pooled resources of two neighbouring general hospitals, just north of London. Emergency endoscopy is performed at the start of the list followed by elective endoscopy in the endoscopy unit on Saturday and Sunday mornings. From Friday evening to Sunday morning, patients admitted to Queen Elizabeth II Hospital (QEII) are medically stabilised and transferred to Lister Hospital by ambulance. Results 240 endoscopies were performed out of hours from December 2007 to March 2011. Of these, 54 patients were transferred: nine had emergency endoscopy at QEII as they were medically unstable; eight of the patients transferred required therapeutic intervention for active bleeding. The mean pre-endoscopy Rockall score of those transferred was 2.5. We examined the records of 51 of the 54 patients transferred. There were three deaths within 30 days after endoscopy not associated with the transfer process. 19 (37%) patients had reduced hospitalisation after having their endoscopy at the weekend. Conclusions The introduction of the out-ofhours endoscopy service in our trust has had multiple benefits, including patients consistently receiving timely emergency endoscopy, significantly reduced disruption to emergency operating theatres, and participation of endoscopy nurses ensures a better and safer experience for patients, and better endoscopy decontamination. We suggest our model is safe and feasible for other small units wishing to set up their own out-of-hours endoscopy service to adopt.