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Este artigo discute a gastronomia como um campo multidimensional que ultrapassa o preparo técnico de alimentos, refletindo práticas culturais, históricas e identitárias de sociedades. Fundamentado em teóricos como Mauss, Poulain, Collaço, Bueno, Gonzales, Ferro, Soares e Ribeiro, o texto posiciona a gastronomia como um fato social total, integrando aspectos econômicos, políticos e culturais. A alta gastronomia francesa é reconhecida por sua influência técnica e hegemônica, mas também criticada por padronizar práticas alimentares globais, invisibilizando tradições locais. Nesse contexto, emerge a necessidade de descolonizar a gastronomia, valorizando saberes regionais e desafiando hierarquias culturais. O objetivo deste texto é analisar criticamente a consolidação da gastronomia como um campo acadêmico-científico, evidenciando como a combinação entre tradição, inovação e valores socioculturais pode fortalecer sua potencialidade transformadora e ampliar a compreensão das relações entre comida, cultura e identidade. Ao revisitar epistemologias e práticas pedagógicas, sugere-se um ensino de base transdisciplinar e extensionista, conectado às demandas contemporâneas, como a soberania alimentar e a sustentabilidade. Os resultados indicam que a consolidação acadêmica da gastronomia ainda enfrenta desafios, como a ausência de diretrizes curriculares nacionais e a marginalização do campo por áreas consolidadas. No entanto, avanços significativos incluem a criação do Mestrado Acadêmico em Gastronomia na UFC e a inclusão de disciplinas voltadas ao ensino e pesquisa gastronômica. Concluímos que a gastronomia deve ser valorizada como espaço de expressão identitária e transformação social, promovendo diálogos interculturais e práticas inclusivas. Esse movimento requer a integração entre técnica, criatividade e raízes culturais, consolidando a gastronomia como um campo acadêmico autônomo e relevante.

Este artigo discute a criação e o desenvolvimento do Encontro de Pesquisa em Gastronomia do Brasil (ENPEGASTRO), um espaço voltado à divulgação científica e ao fortalecimento do campo acadêmico-científico da Gastronomia. Criado em 2020 como resposta aos desafios impostos pela pandemia de Covid-19 e à carência de espaços específicos para pesquisa na área, o evento tem como objetivo reunir pesquisadores, grupos de pesquisa, docentes e discentes, promovendo o avanço do campo enquanto ciência. Ao longo dos últimos cinco anos, o ENPEGASTRO tem fomentado diálogos interdisciplinares e colaboração, conectando profissionais e acadêmicos dentro e fora da Gastronomia. Este texto apresenta um histórico-temporal das edições realizadas, o perfil dos participantes e as múltiplas conexões estabelecidas, destacando a relevância desse espaço na consolidação das Ciências Gastronômicas no contexto brasileiro, marcado por suas particularidades territoriais. O ENPEGASTRO emerge, assim, como um espaço efetivo para a troca de conhecimentos, fortalecimento teórico e formação de redes interinstitucionais, contribuindo para a superação dos desafios do campo e para seu delineamento como área científica.

Purpose: Social support is a known facilitator of exercise for people with disability. A qualitative approach was used to understand current social support practices in community gyms for young adults with disability., Methods: Embedded within a larger project "Getting Young adult Moving - Supporting Participation and Access to Recreation Centres" (GYM-SPARC), semi-structured interviews were completed with 25 gym staff, representing 29 community gym facilities across Victoria, Australia. Data were analysed using inductive thematic analysis., Results: Social support types and availability varied across community gyms. Social support practices included orientation, supervision, specialist input, logistical support, motivation, peer support and social activities. These were provided as "standard" supports available to all members, "inclusion" supports specific to people with disabilities, or "external" supports provided by external services but operating within the gym facility. Two themes described how social supports were implemented: (i) stages of participation - "getting in the door, getting started and ongoing participation," and (ii) influencing factors - "people, partnerships and policy.", Conclusion: Social support practices are seldom implemented by community gyms to facilitate young adults with disability to "get in the door." Improving partnerships between gyms, rehabilitation, health and disability services may support the transition into community gym exercise.IMPLICATIONS FOR REHABILITATIONUnderstanding current social support practices enables rehabilitation clinicians and the recreation sector to identify gaps and opportunities to promote gym participation for young adults with disability.Social supports for young adults with a disability are implemented variably across participation phases and driven by people, partnership, and policy factors.Currently, a gap exists in the provision of social support to facilitate young adults with disability "getting in the door" of community gyms.An opportunity exists for rehabilitation clinicians (such as physiotherapists) and community gyms to collaborate and facilitate the transition into community-based gym exercise for young adults with disability.

Background and Aims: Despite the known association of hip dysplasia and Charcot Marie Tooth disease (CMT), evidence is limited regarding its exact prevalence. Available studies pre-date genetic confirmation of CMT subtypes and current hip reconstruction surgical options. This study examined the prevalence of hip dysplasia in CMT in a tertiary neuromuscular center., Methods: This was a retrospective study of children with CMT who had at least one pelvic radiograph between 2000 and 2020. Reimer's migration percentage, acetabular index and lateral center edge angle were used to identify hip dysplasia., Results: A total of 178 children were included with a median age of 6.4 (IQR 3.4-11.3) years at CMT diagnosis. First pelvic radiographs were performed at a median age of 8.0 (IQR 4.6-12.2) years and 64 (35.8%) had hip dysplasia, of which 20 normalized over time. Repeat radiographs were done in 96/178 children (53.9%), and six children with originally normal radiographs developed later radiographic hip dysplasia. At the time of last follow up, 50/178 children (28.1%) had hip dysplasia and 17/178 children (9.6%) required surgical intervention. The frequency of hip dysplasia in specific CMT subtypes was: 28/100 in CMT1A, 5/7 in Dejerine-Sottas disease, 3/10 in CMT2A, and 4/4 in TRPV4-related CMT., Interpretation: The prevalence of hip dysplasia in children with CMT in this cohort was estimated to be between 9.6% and 28.1%. Serial imaging is important to monitor outcomes into adulthood. Specific CMT subtypes were more likely to be associated with hip dysplasia., (© 2025 The Author(s). Journal of the Peripheral Nervous System published by Wiley Periodicals LLC on behalf of Peripheral Nerve Society.)

Background: Colorectal cancer (CRC) screening services in Ireland were cancelled or postponed for periods during the COVID-19 pandemic. The aim of this study was to assess the impact of screening colonoscopy delays after a positive FIT on clinical and histopathological outcomes due to these restrictions., Methods: Participants in the Irish National Bowel Screening Programme with a positive Immunochemical Faecal Test (FIT) during the COVID-19 pandemic (March 2020-December 2021) were included. Patients were categorised into attended for a colonoscopy <3 months and attended for colonoscopy ≥3-17 months post positive FIT. Chi-Square Test of independence was performed using WinPepi., Results: 3227 individuals had a complete index colonoscopy <3 months and 262 attended colonoscopy from ≥3 to 17 months post positive FIT. Of the clients whose colonoscopy was between ≥3-17 months from positive FIT, the median wait time was 3 months. There was no significant difference found between the two groups for CRC (5.8 % vs 5.0 %, p=0.544) or for the proportion of cancer stage I, stage II and unknown (33.7 %, 40.6 %, 25.7 %, p=0.411). There was no difference in the proportions of adenomas (57.8 % vs 58.4 %, p=0.849) and the proportion of advanced adenomas (7.7 % vs 10.7 %, p=0.077) detected between the two groups. A similar proportion of polyps were detected in individuals whose index colonoscopies were postponed <3 months from positive FIT (66.9 % vs 66 %, p=0.786)., Conclusion: A median delay of 3 months in screening colonoscopies after a positive FIT does not adversely impact clinical or histopathological outcomes. There was no significant difference in cancer staging, advanced adenomas or polyps detected between those who attended colonoscopies <3 months and ≥3-17 months post positive FIT. COVID-19 related disruptions to the normal functioning of the Irish bowel screening programme did not compromise our key objectives of advanced adenoma and cancer detection., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Approaches to gait analysis are evolving rapidly and now include a wide range of options: from e-patches to video platforms to wearable inertial measurement unit systems. Newer options for gait analysis are generally more inclusive for the assessment of children, more cost effective and easier to administer. However, there is limited data on the comparability of newer systems with more established traditional approaches in young children., Research Question: To determine comparability between the Physilog®5 wearable inertial sensor and GAITRite® electronic walkway for spatiotemporal (stride length, time and velocity, cadence) and relative phase (double support time, stance, swing, loading, foot flat and push off) data in young children., Methods: A total 34 typically developing participants (41% female) aged 6-11 years old median age 8.99 years old (interquartile range 2.83) were assessed walking at self-selected speed over the GAITRite® electronic walkway while concurrently wearing shoe-attached Physilog®5 IMU sensors. Level of agreement was analysed by Lin's concordance correlation coefficient (CCC), Bland-Altman plots and 95% limit of agreement. Systematic bias was assessed using 95% confidence interval of the mean difference., Results: Excellent to almost perfect agreement was observed between systems for spatiotemporal metrics: cadence (CCC=0.996), stride length (CCC=0.993), stride time (CCC=0.996), stride velocity (CCC=0.988). The relative phase metrics adjusted for stride velocity showed improved comparability when compared to the unadjusted metrics: swing adjusted (adj) (CCC=0.635); stance adj (CCC: 0.879); loading adj: (CCC=0.626)., Significance: Spatiotemporal metrics are highly compatible across GAITRite® electronic walkway and Physilog®5 IMU systems in young children. Relative phase metrics were somewhat compatible between systems when adjusted for stride velocity., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction/aims: Young people with Duchenne muscular dystrophy (DMD) are at increased risk of obesity. Weight management is important to families; however, several barriers exist. This pilot study aimed to investigate the feasibility and acceptability of a co-designed weight management program for DMD., Methods: The Supporting Nutrition and Optimizing Wellbeing Program (SNOW-P) was a single-arm diet and behavior weight management intervention delivered via weekly telehealth/phone visits over 6 weeks to young people with DMD and obesity (body mass index (BMI) ≥95th percentile) and their caregivers. Using an online survey, caregivers of boys with DMD were consulted on the structure and topics delivered in SNOW-P. Primary outcomes were feasibility and acceptability; secondary outcomes were weight, physical function, and quality of life at 6- and 12-weeks follow-up., Results: Of nineteen eligible participants, eight were enrolled (median age 11.4 years, range 4.9-15.8), and seven completed the program. Visit attendance was high (88%-100%); most participants reported high satisfaction and that participation was easy. Suggested changes included online and visual DMD-specific resources. At 6-weeks, median change in weight z-scores was -0.01 (IQR: -0.23, 0.17) indicating that on average, weight gain tracked as expected for age. Waist circumference measured by caregivers lacked accuracy and the completion rate of caregiver-reported secondary outcome measures (e.g., food diaries) was low., Discussion: A co-designed, telehealth/phone weight management program appeared to be feasible and acceptable in a small group of boys with DMD. An adapted, hybrid telehealth and face-to-face program is recommended for efficacy testing., (© 2024 The Authors. Muscle & Nerve published by Wiley Periodicals LLC.)

Oral squamous cell carcinomas (OSCCs) are genetically heterogeneous and exhibit diverse stromal and immune microenvironments. Acquired resistance to standard chemo-, radio-, and targeted therapies remains a major hurdle in planning effective treatment modalities for OSCC patients. Since Caspase 8 (CASP8) is frequently mutated in OSCCs, we were interested to explore a potential interaction between tumour-infiltrating lymphocytes (TILs) and CASP8 activation using high-content image analysis of human tumour (n = 32) sections. Despite the lymphocyte-rich tumour microenvironment, we observed lower activation of CASP8 (0-10% of tumour area) and its downstream effector CASP3 (0-6%) in tumours than in normal oral epithelium. Conversely, we found apoptosis was high for all the lymphocyte subtypes examined (38-52% of lymphocytes within tumour islands). Tumours with higher Fas ligand (FasL) expression had a significantly higher proportion of cleaved CASP3/8 positive cytotoxic T cells within the tumour islands (p = 0.05), and this was associated with the presence of lymph node metastatic disease [odds ratio: 1.046, 95% confidence interval (1.002-1.091), p = 0.039]. Our finding of extensive activation of the extrinsic pathway of apoptosis in TILs, together with evidence of higher FasL in CASP8 mutated tumours, may be useful in predicting the course of disease in individual patients. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland., (© 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.)

People with disability report social support facilitates participation in physical activity. A scoping review explored social support strategies used to facilitate exercise participation for people with disability (aged ≥ 15 years) in community gym settings. Seven electronic databases were searched. Studies were screened for eligibility based on title and abstract followed by full-text review. Data were analysed using content analysis and narrative synthesis. Forty-two articles reporting data from 35 studies were included. Eight types of social support were identified: supervision ( n = 30), peer support ( n = 21), specialist support ( n = 19), orientation ( n = 15), education ( n = 7), logistical support ( n = 6), motivational support ( n = 5) and organised social activities ( n = 4). Direct supervision was typically provided 1:1 or in small groups by staff experienced working with people with disability. Peer support typically involved support from exercise group participants or a peer mentor. Specialist support was usually provided by a health or exercise professional either directly to people with disability or to the people providing support to them (e.g., trainer). Orientation to the gym environment, equipment and exercise program was usually provided over 1 or 2 sessions. Gym staff may use these strategies to guide the implementation of social supports within their facilities to promote social connectedness and participation for people with disability.

Aim: Few studies have characterised the relationship between disease and gait function in children and young people with rare neuromuscular disorders (NMDs). This study aimed to describe the relationship between disease and gait in a large paediatric cohort from a neuromuscular outpatient clinic., Methods: A prospective, cross-sectional study of gait in independently ambulant children and young people aged 4-21 years with a clinical or genetically confirmed NMD. Participants traversed an electronic walkway barefoot and in footwear at self-selected and fast pace. Analysis of disease included a typically developing (TD) reference group., Results: A sample of 113 participants with NMD, mean age 9.5 years (SD 3.1), 28% female, grouped into nine diagnostic subgroups. Eighty percent reported limitations to functional mobility. Children with NMD walked slower, with a shorter and wider step compared to a TD reference group, with moderate to large effect sizes for each of these gait parameters indicative of the clinical significance of these gait deviations. Children with Duchenne muscular dystrophy (DMD) walked slowest with a markedly wide gait pattern. Footwear had little overall effect on gait in children with NMDs. All children could accelerate over short distances., Conclusions: Gait, notably speed, step length, and width are clinically significant biomarkers of disease in paediatric NMDs, affording objective functional measures in clinical settings and research.Implications for rehabilitationGait should be considered a functional biomarker of disease in children and young people with neuromuscular disorders (NMDs).Comparison of gait in a paediatric neuromuscular cohort indicates that children with Duchenne muscular dystrophy (DMD) walk slowest with a shorter step length and a wider step width which increases with age and disease progression.Measurement of gait speed is a simple, pragmatic tool to monitor disease progression in the outpatient clinical environment and relates to everyday function.In clinical research, gait can be measured as a functional outcome to demonstrate change from disease-modifying interventions and treatments in NMDs.

Introduction/aims: In response to coronavirus disease 2019 (COVID-19) pandemic restrictions int 2020, our face-to-face (F2F) multidisciplinary neuromuscular clinic (NMC) transitioned to widespread use of telehealth (TH). This study aimed to (1) understand parent/guardian, child, and clinician perceptions of TH; (2) examine TH-related changes in clinical activity; and (3) use these findings to inform a future model of care for the NMC., Methods: A clinical audit was undertaken to examine clinical activity throughout 2018-2020. Online surveys were distributed to clinicians and parents of children attending the NMC via TH in 2020. A working group of clinicians created a checklist to guide a future hybrid model of TH and F2F care., Results: Total clinical activity in 2020 was maintained from previous years; 62.8% of all appointments occurred via TH, and 82.3% of patients attended NMC by TH at least once. Ninety-nine parents (30.6% response rate), 52 children, and 17 clinicians (77% response rate) responded to the survey. All groups reported better interaction when F2F compared to TH. Eighty percent of parents identified advantages of TH and reported lower levels of stress. A lack of "hands-on" physical assessment was identified by parents and clinicians as a TH limitation. Most families (68.1% of parents; 58.8% of children) and all clinicians indicated a preference for a mix of TH and F2F NMC appointments in the future., Discussion: This study has informed a checklist to guide future TH use in a new hybrid model of care. Further investigation is required to assess health impacts of TH use in pediatric neuromuscular care., (© 2022 The Authors. Muscle & Nerve published by Wiley Periodicals LLC.)

Purpose: To evaluate feasibility of scaling up a 12-week community-based exercise program ( FitSkills ) in which young people with disability exercise with a student mentor., Method: Within a stepped wedge cluster randomised trial, seven domains of feasibility were assessed: demand, implementation, acceptability, practicality, adaptation, integration, and expansion., Results: Of the 163 participants with disability (61 females; 20.8 ± 5 y) and 226 mentors who enrolled, 123 participants and mentors completed FitSkills . Population demand was estimated at 9% of members of participating organisations. Most participants (76%) completed the twice-weekly program within 12 weeks, attending 79% of sessions (mean 18.9 ± 4.7). Key program elements valued by participants were the mentor, tailored exercise, and regular program schedule. Majority (87%) of mentors were recruited from physiotherapy, occupational therapy, and exercise science courses. Positives for participants were perceived benefits and organisational support, and for mentors, understanding disability. Communication and scheduling were burdens. Three serious and 28 non-serious adverse events occurred. Adaptations (additional screening, risk analysis, extra mentor support, or in-person consultation) enabled 29 young people with complexity to participate. The number of trial sites was expanded to 11 to accommodate participants., Conclusions: Scaling-up FitSkills is feasible, but with caveats related to communication, scheduling, and efficiency of recruitment.IMPLICATIONS FOR REHABILITATIONKey elements valued by participants as part of the successful scale-up of a community-based exercise program ( FitSkills ) across a large metropolitan city included a peer-mentor, tailored exercise, and organisational support structure. FitSkills can be adapted to include young people with complex disability with additional supports including screening, risk analysis, and professional support for the peer-mentor.The benefits of FitSkills , including social connectedness for young people with a disability and normalisation of disability for mentors, outweigh the burdens of participation.Communication with program organisers and scheduling logistics between the young person, their family/carers and peer mentors are important factors to manage for the successful implementation of FitSkills .

Background and Objectives: Charcot-Marie-Tooth disease (CMT) is the most common inherited neuropathy and often presents during childhood. Guidelines for the optimal management of common problems experienced by individuals with CMT do not exist, for either children or adults. We formed the Paediatric CMT Best Practice Guidelines Consortium to develop evidence and consensus-based recommendations for the clinical management of children and adolescents with CMT, with the primary objective of promoting optimal, standardised care globally., Methods: Development of this clinical practice guideline involved a series of systematic reviews covering 10 clinical questions, modified Delphi methodology involving an international panel of clinicians to generate consensus where evidence did not exist, and application of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to evaluate the body of literature and formulate recommendations., Results: The final guideline includes three evidence-based and 31 consensus-based recommendations. They encompass the management of muscle weakness, balance and mobility impairment, sensory symptoms, muscle cramps, impaired upper limb function, respiratory impairment, maintenance of joint range of motion and non-surgical management of joint deformity. Consensus was not achieved in some management areas, reflecting differences in practice between clinicians and healthcare settings, and highlighting the need for further research., Conclusions: This clinical practice guideline provides practical and implementable guidance on the management of common clinical problems experienced by children with CMT and advocates for improved access to multidisciplinary care. Successful dissemination and implementation of these recommendations will be critical in ensuring their application across multiple healthcare settings., Competing Interests: Competing interests: MES has received consulting fees or honoraria from Inflectis Bioscience, Passage Biosci and Mitochondria in Motion, Temple University and Albert Einstein Medical College, and is the Chair of the CMT and Related Disorders (CMTR) Consortium of the Peripheral Nerve Society. SR has been employed at the Janssen Pharmaceutical Companies of Johnson & Johnson since January 2021 and has restricted stock options. Her contributions to the paper were made prior to her current employment. IM is a board member of the CMTR Consortium of the Peripheral Nerve Society. CES is a voluntary advisory board member of the CMT Association. EMY, PB, JBa, SKB, NB, KdV, TE, MAF, RSF, JH, RAK, GAN, MaMR, KR, SWY, MPM, MoMR and JBu report no competing interests., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Gait Up Physilog® wearable inertial sensors are a powerful alternative to traditional laboratory-based gait assessment for children with gait impairment. To build clinician trust in these devices and ultimately facilitate their use outside confined spaces, studies have examined performance of previous versions of Physilog® wearable inertial sensors but predominant focus has been on older adults. Despite their different gait patterns and behavioural/cognitive profiles, there are limited studies in children., Research Question: To determine whether key spatiotemporal gait parameters (stride length, time and velocity) collected by shoe-worn Physilog®5 sensors in a hallway assessment protocol are a valid method of gait assessment in typically developing adolescents aged 12-15 years., Methods: A total 30 typically developing participants (50 % female) median age 13.7 (interquartile range 2.34) were assessed in an exploratory study whilst walking at self-selected speed over the GAITRite® electronic walkway, concurrently wearing Physilog®5 sensors. Concurrent validity was analysed by Lin's concordance correlation coefficient (CCC), Bland-Altman plots and 95 % limit of agreement. Systematic bias was assessed using 95 % confidence interval of the mean difference., Results: Mean stride data demonstrated substantial agreement for stride length (CCC = 0.975) and stride velocity (CCC = 0.979) to almost perfect agreement for stride time (CCC > 0.996). Agreement between the technologies for individual stride-to-stride data remained high for stride time (CCC = 0.952); yet reduced for stride length (CCC = 0.868) and stride velocity (CCC = 0.877). Male/female differences in performance of the technology were observed for stride velocity, favouring females., Significance: Physilog®5 inertial sensors accurately measure walking in adolescents, with stride time the most accurately detected parameter. This demonstrates that wearables can be used by researchers and clinicians working with adolescent groups as an alternative to fixed systems. These findings will ultimately pave the way to using wearables for assessments with children outside of the laboratory environment., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: We explored the effects of standardized calf massage in ambulant boys with Duchenne muscular dystrophy (DMD) using a prospective study design., Materials and Methods: Twenty boys completed two study visits, 1 week apart. At both visits, each leg received a 10-min calf massage (intervention) and a 10-min control rest period (placebo) in randomized order. Muscle length of calf and hamstrings and gastrocnemius stiffness were measured by a blinded assessor before and after intervention and placebo. Measures of gait function (timed 10-m walk/run and spatio-temporal gait parameters); gastrocnemius muscle ultrasound findings; participant perception of leg pain, stiffness and effort of walking and general psychological well-being were also collected., Results: Consistent significant small increases in muscle length of soleus, gastrocnemius and hamstrings were recorded post-massage, and gastrocnemius stiffness decreased. Small changes in gastrocnemius and soleus length only were also recorded following the control rest period. Gait function and general well-being remained stable throughout. Measurement across both study visits suggested that gains in muscle length may be cumulative with repeated massage., Conclusions: Calf massage is safe and associated with benefits to muscle length and stiffness for ambulant boys with DMD.Implications for RehabilitationIn a small sample of boys with Duchenne muscular dystrophy, calf massage was found to be safe, well-tolerated and associated with increased muscle length and decreased stiffness.The use of massage may assist in managing muscle length in boys with Duchenne muscular dystrophy.

Purpose: To compare the global positioning system- and accelerometry-derived running demands, creatine kinase (CK), and self-reported wellness during an Olympic Games in international hockey., Methods: Data were collected across 5 games during the 2016 Rio Olympic Games. Global positioning system units (10 Hz) were used to assess the running demands, accelerations, and decelerations of outfield players in a men's hockey squad with matches 2 to 5 compared with match 1. CK was used as a marker of muscle damage, and self-reported psychometric questionnaires were used to assess wellness, with each of the 5 matches compared with precompetition assessments., Results: There were significant increases (P < .05) in either, or both, absolute and relative total distance, player load, high-speed running distance, sprint distance, and accelerations and decelerations, compared with baseline. There was a significant decrease (P < .05) in maximal velocity by match 5. CK significantly increased from match 1 to 5 and displayed significant correlations with total distance (r = .55) and player load (r = .41). Muscle soreness correlated with total distance and player load, with other wellness markers unchanged compared with baseline., Conclusions: International hockey athletes may maintain or increase running activities over the course of an Olympic tournament; however, this may be impacted by situational (match score/outcome) and environmental (ambient temperature) factors. Despite CK and muscle soreness displaying relationships with running variables, further work is needed to establish their individual value in monitoring international hockey athletes.

Context: Overcoming the intestinal mucosal barrier can be a challenge in drug delivery. Nanoemulsions with negative zeta potentials can effectively permeate the mucus layer, but those with positive zeta potentials are better taken up by cells; a nanoemulsion with capricious zeta potential from negative to positive can achieve both good permeation and high uptake., Objective: This study aimed to develop dual-acting zeta-potential-amphoteric micelles enabling optimal muco-permeation and enhancement of cellular uptake., Methods: A micellar pre-concentrate was prepared from 15% Labrasol, 15% Kolliphor EL, 30% Kolliphor RH 40, and 40% dimethylsulfoxide. The micellar pre-concentrate was loaded with anionic stearic acid (SA), forming ionic complexes with cationic polymers at a ratio of 25:1 with Eudragit RS 100 and Eudragit RL 100. Blank micelles and those containing complexes were separately diluted in physiological buffers and examined for their droplet sizes, polydispersity indices (PDIs), zeta potentials, and cytotoxicity. The SA release from the micellar complexes was evaluated in 0.1 mM phosphate buffer (pH 6.8) containing 0.001% fluorescein, thereby enabling an instant decrease in fluorescence. Finally, the micelles were loaded with the model drug fluorescein diacetate (FDA) and evaluated for their muco-permeation behavior and cellular uptake., Results: The micellar dilutions formed micelles at the critical micelle concentration (CMC) of 312 µg/mL and showed a uniform average droplet size of 14.2 nm, with a PDI < 0.1. Micellar dilutions were non-cytotoxic when used at 1:100 in a physiological medium. Micelles loaded with ionic complexes achieved a sustained release of 95.5 ± 3.7% of the SA in 180 min. Moreover, the zeta potential of the complex-loaded micelles shifted from -5.4 to +1.8 mV, whereas the blank micelles showed a stabilized zeta potential of -10 mV. Furthermore, the negatively charged blank and complex-loaded micelles exhibited comparable muco-permeation, with an overall average of 58.2 ± 3.7% diffusion of FDA. The complex-loaded micellar droplets, however, provided a significantly higher cellular uptake of the model drug FDA (2.2-fold, p ≤ 0.01) Conclusion: Due to undergoing a shift in zeta potential, the modified micelles significantly enhanced cellular uptake while preserving mucus-permeating properties.

Abstract: Kennedy, RA and Drake, D. Improving the signal-to-noise ratio when monitoring countermovement jump performance. J Strength Cond Res 35(1): 85-90, 2021-Countermovement jump (CMJ) performance has been routinely used to monitor neuromuscular status. However, the protocol used to establish the criterion score is not well documented. The purpose of this study was to examine how the protocol used would influence of the sensitivity of CMJ variables in rugby union players. Fifteen male (age: 19.7 ± 0.5 years) rugby union players performed 8 CMJs on 2 occasions, separated by 7 days. The between-session coefficient of variation (CV) was calculated using 2 techniques for treating multiple trials, the average, and the trial with the best jump height (JH), and then compared with the smallest worthwhile change (SWC). The signal-to-noise ratio was measured as the group mean change in a variable divided by the CV. Using the average value across multiple trials is superior to the best trial method, based on lower CVs for all variables. Only the average performance across 6 or more trials was classified as ideal (CV < 0.5 × SWC) for peak velocity (PV). In addition, the signal-to-noise ratio for peak concentric power (PCP), PV, and JH were classified as good, irrespective of the treatment method. Although increasing the number of trials can reduce the random error, it may be pragmatic to simply take the average from 2 to 3 trials, facilitating a CV < SWC for PV, PCP, and JH. Due to its simplicity, JH may be considered the principal variable to monitor neuromuscular fatigue., (Copyright © 2018 National Strength and Conditioning Association.)

Purpose: This quality improvement project aimed to assess the elements of the current workflow process that meets requirements for transitions of care from a family medicine inpatient to outpatient service following the Transitional Care Management (TCM) program developed by the Centers for Medicare & Medicaid Services. The purpose of the study was to assess the current family medicine workflow and determine whether the current process meets the criteria for billing and calculate the potential loss of reimbursement., Methods: Interviews with key personnel, review of practice policies, and a retrospective chart review were performed for clinic patients discharged from the inpatient to outpatient family medicine service., Results: A total of 37 patients met inclusion criteria for the chart review. Of these, 8% of patients seen at the outpatient clinic met all criteria for TCM. Potential reimbursement for those who met TCM criteria was $293.14 USD; the estimated potential TCM reimbursement for patients not meeting criteria was $1997.76 USD., Conclusion: Standardized, team-based TCM services have shown to decrease readmission rates for high-risk patient populations. Results from this project identified processes in place at the family medicine practice to facilitate the development of a standardized transitional care service which could meet both TCM and best practice models.

Background: Weakness is the primary impairment in paediatric neuromuscular diseases, impacting gait and gait-related functional activities in ambulant children affected by these rare and often degenerative diseases. Gait speed is an indicator of health and disability, yet gait is a complex, multi-faceted activity. Using the International Classification of Function, Health and Disability (ICF) model, assessment of gait and functional ambulation should consider the impairments, activity limitations and participation restrictions due to disease, and factors related to the environment and the individual person., Methods: This narrative review involved a literature search of databases including Medline, Embase and Pubmed from 1946 to October 2019. Inclusion criteria included assessments of gait, endurance and ambulatory function in paediatric (0-18 years) neuromuscular diseases., Results: Fifty-two papers were identified reporting assessments of gait speed, timed function, endurance and ambulatory capacity, gait-related balance and qualitative descriptive assessments of gait function and effect of disease on gait and gait-related activities. Gait speed is an indicator of disability and children with neuromuscular disease walk slower than typically developing peers. Increasing disease severity and age were associated with slower walking in children with Duchenne muscular dystrophy and Charcot-Marie-Tooth disease. The six-minute walk test is used widely as a test of endurance and ambulatory capacity; six-minute walk distance was substantially reduced across all paediatric neuromuscular diseases. Endurance and ambulatory capacity was more limited in children with spinal muscular atrophy type 3, congenital muscular dystrophy and older boys with Duchenne muscular dystrophy. Only a few papers considered normalisation of gait parameters accounting for the effect on gait of height in heterogeneous groups of children and linear growth in longitudinal studies. Balance related to gait was considered in five papers, mainly in children with Charcot-Marie-Tooth disease. There was limited investigation of factors including distance requirements and terrain in children's typical environments and personal factors related to self-perception of disease effect on gait and gait-related function., Conclusion: Assessments of gait and functional ambulation are important considerations in documenting disease progression and treatment efficacy in the clinical setting; and in clinical trials of disease-modifying agents and physiotherapeutic interventions in paediatric neuromuscular diseases. There is a need for expert consensus on core gait and functional ambulation assessments for use in clinical and research settings.

To validate the use of neck dissection as part of the management of patients with parotid carcinomas, we retrospectively reviewed pathological and clinical data from the head and neck pathology archive at Guy's and St Thomas' Hospital on all patients who had primary parotid carcinomas resected between 1992 and 2014. The main outcome measure was the incidence of metastatic disease. A total of 54 of the 82 patients identified had neck dissections. Nodal metastases were detected in 10 with high-grade, invasive carcinoma ex-pleomorphic adenomas, two with salivary duct carcinomas, one with a high-grade adenocarcinoma not otherwise specified (NOS), one with an adenoid cystic carcinoma, and one with a high-grade acinic cell carcinoma. No metastases were found in those with a low-grade acinic cell carcinoma, low-grade mucoepidermoid carcinoma, epithelial-myoepithelial carcinoma, or non-invasive carcinoma ex-pleomorphic adenoma. The findings of this study support the use of routine neck dissection for the treatment of high-grade, invasive carcinoma ex-pleomorphic adenoma, salivary duct carcinoma, high-grade adenocarcinoma NOS, adenoid cystic carcinoma, and high-grade acinic cell carcinoma., (Copyright © 2019. Published by Elsevier Ltd.)

This study aimed to evaluate responsiveness (ability to detect change) of isometric force-time measures to neuromuscular fatigue in resistance-trained participants using two differing protocols that modified both the instructions provided to participants and the duration of the test. Both protocols were completed at two knee joint angles in the isometric squat test. Ten participants volunteered to take part in this study (age: 27.0 ± 4.5 years, strength training experience: 7.7 ± 2.6 years). Isometric peak force (ISqT peak ) and isometric explosive force (ISqT exp ) test protocols were assessed at two joint angles (knee angle 100° and 125°) pre-high intensity strength training, immediately post strength training, 24-h post, 48-h post and analysed for peak and RFD performance. Participants completed eight sets of three repetitions of the back-squat exercise as the high-intensity strength training. Results showed the highest standardised response means (SRM) detected was peak force using the ISqT peak 100, SRM -1.97 compared to an SRM of -1.31 for RFD 200 ms in the ISqT exp 125. Peak force was the most responsive variable using the ISqT peak protocol, whereas the ISqT exp protocol was most responsive for RFD measures. Therefore, ISqT peak and ISqT exp test protocols should not be used interchangeably to evaluate RFD variables.

McMahon, GE and Kennedy, RA. Changes in player activity profiles after the 2015 FIH rule changes in elite women's hockey. J Strength Cond Res 33(11): 3114-3122, 2019-The aim of this study was to compare the player activity profiles of elite international women's hockey players before (2014) and after (2015) the 2015 the International Hockey Federation (FIH) match rule changes at team and positional levels. The match activity profiles (n = 400) of 19 female hockey players (age 23 ± 4 years, mass 63.6 ± 5.5 kg, VO2max 57 ± 6 ml·kg·min in 2014, 58 ± 6 ml·kg·min in 2015) were recorded during competitive international matches in 2014 (match n = 12) and 2015 (match n = 13) using 10-Hz global positioning system units. The practical utility of an effect was only classified as substantial when there was a >75% likelihood that the ±90% confidence interval of the effect size (ES) was equal to or greater than the small (ES ± 0.2) reference value. Mean match time decreased by over 2 minutes from 71.72 ± 1.38 to 69.40 ± 4.72 minutes. There were increases at the team level in relative substitutions (SUB), relative distance (RD), high-speed running (HSR: 3.08-5.27 m·s), and surges (S), with a fall in low-speed running (LSR: 0-3.05 m·s) between 2014 and 2015. There were no changes in the between-position differences observed from 2014 to 2015. Within positions, there were relative increases in RD for all positions, HSR and S for midfield, and in SUB and S in forwards. The 2015 FIH rule changes seem to have increased the general intensity of international women's hockey. However, the different facets of physical performance did not change uniformly across team positions. Therefore, specific modifications to conditioning practices for each position may be warranted to more accurately reflect match demands.

Isometric tests have been used to assess rate of force development (RFD), however variation in testing methodologies are known to affect performance outcomes. The aim of this study was to assess the RFD in the isometric squat (ISqT) using two test protocols and two testing angles. Eleven participants (age: 26.8 ± 4.5 years, strength training experience: 7.1 ± 3.03 years) completed test and retest sessions one week apart, whereby two test protocols with respect to duration and instructions were compared. Isometric peak force (ISqT peak ) and isometric explosive force (ISqT exp ) tests were assessed at two joint angles (knee flexion angle 100° and 125°). Force-time traces were sampled and subsequently analysed for RFD measures. Average and instantaneous RFD variables did not meet reliability minimum criteria in ISqT peak at 100° or 125°. The ISqT exp test at 100° met reliability criteria in the RFD 0-200 and 0-250ms variables. The ISqT exp test at 125° met reliability criteria in the RFD 0-150, 0-200 and 0-250ms variables. Force-time characteristics were optimized at the higher knee joint angle. Average and instantaneous RFD measures obtained using a traditional peak force test do not meet basic reliability criteria. Researchers assessing multi-joint RFD should employ the explosive RFD test protocol as opposed to the traditional isometric peak force protocol.

Background: Disability related to the progressive and degenerative neuropathies known collectively as Charcot-Marie-Tooth disease (CMT) affects gait and function, increasing with age and influencing physical activity in adults with CMT. The relationship between CMT-related disability, ambulatory function and physical activity in children and adolescents with CMT is unknown., Method: A cross-sectional case-controlled study of physical activity in 50 children with CMT and age- and gender-matched typically developing (TD) controls [mean age 12.5 (SD 3.9) years]. A 7-day recall questionnaire assessed physical activity; CMT-related disability and gait-related function were measured to explore factors associated with physical activity., Results: Children with CMT were less active than TD controls (estimated weekly moderate to vigorous physical activity CMT 283.6 (SD 211.6) minutes, TD 315.8 (SD 204.0) minutes; p < 0.001). The children with CMT had moderate disability [CMT Pediatric Scale mean score 17 (SD 8) /44] and reduced ambulatory capacity in a six-minute walk test [CMT 507.7 (SD 137.3) metres, TD 643.3 (74.6) metres; p < 0.001]. Physical activity correlated with greater disability (ρ = -0.56, p < 0.001) and normalised six-minute walk distance (ρ = 0.74, p < 0.001)., Conclusions: CMT-related disability affects physical activity and gait-related function in children and adolescents with CMT compared to TD peers. Reduced physical activity adversely affects function across the timespan of childhood and adolescence into adulthood in people with CMT., Competing Interests: The authors have declared that no competing interests exist.

Objective: To prospectively study falls in children and adolescents with Charcot-Marie-Tooth disease (CMT)., Design: Prospective cohort study., Setting: Neuromuscular outpatient clinic of a tertiary paediatric hospital., Patients: Sixty children and adolescents ('children') aged 4-18 years, 30 with CMT and 30 typically developing (TD)., Main Outcome Measures: Falls rate over 6 months and falls characteristics questionnaire., Results: Twenty-two children with CMT reported falling at least once in 6 months compared with eight TD children (CMT 2819 (0-1915), TD 31 (0-6) total falls (range)). Detailed falls characteristics were collected from 242 individual falls (CMT 216, TD 26). Injurious falls were reported by 19 children with CMT (74 falls) compared with 2 TD children (3 falls), with cuts, grazes and bruising most common. No fractures were sustained and no child required hospitalisation. However, 12 injuries from falls in children with CMT required management by a healthcare provider, versus none in TD children. Tripping was the most common mechanism of falls in both groups. Age was the strongest predictor of falls (ρ=-0.53, p=0.006) with all children (CMT and TD) aged <7 years falling. Balance was the strongest impairment-related predictor of falls (ρ=-0.47, p=0.02). The conservative estimate of risk of falls in children and adolescents with CMT was 33 times higher than their TD peers (incidence rate ratio=32.8, 95% CI 10.2 to 106.0)., Conclusions: Children and adolescents with CMT fall more often than TD peers and sustain more injuries when they fall., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The aim of this study was to examine the implications of increased maternal Breath Carbon Monoxide (BCO) levels at the first antenatal visit for subsequent birthweight (BW) and neonatal outcomes., Study Design: Secondary analysis of a prospective, observational study. Pregnant women aged ≥18years who understood English were recruited (n=250). However, only women who delivered a normally formed baby weighing ≥500g were analysed (n=234). At the first antenatal visit, a research questionnaire was completed and a BCO test was performed. Obstetric and neonatal data computerised by midwives at the first antenatal visit and updated after delivery were also analysed., Results: Results from the receiver operating characteristic (ROC) curve indicated the highest combined sensitivity and specificity for smoking was observed at a BCO cut-off level of 3ppm (sensitivity 85%, specificity 90%). Of the 234 women, 53 (22.6%) had a BCO ≥3ppm but only 36 (15.4%) disclosed smoking to the midwife on routine questioning. A further 23 (9.8%) were classified as non-disclosers based on a research questionnaire and/or a BCO measurement ≥3ppm. No relationship was found between the self-reported number of cigarettes daily in early pregnancy and BW (r=0.05, p=0.78). However, an inverse relationship was found between maternal BCO levels and BW (r=-0.31, p<0.001). BCO levels ≥3ppm in early pregnancy were associated with an increased risk of emergency caesarean section, low birth weight, BW <25th centile, fetal distress and having two or more adverse pregnancy events (all p<0.05). Smoking non-disclosers had babies with decreased BWs (-400.1g, 95% CI 141.1-659.0g, p<0.001), and higher rates of BW <25th centile (56.5% versus 25.3%, p<0.001), small-for-gestational-age (21.7% versus 9.1%, p<0.001) and fetal distress (39.1% versus 16.0%, p<0.01) compared to non-smokers Non-disclosers at the first antenatal visit also had a 22% higher rate of having two or more adverse pregnancy events (p<0.05)., Conclusion: The results showed that an increased BCO level was associated with a lower BW and increased risk of adverse pregnancy and neonatal outcomes. This strengthens the case for universal BCO screening at the first antenatal visit. A high BCO reading should be an indication for referral to stop smoking services referral and close fetal surveillance., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Sodium alginate is a non-toxic natural polysaccharide found in marine brown algae. It is able to form solid gels by the action of poly-valent cations (commonly calcium but not magnesium) which cross-link the polysaccharide chains at the guluronic acid groups. Alginate-based products are popular in many industries, including food production and in pharmaceutical and biomedical applications. It is utilized in manufacture of wound-care products due to its biocompatibility and gel forming capabilities upon the absorption of wound exudate. Considering the potential influence of the alginate composition on the properties of the resultant fibers, two sodium alginate powders were selected based on their contrasting compositions. The GHB alginate was high in guluronic acid whereas the LKX alginate was high in mannuronic acid. The sodium alginate solutions (4% w/w) were extruded into a calcium chloride (3% w/v) bath to produce calcium alginate fibers. The fibers were dried at 22 °C and 32% relative humidity for 72 h. Selected properties of the blank (unloaded) fibers were analysed: diameter measurements by optical microscopy, mechanical strength using a universal testing machine, morphology by scanning electron microscopy, and calcium content by inductively coupled plasma atomic emission spectroscopy. One of the key aims of this work was to evaluate the variability of these properties along moderately large lengths of fiber and to determine the difference (if any) between replicate lengths of fibers. This study showed that the alginate type influenced selected properties of the resultant fibers. The mean diameter and calcium content of the GHB fibers were 232 µm and 2.79µmoles/mg respectively, whereas the LKX fibers were about 10% thicker and had 2.58µmoles/mg calcium ion content. The fibers of each alginate could be distinguished visually based on gross differences as well as differences in their microstructure. Mechanical testing of the fibers produced stress-strain plots displaying largely non-elastic behaviour. There was no statistically significant (p < 0.05) difference between the Young's modulus or the strain at break for the two types of fibers, namely about 5-5.6 GPa and 0.123-0.131 respectively. All the measured properties were found to be consistent along the nine sampling positions along the lengths of fibers and were reproducible between the different batches of fibers., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study evaluated breath carbon monoxide (BCO) testing in identifying maternal smokers as well as the difference between disclosers and non-disclosers of smoking status. We also investigated if other extrinsic factors affected the women's BCO levels in pregnancy., Design: A prospective observational study., Setting: A university obstetric hospital in an urban setting in Ireland., Participants: Women (n=250) and their partners (n=54) were recruited at their first antenatal visit. Women <18 years and those who did not understand English were excluded. A booking history, including recording of smoking status, was collected by midwives. Following this, women were recruited and completed a detailed research questionnaire on smoking and extrinsic/environmental BCO sources. A BCO test was performed on both the woman and her partner., Primary and Secondary Outcome Measures: The number of self-reported smokers and those that were positive on the BCO test. The characteristics of women who disclosed and did not disclose smoking status. The effect of extrinsic factors on the BCO test results., Results: Based on the receiver-operating characteristic curve, a BCO cut-off point of ≥3 ppm was the optimal level to identify ongoing smoking. At booking history, 15% of women reported as current smokers. Based on BCO levels ≥3 ppm combined with self-reported smoking in the research questionnaire, the rate increased to 25%. Non-disclosers had similar characteristics to non-smokers. No extrinsic factors affected maternal BCO levels., Conclusions: Based on self-report and BCO levels, a quarter of women presenting for antenatal care continued to smoke, but only 60% reported their smoking to midwives. BCO measurement is an inexpensive, practical method of improving identification of maternal smoking, and it was not effected by extrinsic sources of BCO. Improved identification means more smokers can be supported to stop smoking in early pregnancy potentially improving the short-term and long-term health of both mother and child., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Children with Charcot-Marie-Tooth disease (CMT) report problems with gait and footwear. We evaluated differences in spatio-temporal gait variables and gait variability between children with CMT and typically developing (TD) children, and investigated the effect of footwear upon gait., Method: A cross-sectional study of 30 children with CMT and 30 age- and gender-matched TD children aged 4-18 years. Gait was assessed at self-selected speed on an electronic walkway while barefoot and in two types of the child's own footwear; optimal (e.g., athletic-type runners) and suboptimal (e.g., flip-flops)., Results: Children with CMT walked more slowly (mean (SD) -13.81 (3.61) cm/s), with shorter steps (-6.28 (1.37) cm), wider base of support (+2.47 (0.66) cm; all p < 0.001) and greater base of support variability (0.48 (0.15) cm, p = 0.002) compared to TD children. Gait was faster in optimal footwear than suboptimal (-7.55 (1.31) cm/s) and barefoot (-7.42 (1.07) cm/sec; both p < 0.001) in the combined group of children. Gait in suboptimal footwear was more variable compared to barefoot and optimal footwear. Greater base of support variability and reduced balance was moderately correlated for both groups (CMT and TD)., Conclusion: Gait is slower with shorter, wider steps and greater base of support variability in children with CMT. Poor balance is associated with greater base of support gait variability. Suboptimal footwear negatively affects gait in all children (CMT and TD), which has clinical implications for children and adolescents with CMT who have weaker feet and ankles, and poor balance., (Copyright © 2018 Elsevier B.V. All rights reserved.)

A countermovement jump (CMJ) represents one of the most frequently used performance tests for monitoring neuromuscular function in athletes. An often-overlooked feature that may provide some useful diagnostic information is the actual shape of the force-time curve. The aim of this study was therefore to consider how the shape of the force-time curve influences jump performance. Thirty-three male rugby union players performed two CMJs on a force plate, with discrete variables and continuous curve analysis used. The subjects were dichotomized based on shape of the force-time curve during the propulsion phase and by jump height. The differences between the unimodal and bimodal groups were unclear for jump height (ES = 0.28, ±0.58) and reactive strength index-modified (ES = &minus;0.30, ±0.59). A substantial difference between high (40.2 ± 2.9 cm) and low (31.2 ± 3.2 cm) jumpers only existed in the late propulsion phase by 79.0% to 97.0% of the normalized force-time curve. A bimodal force-time curve is not representative of an optimal pattern of performance and simply reflects an inefficient stretch-shortening cycle. The inter-individual variability that exists in braking COM displacement renders temporal phase analysis impractical in cross-sectional type studies.

Kennedy, RA and Drake, D. Dissociated time course of recovery between strength and power after isoinertial resistance loading in rugby union players. J Strength Cond Res 32(3): 748-755, 2018-There is a substantial amount of research on the responses to isometric and eccentric loading. However, only a paucity of literature exists on the responses to isoinertial loading, especially in trained athletic populations using realistic loading protocols. The purpose of this study was to examine the acute neuromuscular response to a bout of isoinertial resistance loading in elite rugby players. Seventeen male (age: 19.5 ± 2.3 years) rugby union players performed a conventional maximal isoinertial resistance loading protocol. Countermovement jump (CMJ) and maximal voluntary isometric contraction (MVC) squat performance were measured on 3 occasions: at baseline, immediately post, and 48 hour post. The results indicated that the decrease in MVC (9.7%) is greater than or comparable with the CMJ output variables (4.2-10.3%), immediately postexercise. Although isometric strength had demonstrated a full recovery at 48 hour post, many of the key CMJ output variables were still impaired (p ≤ 0.05). Similar findings were observed in the normalized CMJ curves. Complete recovery of the ability to rapidly produced force may require more than 48 hours in many athletes. Individual responses should, therefore, be monitored to help plan acute and chronic training loads. It is recommended that future fatigue studies should incorporate temporal phase analyses to consider the power-, force-, velocity-, and displacement-time curves.

Introduction: The nerve sonographic features of Dejerine-Sottas disease (DSD) have not previously been described., Methods: This exploratory cross-sectional, matched, case-control study investigated differences in nerve cross-sectional area (CSA) in children with DSD compared to healthy controls and children with Charcot-Marie-Tooth disease type 1A (CMT1A). CSA of the median, ulnar, tibial, and sural nerves was measured by peripheral nerve ultrasound. The mean difference in CSA between children with DSD, controls, and CMT1A was determined individually and within each group., Results: Five children with DSD and five age- and sex-matched controls were enrolled. Data from five age-matched children with CMT1A was also included. Group comparison showed no mean difference in nerve CSA between children with DSD and controls. Individual analysis of each DSD patient with their matched control indicated an increase in nerve CSA in three of the five children. The largest increase was observed in a child with a heterozygous PMP22 point mutation (nerve CSA fivefold larger than a control and twofold larger than a child with CMT1A). Nerve CSA was moderately increased in two children-one with a heterozygous mutation in MPZ and the other of unknown genetic etiology., Conclusions: Changes in nerve CSA on ultrasonography in children with DSD differ according to the underlying genetic etiology, confirming the variation in underlying pathobiologic processes and downstream morphological abnormalities of DSD subtypes. Nerve ultrasound may assist in the clinical phenotyping of DSD and act as an adjunct to known distinctive clinical and neurophysiologic findings of DSD subtypes. Larger studies in DSD cohorts are required to confirm these findings.

This review of changes to the 4th edition of the WHO classification of head and neck tumours focuses on their impact on the surgical care of diseases that affect the salivary glands, jaws, and oral cavity. Updates to the chapter on the salivary glands include the addition of secretory carcinoma and sclerosing polycystic adenosis. The odontogenic cysts are back, and the odontogenic keratocyst is listed among them, as it has now lost its brief and confusing designation as a neoplasm. The newly-defined sclerosing odontogenic carcinoma and primordial odontogenic tumour have been added. Oropharyngeal tumours have been separated from those of the oral cavity, which reflects the importance of HPV in carcinoma of the tonsils. The problems of grading oral epithelial dysplasia persist., (Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)