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Objective: This study aimed to systematically investigate whether polarized or non-polarized training leads to greater physiological and performance adaptations in cyclists., Design: A systematic review and meta-analysis were conducted, focusing on interventions categorized as polarized, non-polarized, or unclear. Inclusion criteria required participants to be at least recreationally trained cyclists (VO 2max ≥ 59 ml/kg/min) and interventions lasting > 4 weeks., Methods: A multi-level random-effects meta-analysis using restricted maximum likelihood estimation was performed. A multivariate meta-regression assessed associations between training volume, VO 2max , and time-trial performance., Results: Forty-one studies, comprising 81 training groups and 797 participants, were included. Training significantly improved VO 2max across all groups (g = 0.42, 95 % confidence interval = 0.31-0.53, P ≤ 0.001) and time-trial performance (g = 0.39, 95 % confidence interval = 0.25-0.53, P ≤ 0.001), with no significant differences between training modalities (P > 0.05). Longer intervention durations positively influenced VO 2max (g = 0.03, 95 % confidence interval = 0.02-0.05, P < 0.001) and time-trial performance (g = 0.04, 95 % confidence interval = 0.03-0.06, P < 0.001). No associations were found between weekly or total training volume and changes in VO 2max or time-trial performance., Conclusions: Polarized and non-polarized training modalities yield comparable improvements in VO 2max and time-trial performance in trained cyclists. Beyond achieving a necessary training volume, further increases do not appear to enhance performance. These findings encourage athletes and coaches to prioritize effective training distribution rather than fixating on total volume or a specific model., Competing Interests: Declaration of interest statement The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To identify and summarise the contextual factors associated with running demands in elite male Australian football (AF) gameplay that have been reported in the literature., Design: Scoping review., Methods: A contextual factor in sporting gameplay is a variable associated with the interpretation of results, yet is not the primary objective of gameplay. Systematic literature searches were performed in four databases to identify what contextual factors associated with running demands in elite male AF have been reported: Scopus, SPORTDiscus, Ovid Medline and CINAHL, for terms constructed around Australian football AND running demands AND contextual factors. The present scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and narrative synthesis was conducted., Results and Conclusion: A total of 36 unique articles were identified by the systematic literature search, which included 20 unique contextual factors. The most studied contextual factors were position ( n  = 13), time in game ( n  = 9), phases of play ( n  = 8), rotations ( n  = 7) and player rank ( n  = 6). Multiple contextual factors, such as playing position, aerobic fitness, rotations, time within a game, stoppages, and season phase appear to correlate with running demands in elite male AF. Many identified contextual factors have very limited published evidence and thus additional studies would help draw stronger conclusions.

Objective: to evaluate the immune response to the SARS-CoV-2 vaccines in adults with immune-mediated rheumatic diseases (IMRDs) in comparison to healthy individuals, observed 1-20 weeks following the fourth vaccine dose. Additionally, to evaluate the impact of immunosuppressive therapies, vaccination schedules, the time interval between vaccination and sample collection on the vaccine's immune response., Methods: We designed a longitudinal observational study conducted at the rheumatology department of Hospital de Copiapó. Neutralizing antibodies (Nabs) titers against the Wuhan and Omicron variant were analyzed between 1-20 weeks after administration of the fourth dose of the SARS-CoV-2 vaccine to 341 participants (218 IMRD patients and 123 healthy controls). 218 IMRD patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), systemic vasculitis (VS) and systemic scleroderma (SS) were analyzed., Results: Performing a comparison between the variants, Wuhan vs Omicron, we noticed that there were significant differences (p<0.05) in the level of the ID 50 , both for healthy controls and for patients with IMRDs. The humoral response of patients with IMRDs is significantly lower compared to healthy controls for the Omicron variant of SARS-CoV-2 (p = 0.0015). The humoral response of patients with IMRDs decreases significantly when the time interval between vaccination and sample collection is greater than 35 days. This difference was observed in the response, both for the Wuhan variant and for the Omicron variant., Conclusion: The IMRDs patients, the humoral response variation in the SARS-CoV-2 vaccine depends on doses and type of vaccine administered, the humoral response times and the treatment that these patients are receiving., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Gallardo-Nelson, Cruces, Gómez, Fuenzalida, Silva, Aravena-Traipi, Nuñez, Gaete-Angel, Rivas-Yañez, Kalergis, Soto-Rifo and Valiente-Echeverria.)

Background: The aac(6')-Im (aacA16) amikacin, netilmicin and tobramycin resistance gene cassette had been circulating globally undetected for many years in a sublineage of Acinetobacter baumannii global clone 2., Objectives: To identify sources for the aac(6')-Im fragment found in A. baumannii., Methods: MinION long-read sequencing and Unicycler hybrid assemblies were used to determine the genetic context of the aac(6')-Im gene. Quantitative reverse transcriptase PCR was used to measure expression., Results: Among >60 000 non-Acinetobacter draft genomes in the MRSN collection, the aac(6')-Im gene was detected in Pseudomonas putida and Enterobacter hormaechei isolates recovered from patients in Thailand between 2016 and 2019. Genomes of multiply resistant P. putida MRSN365855 and E. hormaechei MRSN791417 were completed. The class 1 integron containing the aac(6')-Im cassette was in the chromosome in MRSN365855, and in an HI2 plasmid in MRSN791417. However, MRSN791417 was amikacin susceptible and the gene was not expressed due to loss of the Pc promoter of the integron. Further examples of aac(6')-Im in plasmids from or the chromosome of various Gram-negative species were found in the GenBank nucleotide database. The aac(6')-Im context in integrons in pMRSN791417-8 and a Klebsiella plasmid pAMR200031 shared similarities with the aac(6')-Im region of AbGRI2-Im islands in A. baumannii. In other cases, the cassette array including the aac(6')-Im cassette was different., Conclusions: The aac(6')-Im gene is widespread, being found so far in several different species and in several different gene cassette arrays. The lack of amikacin resistance in E. hormaechei highlights the importance of correlating resistance gene content and antibiotic resistance phenotype., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Objective: The aim of this study was to investigate the cognitive effects of unilateral directional versus ring subthalamic nucleus deep brain stimulation (STN DBS) in patients with advanced Parkinson's disease., Methods: We examined 31 participants who underwent unilateral STN DBS (left n = 17; right n = 14) as part of an National Institutes of Health (NIH)-sponsored randomized, double-blind, crossover study contrasting directional versus ring stimulation. All participants received unilateral DBS implants in the hemisphere more severely affected by motor parkinsonism. Measures of cognition included verbal fluency, auditory-verbal memory, and response inhibition. We used mixed linear models to contrast the effects of directional versus ring stimulation and implant hemisphere on longitudinal cognitive function., Results: Crossover analyses showed no evidence for group-level changes in cognitive performance related to directional versus ring stimulation. Implant hemisphere, however, impacted cognition in several ways. Left STN participants had lower baseline verbal fluency than patients with right implants (t [20.66 = -2.50, p = 0.02]). Verbal fluency declined after left (p = 0.013) but increased after right STN DBS (p < 0.001), and response inhibition was faster following right STN DBS (p = 0.031). Regardless of hemisphere, delayed recall declined modestly over time versus baseline (p = 0.001), and immediate recall was unchanged., Interpretation: Directional versus ring STN DBS did not differentially affect cognition. Similar to prior bilateral DBS studies, unilateral left stimulation worsened verbal fluency performance. In contrast, unilateral right STN surgery increased performance on verbal fluency and response inhibition tasks. Our findings raise the hypothesis that unilateral right STN DBS in selected patients with predominant right brain motor parkinsonism could mitigate declines in verbal fluency associated with the bilateral intervention. ANN NEUROL 2024;95:1205-1219., (© 2024 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Storylines of Family Medicin e is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VII: family medicine across the lifespan', authors address the following themes: 'Family medicine maternity care', 'Seeing children as patients brings joy to work', 'Family medicine and the care of adolescents', 'Reproductive healthcare across the lifespan', 'Men's health', 'Care of older adults', and 'Being with dying'. May readers appreciate the range of family medicine in these essays., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This systematic review investigates the bidirectional relationship between alcohol consumption and disrupted circadian rhythms. The goal of this study was to identify (i) the types of circadian rhythm disruptors (i.e. social jet lag, extreme chronotypes, and night shift work) associated with altered alcohol use and (ii) whether sex differences in the consequences of circadian disruption exist. We conducted a search of PubMed, Embase, and PsycINFO exclusively on human research. We identified 177 articles that met the inclusion criteria. Our analyses revealed that social jet lag and the extreme chronotype referred to as eveningness were consistently associated with increased alcohol consumption. Relationships between night shift work and alcohol consumption were variable; half of articles reported no effect of night shift work on alcohol consumption. Both sexes were included as participants in the majority of the chronotype and social jet lag papers, with no sex difference apparent in alcohol consumption. The night shift research, however, contained fewer studies that included both sexes. Not all forms of circadian disruption are associated with comparable patterns of alcohol use. The most at-risk individuals for increased alcohol consumption are those with social jet lag or those of an eveningness chronotype. Direct testing of the associations in this review should be conducted to evaluate the relationships among circadian disruption, alcohol intake, and sex differences to provide insight into temporal risk factors associated with development of alcohol use disorder., (© The Author(s) 2023. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Blood and surveillance cultures from an injured service member from Ukraine grew Acinetobacter baumannii, Klebsiella pneumoniae, Enterococcus faecium, and 3 distinct Pseudomonas aeruginosa strains. Isolates were nonsusceptible to most antibiotics and carried an array of antibiotic resistant genes, including carbapenemases (bla IMP-1 , bla NDM-1 , bla OXA-23 , bla OXA-48 , bla OXA-72 ) and 16S methyltransferases (armA and rmtB4).

Though it may seem simple, object naming is a complex multistage process that can be impaired by lesions at various sites of the language network. Individuals with neurodegenerative disorders of language, known as primary progressive aphasias (PPA), have difficulty with naming objects, and instead frequently say "I don't know" or fail to give a vocal response at all, known as an omission. Whereas other types of naming errors (paraphasias) give clues as to which aspects of the language network have been compromised, the mechanisms underlying omissions remain largely unknown. In this study, we used a novel eye tracking approach to probe the cognitive mechanisms of omissions in the logopenic and semantic variants of PPA (PPA-L and PPA-S). For each participant, we identified pictures of common objects (e.g., animals, tools) that they could name aloud correctly, as well as pictures that elicited an omission. In a separate word-to-picture matching task, those pictures appeared as targets embedded among an array with 15 foils. Participants were given a verbal cue and tasked with pointing to the target, while eye movements were monitored. On trials with correctly-named targets, controls and both PPA groups ceased visual search soon after foveating the target. On omission trials, however, the PPA-S group failed to stop searching, and went on to view many foils "post-target". As further indication of impaired word knowledge, gaze of the PPA-S group was subject to excessive "taxonomic capture", such that they spent less time viewing the target and more time viewing related foils on omission trials. In contrast, viewing behavior of the PPA-L group was similar to controls on both correctly-named and omission trials. These results indicate that the mechanisms of omission in PPA differ by variant. In PPA-S, anterior temporal lobe degeneration causes taxonomic blurring, such that words from the same category can no longer be reliably distinguished. In PPA-L, word knowledge remains relatively intact, and omissions instead appear to be caused by downstream factors (e.g., lexical access, phonological encoding). These findings demonstrate that when words fail, eye movements can be particularly informative., 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., (Published by Elsevier Ltd.)

Introduction: As the prevalence of patients with left ventricular assist devices (LVAD) presenting to the emergency department (ED) increases, clinicians must be aware of LVAD-associated infections., Case Report: A well-appearing, 41-year-old male with history of heart failure status post prior-LVAD placement presented to the ED for swelling of his chest. What appeared initially as a superficial infection was further assessed with point-of-care ultrasound and found to represent a chest wall abscess involving the driveline, ultimately resulting in sternal osteomyelitis and bacteremia., Conclusion: Point-of-care ultrasound should be considered an important tool in the initial assessment of potential LVAD-associated infection.

Objectives: Our primary objective was to assess the accuracy of Doppler ultrasound versus manual palpation in detecting any pulse with an arterial line waveform in cardiac arrest. Secondarily, we sought to determine whether peak systolic velocity (PSV) on Doppler ultrasound could detect a pulse with a systolic blood pressure (SBP) ≥ 60 mmHg., Methods: We conducted a prospective, cross-sectional, diagnostic accuracy study on a convenience sample of adult, Emergency Department (ED) cardiac arrest patients. All patients had a femoral arterial line. During a pulse check, manual pulse detection, PSV and Doppler ultrasound clips, and SBP were recorded. A receiver operator characteristic curve analysis was performed to determine the optimal cut-off of PSV associated with a SBP ≥ 60 mmHg. Accuracy of manual palpation and Doppler ultrasound for detection of any pulse and SBP ≥ 60 mmHg were compared with McNemar's test., Results: 54 patients and 213 pulse checks were analysed. Doppler ultrasound demonstrated higher accuracy than manual palpation (95.3% vs. 54.0%; p < 0.001) for detection of any pulse. Correlation between PSV and SBP was strong (Spearman correlation coefficient = 0.89; p < 0.001). The optimal cut-off value of PSV associated with a SBP ≥ 60 mmHg was 20 cm/s (area under the curve = 0.975). To detect SBP ≥ 60 mmHg, accuracy of a PSV ≥ 20 cm/s was higher than manual palpation (91.4% vs. 66.2%; p < 0.001)., Conclusions: Among ED cardiac arrest patients, femoral artery Doppler ultrasound was more accurate than manual palpation for detecting any pulse. When using a PSV ≥ 20 cm/s, Doppler ultrasound was also more accurate for detecting a SBP ≥ 60 mmHg., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To prescribe training loads to improve performance, one must know how an athlete is responding to loading. The maximal rate of heart-rate increase (rHRI) during the transition from rest to exercise is linearly related to changes in endurance exercise performance and can be used to infer how athletes are responding to changes in training load. Relationships between rHRI and anaerobic exercise performance have not been evaluated. The objective of this study was to evaluate relationships between rHRI and anaerobic exercise performance., Methods: Eighteen recreational strength and power athletes (13 male and 5 female) were tested on a cycle ergometer for rHRI, 6-second peak power output, anaerobic capacity (30-s average power), and blood lactate concentration prior to (PRE), and 1 (POST1) and 3 (POST3) hours after fatiguing high-intensity interval cycling., Results: Compared with PRE, rHRI was slower at POST1 (effect size [ES] = -0.38, P = .045) but not POST3 (ES = -0.36, P = .11). PPO was not changed at POST1 (ES = -0.12, P = .19) but reduced at POST3 (ES = -0.52, P = .01). Anaerobic capacity was reduced at POST1 (ES = -1.24, P < .001) and POST3 (ES = -0.83, P < .001), and blood lactate concentration was increased at POST1 (ES = 1.73, P < .001) but not at POST3 (ES = 0.75, P = .11). rHRI was positively related to PPO (B = 0.19, P = .03) and anaerobic capacity (B = 0.14, P = .005) and inversely related to blood lactate concentration (B = -0.22, P = .04)., Conclusions: rHRI is linearly related to acute changes in anaerobic exercise performance and may indicate how athletes are responding to training to guide the application of training loads.

Background: Increasing nitric oxide bioavailability may induce physiological effects that enhance endurance exercise performance. This review sought to evaluate the performance effects of consuming foods containing compounds that may promote nitric oxide bioavailability., Methods: Scopus, Web of Science, Ovid Medline, EMBASE and SportDiscus were searched, with included studies assessing endurance performance following consumption of foods containing nitrate, L-arginine, L-citrulline or polyphenols. Random effects meta-analysis was conducted, with subgroup analyses performed based on food sources, sex, fitness, performance test type and supplementation protocol (e.g. duration)., Results: One hundred and eighteen studies were included in the meta-analysis, which encompassed 59 polyphenol studies, 56 nitrate studies and three L-citrulline studies. No effect on exercise performance following consumption of foods rich in L-citrulline was identified (SMD=-0.03, p=0.24). Trivial but significant benefits were demonstrated for consumption of nitrate and polyphenol-rich foods (SMD=0.15 and 0.17, respectively, p<0.001), including performance in time-trial, time-to-exhaustion and intermittent-type tests, and following both acute and multiple-day supplementation, but no effect of nitrate or polyphenol consumption was found in females. Among nitrate-rich foods, beneficial effects were seen for beetroot, but not red spinach or Swiss chard and rhubarb. For polyphenol-rich foods, benefits were found for grape, (nitrate-depleted) beetroot, French maritime pine, Montmorency cherry and pomegranate, while no significant effects were evident for New Zealand blackcurrant, cocoa, ginseng, green tea or raisins. Considerable heterogeneity between polyphenol studies may reflect food-specific effects or differences in study designs and subject characteristics. Well-trained males (V̇O 2max ≥65 ml.kg.min -1 ) exhibited small, significant benefits following polyphenol, but not nitrate consumption., Conclusion: Foods rich in polyphenols and nitrate provide trivial benefits for endurance exercise performance, although these effects may be food dependent. Highly trained endurance athletes do not appear to benefit from consuming nitrate-rich foods but may benefit from polyphenol consumption. Further research into food sources, dosage and supplementation duration to optimise the ergogenic response to polyphenol consumption is warranted. Further studies should evaluate whether differential sex-based responses to nitrate and polyphenol consumption are attributable to physiological differences or sample size limitations., Other: The review protocol was registered on the Open Science Framework ( https://osf.io/u7nsj ) and no funding was provided., (© 2021. The Author(s).)

Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) have been shown to exhibit altered ventilatory characteristics on the second of two progressive maximal cardiopulmonary exercise tests (CPET) performed on consecutive days. However, maximal exercise can exacerbate symptoms for ME/CFS patients and cause significant post-exertional malaise. Assessment of heart rate (HR) parameters known to track post-exertional fatigue may represent more effective physiological markers of the condition and could potentially negate the need for maximal exercise testing. Sixteen ME/CFS patients and 10 healthy controls underwent a sub-maximal warm-up followed by CPET on two consecutive days. Ventilation, ratings of perceived exertion, work rate (WR) and HR parameters were assessed throughout on both days. During sub-maximal warm-up, a time effect was identified for the ratio of low frequency to high frequency power of HR variability ( p =0.02) during sub-maximal warm-up, and for HR at ventilatory threshold ( p =0.03), with both being higher on Day Two of testing. A significant group ( p <0.01) effect was identified for a lower post-exercise HR recovery (HRR) in ME/CFS patients. Receiver operator characteristic curve analysis of HRR revealed an area under the curve of 74.8% ( p =0.02) on Day One of testing, with a HRR of 34.5bpm maximising sensitivity (63%) and specificity (40%) suggesting while HRR values are altered in ME/CFS patients, low sensitivity and specificity limit its potential usefulness as a biomarker of the condition., Competing Interests: JB was the inventor of the rHRI technology described in this article and is an employee of the University of South Australia and has assigned his rights in the technology to the University. The rHRI technology has been patented by the University of South Australia, which is seeking to commercialise it. Researchers MN, CB and KD are also employees of the University of South Australia, while RT is an adjunct researcher at the University., (Copyright © 2021 Nelson, Buckley, Thomson, Bellenger and Davison.)

Emerging technologies for wastewater treatment face an uphill battle to be adopted in practice because no large-scale costing data exists to prove their cost competitiveness. Similar technologies and their costing data offer some insight to the approximate cost, but more detailed estimates are required for a final decision on process selection. The circulating fluidized bed bioreactor (CFBBR) is one such technology, proven at the lab and pilot and scale, but is yet to be used on a large scale. In order to demonstrate the potential economic competitiveness of the CFBBR, a method of modifying the CapdetWorks costing software by first modeling the CFBBR in the GPS-X process simulation software was employed. The modelling was used to determine the necessary changes to a moving bed bioreactor (MBBR) process (media size, density, surface area, and bed fill fraction) in CapdetWorks to simulate the CFBBR and then generate costing estimates for both capital cost (CapEx) and operation and maintenance cost (OpEx). Benchmarking the cost estimates against simulations of conventional suspended and attached growth processes and external costing data from the US EPA was performed to both validate the costing method and analyze the CFBBR's economic competitiveness. The calculation of the net present value from the CapEx and OpEx showed that the CFBBR is predicted to have 10%-30% lower costs at low flows of 1.5 and 4.6 MGD and comparative costs to conventional processes at higher flows from 10 to 30 MGD. Furthermore, the smaller land footprint of the CFBBR-based plants and lower landfilled biosolids implies that the CFBBR's environmental footprint is superior to its competitors and offers advantages for both small-sized plants and large urban plants., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Rationale, Aims and Objectives: Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach., Methods: We report on changes in health system utilization by new refugee patients of the FHC from 2016 to 2017. We review the literature and summarize relevant theoretical understandings of quality management in complex adaptive systems as it applies to this case example., Results: Applying CAS principles in the FHC, utilization of the Emergency Department and Urgent Care Center by newly arrived refugee patients before their first clinic visit was reduced by more than half (total visits decreased from 31%-14% of the refugee patients). Our review of the literature demonstrates that traditional algorithmic top-down QI processes are most often unsuccessful in improving even a few single-disease metrics, and increases clinician burnout and penalizes clinicians who care for vulnerable patients. Improvement in a CAS occurs when front-line clinicians identify care gaps and are given the flexibility to learn and self-organize to enable new care processes to emerge, which are created from bottom-up leadership that utilize existing interdependencies and interact with the top levels of the organization through intelligent top-down causation. We give examples of early adapters who are better applying the principles of CAS change to their QI efforts., Conclusions: Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up., (© 2020 John Wiley & Sons, Ltd.)

The effect of the menstrual cycle on athlete performance, wellbeing and perceived exertion and fatigue is not well understood. Furthermore, it has not been investigated specifically in Australian Football athletes. This pilot study aimed to explore how naturally menstruating Australian Football athletes may be affected by menstrual cycle phase. The data collected from the routine monitoring of five naturally menstruating athletes (average menstrual cycle length of 28 ± 3 [SD] days) in one team (athlete age range 18-35 years) competing in the Women's Australian Football League during the 2019 season were retrospectively analysed to compare performance (countermovement jump parameters and adductor squeeze pressure), perceived exertion, perceived fatigue and wellbeing (perceived sleep quality, stress and soreness) outcomes between the follicular and luteal phases. Performance, perceived exertion, stress and soreness did not appear to be affected by menstrual cycle phase ( p > 0.17). However, perceived fatigue appeared to be significantly greater ( p = 0.042) and sleep quality worse ( p = 0.005) in the luteal phase. This pilot study suggests further research focusing on the effect of menstrual cycle phase on subjective fatigue and wellbeing is warranted.

Aβ(1-42) peptide is a neurotoxic agent strongly associated with the etiology of Alzheimer's disease (AD). Current treatments are still of very low effectiveness, and deaths from AD are increasing worldwide. Huprine-derived molecules have a high affinity towards the enzyme acetylcholinesterase (AChE), act as potent Aβ(1-42) peptide aggregation inhibitors, and improve the behavior of experimental animals. AVCRI104P4 is a multitarget donepezil-huprine hybrid that improves short-term memory in a mouse model of AD and exerts protective effects in transgenic Caenorhabditis elegans that express Aβ(1-42) peptide. At present, there is no information about the effects of this compound on human erythrocytes. Thus, we considered it important to study its effects on the cell membrane and erythrocyte models, and to examine its protective effect against the toxic insult induced by Aβ(1-42) peptide in this cell and models. This research was developed using X-ray diffraction and differential scanning calorimetry (DSC) on molecular models of the human erythrocyte membrane constituted by lipid bilayers built of dimyristoylphosphatidylcholine (DMPC) and dimyristoylphosphatidylethanolamine (DMPE). They correspond to phospholipids representative of those present in the external and internal monolayers, respectively, of most plasma and neuronal membranes. The effect of AVCRI104P4 on human erythrocyte morphology was studied by scanning electron microscopy (SEM). The experimental results showed a protective effect of AVCRI104P4 against the toxicity induced by Aβ(1-42) peptide in human erythrocytes and molecular models.

Human activities put stress on our oceans and with a growing global population, the impact is increasing. Stressors rarely act in isolation, with the majority of marine areas being impacted by multiple, concurrent stressors. Marine spatial cumulative impact assessments attempt to estimate the collective impact of multiple stressors on marine environments. However, this is difficult given how stressors interact with one another, and the variable response of ecosystems. As a result, assumptions and generalisations are required when attempting to model cumulative impacts. One fundamental assumption of the most commonly applied, semi-quantitative cumulative impact assessment method is that a change in modelled cumulative impact is correlated with a change in ecosystem condition. However, this assumption has rarely been validated with empirical data. We tested this assumption using a case study of seagrass in a large, inverse estuary in South Australia (Spencer Gulf). We compared three different seagrass condition indices, based on survey data collected in the field, to scores from a spatial cumulative impact model for the study area. One condition index showed no relationship with cumulative impact, whilst the other two indices had very small, negative relationships with cumulative impact. These results suggest that one of the most commonly used methods for assessing cumulative impacts on marine systems is not robust enough to accurately reflect the effect of multiple stressors on seagrasses; possibly due to the number and generality of assumptions involved in the approach. Future methods should acknowledge the complex relationships between stressors, and the impact these relationships can have on ecosystems. This outcome highlights the need for greater evaluation of cumulative impact assessment outputs and the need for data-driven approaches. Our results are a caution for marine scientists and resource managers who may rely on spatial cumulative impact assessment outputs for informing policy and decision-making., 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., (Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.)

Golf swing analysis is common in both recreational and professional levels where players are searching for improvements in shot accuracy and distance. The use of motion analysis systems such as the portable Polhemus Liberty system is gaining interest by coaches and players; however, to date, no research has examined the usefulness of the Polhemus Liberty system for golf swing analysis. Therefore, the purpose of this study was to determine the reliability of the Polhemus Liberty system and validity compared to the VICON Nexus motion analysis system when assessing segment (pelvis and thorax) and joint (shoulder, elbow and wrist) angular kinematics during a golf swing at key events (address, top of backswing and impact). Fifteen elite amateur/professional golfers performed ten golf swing trials within specified bounds using their 5-iron club. Reliability was assessed using interclass coefficient, effect size and t -test statistics by all participants completing two separate testing sessions on separate days following the same experimental protocol. Validity was assessed using effect size, Pearson correlation and t -test statistics by comparing swings captured using both Polhemus Liberty and VICON Nexus concurrently. Results demonstrated no difference in ball outcome results using the Trackman launch monitor ( P > 0.05) and that the Polhemus Liberty system was reliable across the two sessions for all segment (pelvis and thorax) and joint (lead shoulder (gleno-humeral joint), elbow and wrist) angular kinematics ( P > 0.05). Validity analysis showed that the Polhemus Liberty system for the segments (pelvis and thorax) and joints (lead shoulder and wrist) were different compared to the VICON Nexus data at key events during the golf swing. Although validity could not be confirmed against VICON Nexus modeling, the Polhemus Liberty system may still be useful for golf swing analysis across training sessions. However, caution should be applied when comparing data from the system to published research data using different motion analysis methods.

To meet the increasing wastewater treatment demand while minimizing the land footprint of the treatment systems and plants, more efficient and compact processes are needed. The circulating fluidized bed bioreactor (CFBBR) has been proven to achieve high levels of biological nutrient removal. Past studies at the lab and pilot scale achieved 94% COD removal and 80% nitrogen removal at HRT's of 2-4 h. A collaborative project between Western University and the Guangzhou Institute of Energy Conversion (GIEC), in Guangzhou, China, further explored the treatment of municipal wastewater with the CFBBR. A pilot CFBBR, with aerobic and anoxic columns for nitrification and denitrification, was constructed at the GIEC for in-situ treatment of septic tank effluent from a residential building. Due to high concentrations of ammonia (NH 4 -N), the wastewater had a COD/N ratio of 2-3. Thus, operating at a longer HRT and supplementing COD, in the form of glucose, was necessary to achieve a high nitrogen removal efficiency. The system was run both with and without supplemental COD at HRT's between 16 and 21 h, treating approximately 1000-1270 L/d. Overall, a COD removal efficiency of at least 92%, ammonia removal of 97%, and nitrogen removal of 82% was achieved. The CFBBR system achieved an effluent with BOD and NH 4 -N concentrations both below 5 mg/L, a NO 3 -N concentration below 15 mg/L, and a total nitrogen concentration below 25 mg/L. The compact design of this pilot-CFBBR, coupled with its high BNR performance make it an excellent option for decentralized treatment of urban wastewaters.

Abstract: Salagaras, BS, Mackenzie-Shalders, KL, Nelson, MJ, Fraysse, F, Wycherley, TP, Slater, GJ, McLellan, C, Kumar, K, and Coffey, VG. Comparisons of daily energy intake vs. expenditure using the GeneActiv accelerometer in elite Australian Football athletes. J Strength Cond Res 35(5): 1273-1278, 2021-To assess validity of the GeneActiv accelerometer for use within an athlete population and compare energy expenditure (EE) with energy and macronutrient intake of elite Australian Football athletes during a competition week. The GeneActiv was first assessed for utility during high-intensity exercise with indirect calorimetry. Thereafter, 14 professional Australian Football athletes (age, 24 ± 4 [SD] y; height, 1.87 ± 0.08 m; body mass, 86 ± 10 kg) wore the accelerometer and had dietary intake assessed via dietitian-led 24-hour recalls throughout a continuous 7 days of competition period (including match day). There was a significant relationship between metabolic equivalents and GeneActiv g·min-1 (SEE 1.77 METs; r2 = 0.64; p < 0.0001). Across the in-season week a significant difference only occurred on days 3 and 4 (day 3: energy intake [EI] EI 137 ± 31 kJ·kg-1·d-1; 11,763 ± 2,646 kJ·d-1 and EE: 186 ± 14 kJ·kg-1·d-1; 16,018 ± 1973 kJ·d-1; p < 0.05; d = -1.4; day 4: EI: 179 ± 44 kJ·kg-1·d-1, 15,413 ± 3,960 kJ·d-1 and EE: 225 ± 42 kJ·kg-1·d-1; 19,313 ± 3,072 kJ·d-1; d = -0.7). Carbohydrate intake (CI) was substantially below current sports nutrition recommendations on 6 of 7 days with deficits ranging from -1 to -7.2 g·kg-1·d-1 (p < 0.05), whereas daily protein and fat intake was adequate. In conclusion, the GeneActiv provides effective estimation of EE during weekly preparation for a professional team sport competition. Australian Footballers attempt to periodize dietary EI to varying daily training loads but fail to match expenditure on higher-training load days. Specific dietary strategies to increase CI may be beneficial to achieve appropriate energy balance and macronutrient distribution, particularly on days where athletes undertake multiple training sessions., (Copyright © 2021 National Strength and Conditioning Association.)

Objectives: Maximal aerobic speed (MAS) may be predicted from 2.0km time trial (TT) running speed in male Australian Rules football (AF) players. Given the between-sex differences in physiological variables precursory to endurance performance, and the impact of this on MAS distance limit, this study determined running speed across various TT distances best approximating MAS in female AF players., Method: 33 female AF players completed assessments of MAS and TT performance separated by at least 48h. In a randomised order, half of the athletes completed TT distances of 1.2, 1.6 and 2.0km, and the other half completed distances of 1.4, 1.8 and 2.2km. Bias, limits of agreement (LOA) and linear mixed modelling determined agreement between TT-derived running speed and MAS., Results: Average speed for all TT distances were different to MAS (bias≥0.59±0.45km·h -1 ; p≤0.015) with the exception of the 1.4km TT (bias=-0.12±0.26km·h -1 ; p=0.34). LOA was narrowest for the 1.4km TT (±0.76km·h -1 ; ±6.1%) compared to other TT distances (±0.82-1.67km·h -1 ; ±6.7-12.9%). A significant linear association between bias and TT distance (r=-0.73; p<0.001) indicated TT speed would be equal to MAS when a 1.4-1.5km TT was completed, and that MAS may be predicted from any distance between 1.2 and 2.2km., Conclusions: MAS was best approximated by a 1.4-1.5km TT in female AF players, but may be predicted from TT speed for any distance between 1.2 and 2.2km. TT-derived MAS provides a time and resource efficient method for the quantification of aerobic fitness and prescription of future training intensities., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Maximal rate of heart rate (HR) increase (rHRI) as a measure of HR acceleration during the transition from rest to exercise, or during an increase in workload, tracks exercise performance. rHRI assessed at relative rather than absolute workloads may track performance better, and a field test would increase applicability. This study therefore aimed to evaluate the sensitivity of rHRI assessed at individualised relative workloads during treadmill and overground running for tracking exercise performance. Treadmill running performance (5 km time trial; 5TTT) and rHRI were assessed in 11 male runners following 1 week of light training (LT), 2 weeks of heavy training (HT) and a 10-day taper (T). rHRI was the first derivative maximum of a sigmoidal curve fit to HR data collected during 5 min of treadmill running at 65% peak HR (rHRI65%), and subsequent transition to 85% peak HR (rHRI85%). Participants ran at the same speeds overground, paced by a foot-mounted accelerometer. Time to complete 5TTT likely increased following HT (ES = 0.14 ± 0.03), and almost certainly decreased following T (ES = - 0.30 ± 0.07). Treadmill and field rHRI65% likely increased after HT in comparison to LT (ES ≤ 0.48 ± 0.32), and was unchanged at T. Treadmill and field rHRI85% was unchanged at HT in comparison to LT, and likely decreased at T in comparison to LT (ES ≤ - 0.55 ± 0.50). 5TTT was not correlated with treadmill or field rHRI65% or rHRI85%. rHRI65% was highly correlated between treadmill and field tests across LT, HT and T (r ≥ 0.63), but correlations for rHRI85% were trivial to moderate (r ≤ 0.42). rHRI assessed at relative exercise intensities does not track performance. rHRI assessed during the transition from rest to running overground and on a treadmill at the same running speed were highly correlated, suggesting that rHRI can be validly assessed under field conditions at 65% of peak HR.

Background: Preparation of nursing students has traditionally occurred in academic settings where faculty develop programs of study. Practice settings often find themselves investing in significant education and support as the new-graduate nurse transitions into the RN role., Problem: A gap in preparation exists between academic and practice expectations for the generalist RN role., Approach: Collaboration among academic and practice partners in the development of a core clinical curriculum, along with supporting content and learning activities, provides enriched clinical experiences that enhance readiness for the practicing role., Outcomes: The Culture of Caring (COC) Model guides academic and practice partners as a teaching-learning framework for the preparation of nursing students., Conclusions: The COC clinical curriculum bundles together supporting resources that include a handbook, workbook, faculty pocket guide, calendar, and nursing student cards used to foster the clinical experience.

Objective: To evaluate the effectiveness of balloon dilation (tuboplasty) of the Eustachian tube (BET) in active duty military personnel working in hyper- and hypobaric environments suffering from baro-challenge-induced ETD using functional outcomes., Methods: Military divers and aviators diagnosed with persistent baro-challenge-induced ETD resulting in disqualification from performing flight and dive duties and who elected for treatment with BET were included for analysis. Posttreatment follow-up assessments were undertaken at 1, 6, and 12 months. Outcome measures included successful hyperbaric chamber testing or return to the hyper- or hypobaric environment without significant baro-challenge-induced ETD symptoms and pre- and postdilation Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores., Results: Mean pretreatment duration of symptoms was 48 months (range: 3-120 months). Following treatment, 92% (12/13) of patients successfully returned to operational duties with resolution of limiting symptoms. Average return to duty time was 8.5 weeks (range: 6-24 weeks). The ETDQ-7 scores improved from a mean of 4.33 (2.57-6.57) predilation to 2.19 (1.00-4.43) postdilation ( Z = 2.73, W = 70, P = .0063). Mean duration of follow-up was 38 weeks (range: 13-70 weeks)., Conclusion: Eustachian tube balloon dilation appears to be a safe and highly effective treatment option for baro-challenge-induced ETD in affected military divers and aviators who work in hyper- and hypobaric environments. Further study is needed to determine whether similar results can be achieved in more diverse subject populations and to assess long-term effectiveness.

Background: This study evaluated the use of several risk prediction models in estimating short- and long-term mortality following hip fracture in an Australian population., Methods: Data from 195 patients were retrospectively analysed and applied to three models of interest: the Nottingham Hip Fracture Score, the Age-Adjusted Charlson Comorbidity Index and the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity. The performance of these models was assessed with receiver operating characteristic curve as well as logistic regression modelling., Results: The median age of participants was 83 years and 69% were women. Ten percent of patients were deceased by 30 days, 25% at 6 months and 31% at 12 months post-operatively. While there was no statistically significant difference between the models, the Age-Adjusted Charlson Comorbidity Index had the largest area under the receiver operating characteristic curve for within 30 day and 12 month mortality, while the Nottingham Hip Fracture Score was largest for 6-month mortality. There was no evidence to suggest that the models were selecting a specific subgroup of our population, therefore, no indication was present to suggest that using multiple models would improve mortality prediction., Conclusions: While there was no statistically significant difference in mortality prediction, the Nottingham Hip Fracture Score is perhaps the best suited clinically, due to its ease of implementation. Larger prospective data collection across a variety of sites and its role in guiding clinical management remains an area of interest., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Phonemic paraphasias are thought to reflect phonological (post-semantic) deficits in language production. Here we present evidence that phonemic paraphasias in non-semantic primary progressive aphasia (PPA) may be associated with taxonomic interference. Agrammatic and logopenic PPA patients and control participants performed a word-to-picture visual search task where they matched a stimulus noun to 1 of 16 object pictures as their eye movements were recorded. Participants were subsequently asked to name the same items. We measured taxonomic interference (ratio of time spent viewing related vs. unrelated foils) during the search task for each item. Target items that elicited a phonemic paraphasia during object naming elicited increased taxonomic interference during the search task in agrammatic but not logopenic PPA patients. These results could reflect either very subtle sub-clinical semantic distortions of word representations or partial degradation of specific phonological word forms in agrammatic PPA during both word-to-picture matching (input stage) and picture naming (output stage). The mechanism for phonemic paraphasias in logopenic patients seems to be different and to be operative at the pre-articulatory stage of phonological retrieval. Glucose metabolic imaging suggests that degeneration in the left posterior frontal lobe and left temporo-parietal junction, respectively, might underlie these different patterns of phonemic paraphasia., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)