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This paper interrogates the phenomenon of boredom at work by considering Ernst Jünger’s potential contribution. We contend that Jünger offers an important yet overlooked alternative to the dominant perspectives of boredom in Management and Organization Studies (MOS), which are largely composed of ‘simple’ psychological diagnoses and managerial prescriptions. Such studies largely understand boredom as a localised experience at work which can be overcome by targeted managerial prescriptions, techniques and interventions. In contrast we show how Jünger understands boredom from a ‘profound’ perspective as a central feature of modernity. This is premised on Jünger’s broader critique of the bourgeois values that define 20th and 21st century managerial work and organization. Jünger’s cultural-historical perspective is therefore aligned to the discrete field of Boredom Studies. By addressing how Jünger understands ‘work’ as the defining feature of the modern age, his critique situates the phenomenon of boredom at work within the broader social, institutional and cultural order of the 21st Century. While Jünger does not set out to provide a theory of boredom as such, we reconstruct such a theory through an exegesis of his writing on ‘work’ and ‘danger’. This reveals boredom and danger as phenomenologically intertwined concepts, which is an understanding of boredom that has not been considered in MOS or Boredom Studies. It is through this, we argue, that Jünger’s conception of work holds the potential for a powerful critique and understanding of boredom at work under the contemporary regime of neoliberal managerialism.

Background: We evaluated the safety, efficacy, and acceptability of a new device designed to facilitate uterine compression in women with postpartum haemorrhage (PPH).Methods: A prospective, phase two clinical device trial with concurrent qualitative study, conducted in a UK consultant obstetric unit. The device was used in addition to standard care in women unresponsive to initial oxytocin therapy. The primary effectiveness outcome was additional blood loss of over 1000mls, whilst safety was assessed through adverse events. Interviews assessed device feasibility and acceptability, and were analyzed using framework analysis.Results: We recruited 57 women with clinical PPH after vaginal birth; 67% were primiparous and 47% had undergone operative birth. All but two (96%) had atony as a cause of the hemorrhage; in addition, 30% also had bleeding from lacerations and 11% had retained tissue.After device use, only one woman had additional blood loss over 1000mls, although 3 women (7%) needed a Bakri balloon and 14% received a blood transfusion. All but one clinician felt that the device was easy to use. Clinicians stated that the device assisted management in 85% of cases. All 56 women who responded stated that if they bled in a future birth they would want the device to be used again. There were no serious adverse events related to the device. However, 3 events were judged as ‘possibly’ being caused by the device - 2 minor vaginal grazes and one postnatal episiotomy infection and breakdown. Lax vaginal tissue complicated the use of the device in three women. In 47 interviews, participants, birth partners, clinician users and attending midwives viewed the device positively. Clinicians found it useful as a way of stopping blood loss and as an aid to diagnose the source of bleeding. Conclusions: The PPH Butterfly may provide a rapid, acceptable and effective treatment for postpartum hemorrhage. Clinical Trial Registration: prospective with ISRCTN15452399 11/09/2017 (www.isrctn.com/ISRCTN15452399).

Objectives The elderly are the most at-risk population for heat-related illness and mortality during the periods of hot weather. However, evidence-based elderly-specific cooling strategies to prevent heat-illness are limited. The aim of this investigation was to quantify the elderly's physiological and perceptual responses to cooling through cold water ingestion (COLD) or an L-menthol mouth rinse (MENT) during simulated activities of daily living in UK summer climatic conditions. Study design Randomised, controlled repeated measures research design. Methods A total of ten participants (men n = 7, women n = 3: age; 69 ± 3 yrs, height; 168 ± 10 cm, body mass; 68.88 ± 13.72 kg) completed one preliminary and three experimental trials; control (CON), COLD and MENT. Experimental trials consisted of 40 min rest followed by 30 min of cycling exercise at 6 metabolic equivalents and a 6-min walk test (6MWT), within a 35 °C, 50% relative humidity environment. Experimental interventions (every 10 min); cold water (4 °C) ingestion (total of 1.5L) or menthol (5 ml mouth swill for 5 s, menthol concentration of 0.01%). Results Peak rectal temperature (Tre) was significantly (P Conclusion The elderly have reduced physiological strain (Tre and HR) during activities of daily living and a 6MWT in hot UK climatic conditions, when they drink cold water. Furthermore, the elderly's perception (TS and TC) of the hot environment did not differ from CON at the end of exercise with COLD or MENT interventions. Menthol provided neither perceptual benefit to exercise in the heat nor functional gain. The TS data indicate that elderly may be at increased risk of heat illness, due to not feeling hot and uncomfortable enough to implement physiological strain reducing strategies such as cold-water ingestion.

KEY POINTS Patients with renal failure undergoing maintenance haemodialysis are associated with insulin resistance and protein metabolism dysfunction. Novel research suggests that disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in haemodialysis. ILK, PINCH1 and pFAKTyr397 were significantly decreased in haemodialysis compared to controls, whereas Rac1 and Akt2 showed no different between groups. Rac1 deletion in the Rac1 knockout model did not alter the expression of integrin-associated proteins. Phenylalanine kinetics were reduced in the haemodialysis group at 30 and 60 min post meal ingestion compared to controls; both groups showed similar levels of insulin sensitivity and β-cell function. Key proteins in the integrin-cytoskeleton linkage are reduced in haemodialysis patients, suggesting for the first time that integrin-associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients. ABSTRACT Muscle atrophy, insulin resistance and reduced muscle phosphoinositide 3-kinase-Akt signalling are common characteristics of patients undergoing maintenance haemodialysis (MHD). Disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in MHD patients. Eight MHD patients (age: 56 ± 5 years: body mass index: 32 ± 2 kg m-2 ) and non-diseased controls (age: 50 ± 2 years: body mass index: 31 ± 1 kg m-2 ) received primed continuous l-[ring-2 H5 ]phenylalanine before consuming a mixed meal. Phenylalanine metabolism was determined using two-compartment modelling. Muscle biopsies were collected prior to the meal and at 300 min postprandially. In a separate experiment, skeletal muscle tissue from muscle-specific Rac1 knockout (Rac1 mKO) was harvested to investigate whether Rac1 depletion disrupted the cytoskeleton-integrin linkage, allowing for cross-model examination of proteins of interest. ILK, PINCH1 and pFAKTyr397 were significantly lower in MHD (P

Background: Several interventions have been used to relieve chronic low back pain (CLBP). This study aimed to compare the effects of pain neuroscience education (PNE) followed by motor control exercises (MCEs) with core stability training (CST) on pain, disability, and balance in women with CLBP. Methods: Thirty-seven women with CLBP were randomly divided into two groups of PNE/MCE (n = 18, 55.2 ± 2.6 years) or CST (n = 19, 54.6 ± 2.4 years). Eight weeks of PNE/MCE or CST were prescribed for each group, independently. Pain intensity (VAS scale), disability (Roland Morris Disability Questionnaire), unipodal static balance, and dynamic balance (time up and go test) were measured at the beginning and 8 weeks after the intervention. Two-way mixed ANOVA was used to analyze the results with alpha of 5%. Results: After 8 weeks, there was a significant difference in VAS scale between groups (p = 0.024), with both PNE/MCE and CST showing 58% and 42% reductions, respectively. There were no differences for all other variables between groups. Regarding pre- to post-comparisons, both groups showed improvements in all dependent variables (p < 0.001). Conclusion: The treatment with PNE/MCE was more effective in improving pain disability and unipodal static and dynamic balance than treatment with CST. Even so, both treatments were shown to be valid and safe in improving all dependent variables analyzed in women with CLBP.

This study aimed to examine the impact of extreme heat exposure frequency on inflammation and well-being in UK Fire Service personnel.136 Fire personnel and 14 controls (CON) were recruited [92 Firefighters (FF), 44 Breathing Apparatus Instructors (BAI)]. BAI were split into low (LBAI; ≤15 exposures per month) and high (HBAI; ≥20 exposures per month) categories. Measures of inflammation, mood and fatigue were collected at 0, 3 and 6 month times points. These variables were analysed for differences between groups and association with frequency of exposure.HBAI exhibited raised IL-1β, IL-6, IL-10, IgE and lower IgM (p 0.05). In addition, IL-1β, IL-6, IL-10 and IgM were associated with monthly exposure number, with exposures accounting for 15.4% of the variance in IL-6, 11.8% of IL-1β and 25.2% of IL-10. No differences in mood or fatigue were reported (p 0.05).High exposure firefighting consistently causes systemic inflammation without perceptual recognition of potential health risks.

Purpose This paper aims to reconsider the significance of Henry Ford’s claim that “History is more or less bunk”. It argues that this seemingly philistine remark can be understood as a specific historiographical position which informed Ford’s wider worldview, management approach and philosophy of industry. Design/methodology/approach The paper draws on primary philosophical works, secondary criticism and archival evidence. These sources detail the context in which the claim was made, the ideas underpinning its articulation and the conceptual basis on which Ford’s wider perspectives and contributions to historical experience can be interpreted. Findings This paper interprets Ford’s claim as a gesture of allegiance to a deeper cultural sensibility that was informed by Ralph Waldo Emerson’s transcendental view of history. Practical implications In addition to offering a rereading of Ford’s historiographical position, Emerson’s thought is discussed in relation to Ford’s subsequent “living history” project (Greenfield Village), which is considered the materialisation of his historical and industrial worldview. Originality/value This interpretation reveals how a specific historiographical position held by one of the twentieth century’s leading industrialists offers new insights into his wider worldview and philosophy of industry. It contributes to recent studies that challenge taken-for-granted narratives in management history and recent work that has highlighted the influence of transcendental principles on Ford’s philosophy of industry.

Since it was first articulated by Antonio Gramsci in his Prison Notebooks (1929–1935), Fordism has been understood at two interconnected levels. At one level, it is understood in secular materialist terms as an archetypal system of mass production. At another, as a techno-economic paradigm of capitalist expansion. However, little attention has been given to the philosophical influences and ideas that underpinned Henry Ford’s (1863–1947) worldview and how this came to influence the formation of the factory systems at his Highland Park and River Rouge complexes. In most textbooks, it is assumed that Ford based his industrial design on a technological intensification of F.W. Taylor’s Principles of Scientific Management. This article seeks to examine the origins and rationale behind Ford’s factory system by exploring the relationship between his personal worldview and the ‘ism’ which came to bear his name. Through a cultural-historical analysis, this article critically explores Henry Ford’s personal Fordism, and argues that what has come to be understood as one of the most ‘secular’ and ‘materialist’ processes of organising ‘men and machine’ began with an attempt by Henry Ford to realise a ‘metaphysical’ ideal that was informed by the popular philosophical and theological thought of the previous century. By returning to the ideas and the context of this period, Ford’s engagement with the work of the American Transcendentalist, Ralph Waldo Emerson (1803–1882) is considered to both contextualise Henry Ford’s Fordism and explore the philosophical tensions at the heart of his organisational theory and practice.

The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.

Objectives To investigate the efficacy of heat acclimation (HA) in the young (YEX) and elderly (EEX) following exercise-HA, and the elderly utilising post-exercise hot water immersion HA (EHWI). Design Cross-sectional study. Method Twenty-six participants (YEX: n = 11 aged 22 ± 2 years, EEX: n = 8 aged 68 ± 3 years, EHWI: n = 7 aged 73 ± 3 years) completed two pre-/post-tests, separated by five intervention days. YEX and EEX exercised in hot conditions to raise rectal temperature (Trec) ≥38.5 °C within 60 min, with this increase maintained for a further 60 min. EHWI completed 30 min of cycling in temperate conditions, then 30 min of HWI (40 °C), followed by 30 min seated blanket wrap. Pre- and post-testing comprised 30 min rest, followed by 30 min of cycling exercise (3.5 W·kg−1 Ḣprod), and a six-minute walk test (6MWT), all in 35 °C, 50% RH. Results The HA protocols did not elicit different mean heart rate (HR), Trec, and duration Trec ≥ 38.5 °C (p > 0.05) between YEX, EEX, and EHWI groups. Resting Trec, peak skin temperature, systolic and mean arterial pressure, perceived exertion and thermal sensation decreased, and 6MWT distance increased pre- to post-HA (p 0.05). Conclusions Irrespective of age or intervention, HA induced thermoregulatory, perceptual and exercise performance improvements. Both exercise-HA (EEX), and post-exercise HWI (EHWI) are considered viable interventions to prepare the elderly for heat stress.

This paper seeks to examine, in cultural-historical perspective, how the ‘graduate’ has developed as a character central to a significant segment of the contemporary labour market. The argument begins by showing how the rise of the ‘new’ or ‘knowledge economy’ (throughout the 1990s and 2000s) became a new source of pressure on generations entering the world of work. Higher education has been, and continues to be, presented by political, corporate and educational institutions as a core platform upon which future possibilities of personal achievement and accomplishment depend. Gradually, the vocabulary and character of the ‘graduate’ has become more visible through complex and refined modes of cultural dissemination. The themes through which this character is articulated today have, we argue, cultural roots that are not entirely new. With reference to David Riesman’s early understanding of the formation of this kind of cultural ‘character’ (The Lonely Crowd, 1950), we examine Charles Webb’s novel The Graduate (1963). As a cultural-historical resource, it can be re-visited half-a-century later in order to investigate the historical movement of certain themes and questions that now outline what a ‘graduate’ could and should be. The imperatives that underlie the labour market for graduate schemes open up questions that pertain not only to immediate matters of employment. Rather, the discourses of ‘graduate work’ and ‘employability’ now appropriate deeper concerns regarding the meaning of individual freedom, choice, and self-determination. Who is the graduate and what are some of its cultural roots?

The progression from pre-diabetes to overt type 2 diabetes is largely attributed to β-cell dysfunction and reduced insulin responsiveness. Exercise improves β-cell function in type 2 diabetics, however in pre-diabetic populations there is no data to support a similar response to acute high intensity exercise. Nine individuals diagnosed with prediabetes [HbA1c; 6.1 (0.2)%)] underwent a resting control, a continuous exercise and a high-intensity exercise trial.

BACKGROUND CONTEXT Surgical site infections (SSIs) after spinal fusion surgery increase healthcare costs, morbidity and mortality. Routine measures of obesity fail to consider site specific fat distribution. PURPOSE To assess the association between the spine adipose index and deep surgical site infection and determine a threshold value for spine adipose index that can assist in preoperative risk stratification in patients undergoing posterior instrumented lumbar fusion (PILF). STUDY DESIGN/SETTING Multicenter retrospective case-control study. PATIENT SAMPLE We reviewed patients who underwent PILF from January 1, 2010 to December 31, 2018. OUTCOME MEASURES All patients developing a deep primary incisional or organ-space SSI within 90 days of surgery as per US Center for Disease Control and Prevention criteria were identified. We gathered potential pre-operative and intra-operative deep infection risk factors for each patient. A 1:1 match was performed using the following criteria: gender, age (±3 y), ethnicity, date of surgery (± 1 y), and hospital location of surgery. Spine adipose index was measured on pre-operative mid-sagittal cuts of T2 weighted MRI scans. Each measurement was repeated twice by three authors in a blinded fashion, with each series of measurement separated by a period of at least six weeks. Methods Stepwise binary logistic regression analysis was used to assess the association between SAI and the development of deep SSI. Separate logistic regression models were used for body mass index (BMI) and direct measures of subcutaneous fat thickness. Receiver Operating Characteristic analysis was used to determine the optimal value for SAI, and subsequent risk ratios were calculated using the identified threshold. Intra- and inter-observer reliabilities were assessed using intra-class coefficients. Results Forty-two patients were included in final analysis, with twenty-one cases and twenty-one matched controls. The spine adipose index was significantly greater in patients developing deep SSI (p=.029), and this relationship was maintained after adjusting for confounders (p=.046). Risk of developing deep SSI following PILF surgery was increased 2.0-fold when the spine adipose index was ≥0.51. The spine adipose index had excellent (ICC >0.9; p Conclusion The spine adipose index is a novel radiographic measure and an independent risk factor for developing deep SSI, with 0.51 being the ideal threshold value for pre-operative risk stratification in patients undergoing PILF surgery.

Background Gout has been associated with weaker foot/leg muscles and altered gait patterns. There is also evidence of on-going foot pain and an increased risk of tendinopathy, with the Achilles and patella tendons most frequently affected in gout. Additionally, the inflammation associated with gout may change tissue elasticity. Ultrasound imaging utilising shear wave elastography (SWE) offers a non-invasive method of quantifying changes in tendon stiffness. SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with gout compared to controls (non-gout). Methods A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated, and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along the centre of a longitudinal section of the mid-portion of each Achilles tendon. Prior to data collection, intra-observer error was good (>0.69). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 m/s (95% CI (0.38 to 1.7) p = 0.003 and left Achilles mdiff = 0.7 m/s (95% CI 0.09 to 1.32) p = 0.025. No relationship between the presence of tophi and SWE values were detected. Conclusion Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

This reflective case-history presents the findings of a 12-week pilot study of a collaborative organizational change project which oversaw the implementation of predictive policing technology (PPT) into a territorial police force in the North of England. Based on the first year of a two-year initiative, the reflections consider the impact on the future of the project and their potential future application and cultural embeddedness, beyond the organizational and time-bound specifics of this case.

This study aimed to identify a pre-cooling method to reduce the physiological and perceptual strain, and the inflammatory response, experienced by individuals who wear personal protective equipment. Eleven males (age 20 ± 2 years, weight 75.8 ± 9.3 kg, height 177.1 ± 5.0 cm) completed 15min pre-cooling (phase change vest [PCV], forearm cooling [ARM], ice slurry consumption [ICE], or a no cooling control [CON]) and 45min intermittent walk (4 km h-1, 1% gradient) in 49.5 ± 0.6 °C and 15.4 ± 1.0% RH, whilst wearing firefighter ensemble. ICE reduced rectal temperature (Tre) before heat exposure compared to CON (ΔTre: 0.24 ± 0.09 °C, p < 0.001, d=0.38) and during exercise compared to CON, ARM, and PCV (p=0.026, ηp 2=0.145). Thermal sensation was reduced in ICE and ARM vs. CON (p=0.018, ηp 2=0.150). Interleukin-6 was not affected by precooling (p=0.648, ηp 2=0.032). It is recommended that those wearing protective equipment consume 500 ml of ice slurry 15min prior to work to reduce physiological and perceptual strain.

Analysis of Fire Service Instructors (FSI) working practices and health is needed to minimise health risks related to heat illness, cardiovascular events and immunological stress. Online surveys were distributed to UK FSI and Firefighters (FF). One hundred and thirty FSI (age: 43 ± 7yrs) and 232 FF (age: 41 ± 8yrs) responded. FSI experienced 2-10 live fires per week, with 45% of FSI reporting management does not set a limit on the number of exposures. Few FSI followed hydration guidelines, or cooling methods. New symptoms of ill health were reported by 41% of FSI and 21% of FF. FSI with ≥11 Breathing Apparatus exposures per month were 4.5 times (95% CI 1.33-15.09) more likely to experience new symptoms. A large proportion of FSI are experiencing new symptoms of illness after starting their career, and guidelines on exposure and hydration are not universally in place to reduce the risk of future health problems.

Insulin resistance (IR) in skeletal muscle contributes to whole body hyperglycemia and the secondary complications associated with type 2 diabetes. Inositol hexakisphosphate kinase-1 (IP6K1) may inhibit insulin-stimulated glucose transport in this tissue type.Muscle and plasma IP6K1 were correlated with two-compartment models of glucose control in insulin-resistant hyperinsulinemic individuals. Muscle IP6K1 was also compared after two different exercise trials.Nine prediabetic [hemoglobin A1c; 6.1% (0.2%)] patients were recruited to take part in a resting control, a continuous exercise (90% of lactate threshold), and a high-intensity exercise trial (6 30-second sprints). Muscle biopsies were drawn before and after each 60-minute trial. A labeled ([6,62H2]glucose) intravenous glucose tolerance test was performed immediately after the second muscle sample.Fasting muscle IP6K1 content did not correlate with insulin sensitivity (SI2*) (P = 0.961). High-intensity exercise reduced IP6K1 muscle protein and messenger RNA expression (P = 0.001). There was no effect on protein IP6K1 content after continuous exercise. Akt308 phosphorylation of was significantly greater after high-intensity exercise. Intermittent exercise reduced hepatic glucose production after the same trial. The same intervention also increased SI2*, and this effect was significantly greater compared with the effect of continuous exercise improvements. Our in vitro experiment demonstrated that the chemical inhibition of IP6K1 increased insulin signaling in C2C12 myotubes.The in vivo and in vitro approaches used in the current study suggest that a decrease in muscle IP6K1 may be linked to whole body increases in SI2*. In addition, high-intensity exercise reduces hepatic glucose production in insulin-resistant individuals.

To prepare for extremes of heat, cold or low partial pressures of oxygen (O2), humans can undertake a period of acclimation or acclimatization to induce environment-specific adaptations, e.g. heat acclimation (HA), cold acclimation (CA), or altitude training. While these strategies are effective, they are not always feasible due to logistical impracticalities. Cross-adaptation is a term used to describe the phenomenon whereby alternative environmental interventions, e.g. HA or CA, may be a beneficial alternative to altitude interventions, providing physiological stress and inducing adaptations observable at altitude. HA can attenuate physiological strain at rest and during moderate-intensity exercise at altitude via adaptations allied to improved O2 delivery to metabolically active tissue, likely following increases in plasma volume and reductions in body temperature. CA appears to improve physiological responses to altitude by attenuating the autonomic response to altitude. While no cross-acclimation-derived exercise performance/capacity data have been measured following CA, post-HA improvements in performance underpinned by aerobic metabolism, and therefore dependent on O2 delivery at altitude, are likely. At a cellular level, heat shock protein responses to altitude are attenuated by prior HA, suggesting that an attenuation of the cellular stress response and therefore a reduced disruption to homeostasis at altitude has occurred. This process is known as cross-tolerance. The effects of CA on markers of cross-tolerance is an area requiring further investigation. Because much of the evidence relating to cross-adaptation to altitude has examined the benefits at moderate to high altitudes, future research examining responses at lower altitudes should be conducted, given that these environments are more frequently visited by athletes and workers. Mechanistic work to identify the specific physiological and cellular pathways responsible for cross-adaptation between heat and altitude, and between cold and altitude, is warranted, as is exploration of benefits across different populations and physical activity profiles.

This study investigated the effect of 5 days of controlled short-term heat acclimation (STHA) on the determinants of endurance performance and 5-km performance in runners, relative to the impairment afforded by moderate heat stress. A control group (CON), matched for total work and power output (2.7 W·kg−1), differentiated thermal and exercise contributions of STHA on exercise performance. Seventeen participants (10 STHA, 7 CON) completed graded exercise tests (GXTs) in cool (13 °C, 50% relative humidity (RH), pre-training) and hot conditions (32 °C, 60% RH, pre- and post-training), as well as 5-km time trials (TTs) in the heat, pre- and post-training. STHA reduced resting (p = 0.01) and exercising (p = 0.04) core temperature alongside a smaller change in thermal sensation (p = 0.04). Both groups improved the lactate threshold (LT, p = 0.021), lactate turnpoint (LTP, p = 0.005) and velocity at maximal oxygen consumption (vV̇O2max; p = 0.031) similarly. Statistical differences between training methods were observed in TT performance (STHA, −6.2(5.5)%; CON, −0.6(1.7)%, p = 0.029) and total running time during the GXT (STHA, +20.8(12.7)%; CON, +9.8(1.2)%, p = 0.006). There were large mean differences in change in maximal oxygen consumption between STHA +4.0(2.2) mL·kg−1·min−1 (7.3(4.0)%) and CON +1.9(3.7) mL·kg−1·min−1 (3.8(7.2)%). Running economy (RE) deteriorated following both training programmes (p = 0.008). Similarly, RE was impaired in the cool GXT, relative to the hot GXT (p = 0.004). STHA improved endurance running performance in comparison with work-matched normothermic training, despite equality of adaptation for typical determinants of performance (LT, LTP, vV̇O2max). Accordingly, these data highlight the ergogenic effect of STHA, potentially via greater improvements in maximal oxygen consumption and specific thermoregulatory and associated thermal perception adaptations absent in normothermic training.

Multistage, ultra-endurance events in hot, humid conditions necessitate thermal adaptation, often achieved through short term heat acclimation (STHA), to improve performance by reducing thermoregulatory strain and perceptions of heat stress. This study investigated the physiological, perceptual and immunological responses to STHA prior to the Marathon des Sables. Eight athletes (age 42 ± 4 years and body mass 81.9 ± 15.0 kg) completed 4 days of controlled hyperthermia STHA (60 min·day‒1, 45°C and 30% relative humidity). Pre, during and post sessions, physiological and perceptual measures were recorded. Immunological measures were recorded pre-post sessions 1 and 4. STHA improved thermal comfort (P = 0.02), sensation (P = 0.03) and perceived exertion (P = 0.04). A dissociated relationship between perceptual fatigue and Tre was evident after STHA, with reductions in perceived Physical (P = 0.04) and General (P = 0.04) fatigue. Exercising Tre and HR did not change (P > 0.05) however, sweat rate increased 14% (P = 0.02). No changes were found in white blood cell counts or content (P > 0.05). Four days of STHA facilitates effective perceptual adaptations, without compromising immune status prior to an ultra-endurance race in heat stress. A greater physiological strain is required to confer optimal physiological adaptations.

BACKGROUND: We have recently shown that a novel signalling kinase, inositol hexakisphosphate kinase 1 (IP6K1), is implicated in whole-body insulin resistance via its inhibitory action on Akt. Insulin and insulin like growth factor 1 (IGF-1) share many intracellular processes with both known to play a key role in glucose and protein metabolism in skeletal muscle. AIMS: We aimed to compare IGF/IP6K1/Akt signalling and the plasma proteomic signature in individuals with a range of BMIs after ingestion of lean meat. METHODS: Ten lean [Body mass index (BMI) (in kg/m(2)): 22.7 ± 0.4; Homeostatic model assessment of insulin resistance (HOMA(IR)): 1.36 ± 0.17], 10 overweight (BMI: 27.1 ± 0.5; HOMA(IR): 1.25 ± 0.11), and 10 obese (BMI: 35.9 ± 1.3; HOMA(IR): 5.82 ± 0.81) adults received primed continuous L-[ring-(13)C(6)]phenylalanine infusions. Blood and muscle biopsy samples were collected at 0 min (post-absorptive), 120 min and 300 min relative to the ingestion of 170 g pork loin (36 g protein and 5 g fat) to examine skeletal muscle protein signalling, plasma proteomic signatures, and whole-body phenylalanine disappearance rates (R(d)). RESULTS: Phenylalanine R(d) was not different in obese compared to lean individuals at all time points and was not responsive to a pork ingestion (basal, P = 0.056; 120 & 300min, P > 0.05). IP6K1 was elevated in obese individuals at 120 min post-prandial vs basal (P < 0.05). There were no acute differences plasma proteomic profiles between groups in the post-prandial state (P > 0.05). CONCLUSIONS: These data demonstrate, for the first time that muscle IP6K1 protein content is elevated after lean meat ingestion in obese adults, suggesting that IP6K1 may be contributing to the dysregulation of nutrient uptake in skeletal muscle. In addition, proteomic analysis showed no differences in proteomic signatures between obese, overweight or lean individuals.

Background In addition to acute attacks of severe joint pain and swelling, chronic gout has been associated with weaker foot/leg muscles, altered gait patterns and on-going foot pain. Inflammation associated with gout may change tissue elasticity and ultrasound imaging (US) utilising elastography is a non-invasive method of quantifying these changes in tendon stiffness and elastography findings have not previously been reported in individuals with gout. Objectives To determine differences in Achilles tendon stiffness in people with chronic gout compared to controls (non gout) Methods A cross sectional study comparing people with gout according to 2015 ACR/EULAR criteria and age/sex matched controls. Clinical and demographic data were collated and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Previously validated protocols for conventional US imaging [1] and shear wave elastography [2] were used. Prior to data collection, intra-observer error was good (ICC (2) 0.69 (95%CI 0.62-0.89)). Ten elastography measures were taken along a longitudinal section of the mid-point of the Achilles tendon bilaterally. Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare elastography outcomes between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results A total of 14 people with gout and 13 age/sex matched control subjects participated. Table 1 displays clinical and demographic data. A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons n=7 (27%) for both). There was no significant difference in tendon thickness between groups, neo-vascularity was present in n=3 (21%) gout participants. Elastography findings (table 2) demonstrated significantly reduced tendon stiffness in those with gout compared to controls. Conclusion Subjects with chronic gout show reduced Achilles tendon stiffness compared to controls. From a clinical standpoint, our findings were similar to elastography measurements in otherwise healthy subjects with Achilles tendinopathy and who did not have gout [3]. References [1] Carroll M, Dalbeth N, Allen B, et al. Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls. J Rheumatol. 2017 44(10):1487-1492. [2] Payne C, Watt P, Cercignani M, Webborn N. Reproducibility of shear wave elastography measures of the Achilles tendon. Skeletal Radiol. 2017 17 2846-8. [3] Payne C 2018 Clinical Applications of shear wave elastography to Achilles tendon imaging and monitoring of a rehabilitation protocol for Achilles tendonopathy PhD Thesis, University of Brighton Disclosure of Interests None declared

Objectives Fire Service Instructors (FSI) experience repeated fire exposures a median of 13 ± 8 times a month; consequently they may develop an acclimatised state. However, the chronic immunological implications of heat acclimation are yet to be understood. This study aimed to establish whether FSI exhibit an increased heat tolerance and altered immunological response to heat exposures, compared to non-exposed individuals. The study also aimed to identify if heat tolerance is related to symptoms of ill health. Methods Twenty-two participants were recruited: 11 FSI (age: 41 ± 7 yrs, body mass: 77.4 ± 12.2 kg, height: 174.1 ± 8.2 cm) and 11 non-exposed controls (CON) (age: 41 ± 7 yrs, body mass: 75.9 ± 12.2 kg, height: 177.0 ± 8.1 cm). Participants completed a 40 min heat occupational tolerance test (HOTT) exercising at 6 W kg−1 (50.0 ± 1.0 °C, 12.3 ± 3.3% relative humidity) on two occasions, separated by 2 months. Physiological and perceptual measures were collected throughout and venous blood samples were collected prior to and post exposure. Results FSI displayed significantly reduced peak rectal temperature (Tre) (−0.42 °C), change in Tre (−0.33 °C), and thermal sensation (−1.0) and increased sweat rate (+0.25 L h−1) at the end of the HOTT compared to CON (p Conclusion Despite increased heat tolerance compared to non-exposed individuals, FSI may develop a maladaptation to repeated fire exposures, with elevated resting cytokine levels and an increased prevalence of ill health symptoms.

While there is evidence that age-related changes in cognitive performance and brain structure can be offset by increased exercise, little is known about the impact long-term high-effort endurance exercise has on these functions. In a cross-sectional design with 12-month follow-up, we recruited older adults engaging in high-effort endurance exercise over at least 20 years, and compared their cognitive performance and brain structure with a nonsedentary control group similar in age, sex, education, IQ, and lifestyle factors. Our findings showed no differences on measures of speed of processing, executive function, incidental memory, episodic memory, working memory, or visual search for older adults participating in long-term high-effort endurance exercise, when compared without confounds to nonsedentary peers. On tasks that engaged significant attentional control, subtle differences emerged. On indices of brain structure, long-term exercisers displayed higher white matter axial diffusivity than their age-matched peers, but this did not correlate with indices of cognitive performance.

Ischaemic preconditioning (IP) has been shown to be ergogenic for endurance performance in normothermic conditions and alleviate physiological strain under hypoxia, potentially through haemodynamic and/or metabolic mechanisms. Exertional hyperthermia is characterised by competition for blood flow between the muscles and skin, an enhanced metabolic strain and impaired endurance performance. This study investigated the effect of IP on the determinants of endurance performance, through an incremental exercise test in the heat.Eleven males completed two graded exercise tests in the heat (32 °C, 62 % RH) until volitional exhaustion, preceded by IP (4 × 5 min 220 mmHg bilateral upper leg occlusion) or a control (CON) condition (4 × 5-min 50 mmHg bilateral).IP did not improve running speeds at fixed blood lactate concentrations of 2 and 4 mMol L(-1) (p = 0.828), or affect blood glucose concentration throughout the trial [mean (±SD); CON 5.03 (0.94) mMol L(-1), IP 5.47 (1.38) mMol L(-1), p = 0.260). There was no difference in [Formula: see text]O2max [CON 55.5 (3.7) mL kg(-1) min(-1), IP 56.0 (2.6) mL kg(-1) min(-1), p = 0.436], average running economy [CON 222.3 (18.0) mL kg(-1) km(-1), IP 218.9 (16.5) mL kg(-1) km(-1), p = 0.125], or total running time during graded exercise [CON 347 (42) s, IP 379 (68) s, p = 0.166]. The IP procedure did not change muscle temperature [CON ∆ = 0.55 (0.57) °C, IP ∆ = 0.78 (0.85) °C, p = 0.568], but did reduce T CORE during exercise (~-0.1 °C, p = 0.001).The novel application of IP prior to exercise in the heat does not enhance the determinants of endurance performance. For events where IP appears ergogenic, muscle warming strategies are unnecessary as IP does not influence deep muscle temperature.

Although the mechanisms are largely unidentified, the chronic or intermittent hypoxic patterns occurring with respiratory diseases, such as chronic pulmonary disease or obstructive sleep apnea (OSA) and obesity, are commonly associated with glucose intolerance. Indeed, hypoxia has been widely implicated in the development of insulin resistance either via the direct action on insulin receptor substrate (IRS) and protein kinase B (PKB/Akt) or indirectly through adipose tissue expansion and systemic inflammation. Yet hypoxia is also known to encourage glucose transport using insulin-dependent mechanisms, largely reliant on the metabolic master switch, 5′ AMP-activated protein kinase (AMPK). In addition, hypoxic exposure has been shown to improve glucose control in type 2 diabetics. The literature surrounding hypoxia-induced changes to glycemic control appears to be confusing and conflicting. How is it that the same stress can seemingly cause insulin resistance while increasing glucose uptake? There is little doubt that acute hypoxia increases glucose metabolism in skeletal muscle and does so using the same pathway as muscle contraction. The purpose of this review paper is to provide an insight into the mechanisms underpinning the observed effects and to open up discussions around the conflicting data surrounding hypoxia and glucose control.

This paper is an attempt to understand the rise of ‘the dropout’ as a central figure in the wider myth of entrepreneurial success. Over the past decade, a large number of ‘tech entrepreneurs’ share a success that is often attributed to the fact that they ‘dropped out’ from their respective universities. To address this, the paper begins by exploring the inherent irony that a number of high-profile ‘dropout entrepreneurs’ have given graduation commencement speeches: the irony being that their narrative of success and hope is articulated to those who, as graduates, can never follow this path. From this, the paper traces the cultural lineage of ‘dropping out’ over the latter half of the twentieth century from a position of denigration to the embodiment of the celebrated values of entrepreneurship and its central association with ‘self-reliance’ as an ideal that continues to underpin the ‘American Myth of Entrepreneurial Success.’

Fire service instructors (FSI) regularly experience different types of fire exercises, however the strain experienced from these scenarios is not well understood. This study aims to identify the physiological and perceptual strain of Fire Service Instructors (FSI) to three training exercises: DEMO, ATTACK, COMPARTMENT, and the different roles performed: SETTER, INSTRUCTOR. The study also aims to assess the effect that different exercise patterns over a day (BOX, MULTI, COMBINATION) have on immunological responses. Sixteen FSI (age: 41 ± 8 years, body mass: 83.7 ± 6.7 kg, height: 177.0 ± 6.7 cm) were recruited, with 10 FSI completing the three exercises. Physiological and perceptual measures were collected prior to and immediately post each exercise. Venous blood samples were collected at the beginning and end of each day. One-way analysis of variance (ANOVA) were conducted to assess differences in physiological variables between exercise types, independent samples t-tests were conducted between roles. Day changes in hematological variables were assessed by paired sample t-tests and analyzed by one-way ANOVAs to identify differences between exercise patterns. The COMPARTMENT exercise resulted in a greater change in rectal temperature (ΔT

OBJECTIVE\ud \ud To assess the reproducibility of shear wave elastography (SWE) measures in the Achilles tendon (AT) in vivo.\ud \ud MATERIALS AND METHODS\ud \ud Shear wave velocity (SWV) of 14 healthy volunteers [7 males, 7 females; mean age 26.5 ± 3.8 years, mean height 171.6 ± 10.9 cm, mean Victorian Institute of Sports Assessment Achilles questionnaire (VISA-A) score 99.4 ± 1.2] was measured with the foot relaxed and fixed at 90°. Data were collected over five consecutive measures and 5 consecutive days.\ud \ud RESULTS\ud \ud Mean SWV values ranged from 7.91 m/s-9.56 m/s ± 0.27-0.50 m/s. Coefficient of variation (CV), correlations and intra-class correlation coefficient (ICC) scores ranged from 2.9%-6.3%, 0.4-0.7 and 0.54-0.85 respectively. No significant differences were noted for longitudinal or transverse data with respect to protocol or time and no significant differences were noted for foot position in transverse data. Significant differences in SWV values were noted between foot positions for longitudinal scanning (p =