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The solidification of a binary alloy results in the formation of a porous mushy layer, within which spontaneous localisation of fluid flow can lead to the emergence of features over a range of spatial scales. We describe a finite volume method for simulating binary alloy solidification in two dimensions with local mesh refinement in space and time. The coupled heat, solute, and mass transport is described using an enthalpy method with flow described by a Darcy-Brinkman equation for flow across porous and liquid regions. The resulting equations are solved on a hierarchy of block-structured adaptive grids. A projection method is used to compute the fluid velocity, whilst the viscous and nonlinear diffusive terms are calculated using a semi-implicit scheme. A series of synchronization steps ensure that the scheme is flux-conservative and correct for errors that arise at the boundaries between different levels of refinement. We also develop a corresponding method using Darcy's law for flow in a porous medium/narrow Hele-Shaw cell. We demonstrate the accuracy and efficiency of our method using established benchmarks for solidification without flow and convection in a fixed porous medium, along with convergence tests for the fully coupled code. Finally, we demonstrate the ability of our method to simulate transient mushy layer growth with narrow liquid channels which evolve over time.

Objective: Coagulation assessment in traumatic brain injury (TBI) typically relies upon laboratory-based standard coagulation tests (SCTs), including the activated partial thromboplastin time (aPTT), INR and platelet count. Rotational thromboelastometry (ROTEM) sigma is an alternative point-of-care assay; however, its role in isolated TBI is under-evaluated. The present study aims to assess the prognostic utility of ROTEM sigma in isolated TBI., Methods: ROTEM sigma analysis was performed during the initial evaluation of patients presenting to the Royal Adelaide Hospital between February 2022 and 2023 with radiographically demonstrated traumatic intracranial haemorrhage and GCS ≤14. Patients with concomitant severe extracranial injury, or who received blood products or antifibrinolytic therapy prior to sample collection were excluded., Results: Thirty-six patients had blood samples analysed with ROTEM, 25 of these patients were also evaluated with paired SCTs. Twenty-two per cent (8/36) of patients with isolated TBI had a hypocoaguable ROTEM profile, and this was associated with an increased incidence of head injury-related death (50% [4/8] vs 11% [3/28], P = 0.03). Median diagnostic turn-around-times were shorter for ROTEM parameters compared to SCT counterparts: EXTEM clotting time (CT) versus INR (20 vs 63 min, P < 0.01), and INTEM CT versus aPTT (21 vs 63 min, P < 0.01). EXTEM CT, FIBTEM CT and INR values had similar performance in predicting head injury-related death, area under the receiver operator curves were 0.8, 0.8 and 0.7, respectively., Conclusions: ROTEM sigma expedites the detection of clinically significant coagulopathy in isolated TBI. EXTEM and FIBTEM CT values are more rapidly attainable than INR and comparable in predicting head injury-related death., (© 2024 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

The Glasgow Coma Scale (GCS) was first published in The Lancet by Sir Graham Teasdale and Bryan Jennett 50 years ago based on their pioneering work on developing a numerical scale to describe coma in clear and reproducible terms and to avoid the confusion associated with the wide variety of descriptive terms for consciousness that were in use at the time. It's difficult to know if Teasdale and Jennett could have predicted how influential, widespread and long-lasting the GCS would become, but in retrospect it seems clear that the GCS was introduced at a perfect stage in the development of modern clinical neurosurgery and neuroscience research. The simplicity of the scale, its recognition by senior academics and the emerging radiology technologies in the 1970s heralded a new era of neuroscience and an approach to the management of not only traumatic brain injury (TBI) but other types of central nervous system disease in which consciousness was affected, such as aneurysmal subarachnoid haemorrhage and stroke. Together with its sister scale the Glasgow Outcome Scale, the GCS remains extremely relevant in clinical neurosurgery and neuroscience research, and despite the proposal of various alternative scales the GCS endures in the modern management of TBI., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Adam Wells is the Abbie Simpson Clinical Fellow of the Neurosurgical Research Foundation; at no time has Adam Wells received payment or support in kind for any aspect of the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To characterize the magnitude, timescale, and reliability of changes in functional and systemic outcome markers following moderate (MIR) and high (HIR) isoinertial resistance flywheel squat protocols (FSP)., Methods: Twenty-four resistance-trained males completed two exercise trials (ET1 & ET2) separated by 32 days. Functional and systemic markers were assessed at pre-exercise (PRE), immediately post-exercise (IP), and 24 (24H), 48 (48H), and 72 (72H) hours post-exercise. Three-way group x trial x time repeated measures ANOVAs were conducted to compare all dependent variables between groups (MIR & HIR) and experimental trials across time. Test-retest reliability between trials was assessed using intraclass correlation coefficients (ICC)., Results: At IP, both groups exhibited significantly decreased active range of motion, perceived recovery status, squat maximal voluntary isometric contraction force, and vertical jump performance, along with significantly increased muscle thickness and echo intensity (ultrasound), muscle soreness, and creatine kinase when compared to PRE. Most outcomes remained perturbed at 24H and 48H, especially in the HIR group. By 72H, only a subset of variables remained significantly changed from PRE. No significant attenuation of outcomes between trials were observed and test-retest reliability between trials was excellent for the FSP and moderate to excellent for most outcomes in both groups., Conclusion: Our findings indicate that the FSP is a robust and repeatable exercise stimulus capable of eliciting significant exercise-induced muscle damage and reliable subsequent perturbations to functional and systemic markers of muscle damage. Our findings also support the use of crossover designs in future EIMD research designs with resistance-trained men., Competing Interests: Declarations. Conflict of interest: The authors report there are no competing interests to declare. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Harry Wingfield at the Institutional review board of the University of Central Florida (STUDY00005791) 08/09/2023-08/09/2024. Informed consent: Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Up to half of all surgical adverse events are due to non-technical errors, making non-technical skill assessment and improvement a priority. No specific tools are available to retrospectively identify non-technical errors that have occurred in surgical patient care. This original study aimed to develop and provide evidence of validity and inter-rater reliability for the System for Identification and Categorization of Non-technical Error in Surgical Settings (SICNESS)., Methods: A literature review, modified Delphi process, and two pilot phases were used to develop and test the SICNESS tool. For each pilot, 12 months of surgical mortality data from the Australian and New Zealand Audit of Surgical Mortality were assessed by two independent reviewers using the SICNESS tool. Main outcomes included tool validation through modified Delphi consensus, and inter-rater reliability for: non-technical error identification and non-technical error categorization using Cohen's κ coefficient, and overall agreement using Fleiss' κ coefficient., Results: Version 1 of the SICNESS was used for pilot 1, including 412 mortality cases, and identified and categorized non-technical errors with strong-moderate inter-rater reliability. Non-technical error exemplars were created and validated through Delphi consensus, and a novel mental model was developed. Pilot 2 included an additional 432 mortality cases. Inter-rater reliability was near perfect for leadership (κ 0.92, 95% c.i. 0.82 to 1.00); strong for non-technical error identification (κ 0.89, 0.84 to 0.93), communication and teamwork (κ 0.89, 0.79 to 0.99), and decision-making (κ 0.85, 0.79 to 0.92); and moderate for situational awareness (κ 0.79, 0.71 to 0.87) and overall agreement (κ 0.69, 0.66 to 0.73)., Conclusion: The SICNESS is a reliable and valid tool, enabling retrospective identification and categorization of non-technical errors associated with death, occurring in real surgical patient interactions., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)

Background/objectives: This study examined the differences in participant force production and pain between a squat maximal voluntary isometric contraction (IMVIC) performed with either a waist belt (WB) or full-body harness (FBH) on the Desmotec D.EVO isoinertial device (D.EVO). Agreement between FBH IMVIC and a traditional force plate squat MVIC (TMVIC) was also assessed., Methods: Twenty adults completed FBH, WB, and TMVIC assessments on two separate occasions. Two-way treatment x time ANOVAs were conducted to compare force outputs and pain between treatments (FBH vs. WB) across time. Test-retest reliability was assessed using intraclass correlation coefficients. Associations between outcomes were determined using Pearson's r. Standard error of estimate, constant error, total error, and Bland-Altman plots were used to assess agreement between IMVIC and TMVIC., Results: FBH and WB IMVIC exhibited good to excellent reliability (ICC 2,1 = 0.889-0.994) and strong associations (r = 0.813 and 0.821, respectively) when compared to TMVIC. However, agreement between FBH and TMVIC was poor. No significant interaction or main effects were observed for pain. FBH maximum isometric force (MIF) was significantly higher than WB MIF. WB IMVIC was the only significant predictor of TMVIC (R 2 = 0.674)., Conclusions: Our findings indicate that the D.EVO should not be utilized as a replacement for a traditional MVIC setup.

Context: The Neurotracker CORE assessment is an 8-minute multiple object tracking (MOT) program used in sport science research and clinical rehabilitation as a perceptual-cognitive training tool; however, it has garnered interest for its potential use as an acute assessment of cognitive performance. Although some data exist regarding the learning effect of repeated exposures, it is often overlooked with investigators focusing primarily on the presence of transfer effects to other cognitive realms. As a result, exclusive data on the effect of repeated testing, or subsequent periods of no testing (ie, detraining) on test-retest reliability, and on MOT performance are sparse., Design: Repeated-measures/reliability., Methods: Twenty-three recreationally active men and women completed 15 training sessions consisting of 2 CORE assessments per session (30 assessments). Participants were randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 assessments). Training and retraining periods were divided into 10 blocks (3 assessments/block) for analysis. MOT speed threshold (MOT-ST), consistency, fastest trial score success speed, lowest trial score miss speed, the number of perfect, near misses, and significant miss trials within each block were used to determine performance. Intraclass correlation coefficient, standard error of measurement, and minimal detectable change were used to determine reliability., Results: Significant improvements in MOT-ST and fastest trial score success speed were noted within training blocks 1 to 6 and 1 to 7, respectively (P < .05). MOT-ST and fastest trial score success speed demonstrated excellent test-retest reliability between blocks 8 and 9. There was no effect of detraining period on performance during retraining., Conclusions: Eighteen tests are necessary to overcome training effects and establish a reliable baseline when MOT-ST is used as the performance outcome. Detraining periods up to 2 weeks did not impact performance. The average of 3 discrete tests should be used when assessing MOT-ST performance.

Skeletal muscle is the largest organ system in the human body and plays critical roles in athletic performance, mobility, and disease pathogenesis. Despite growing recognition of its importance by major health organizations, significant knowledge gaps remain regarding skeletal muscle health and its crosstalk with nearly every physiological system. Relevant public health challenges like pain, injury, obesity, and sarcopenia underscore the need to accurately assess skeletal muscle health and function. Feasible, non-invasive techniques that reliably evaluate metrics including muscle pain, dynamic structure, contractility, circulatory function, body composition, and emerging biomarkers are imperative to unraveling the complexities of skeletal muscle. Our concise review highlights innovative or overlooked approaches for comprehensively assessing skeletal muscle in vivo . We summarize recent advances in leveraging dynamic ultrasound imaging, muscle echogenicity, tensiomyography, blood flow restriction protocols, molecular techniques, body composition, and pain assessments to gain novel insight into muscle physiology from cellular to whole-body perspectives. Continued development of precise, non-invasive tools to investigate skeletal muscle are critical in informing impactful discoveries in exercise and rehabilitation science., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Introduction: With the rise of ambulatory surgery centers (ASCs), rapid motor and sensory recovery after anesthesia is crucial. The purpose of this study was to evaluate the safety and efficacy of low-dose single-shot hyperbaric bupivacaine for spinal anesthesia (SA) for patients undergoing outpatient arthroplasty., Methods: Data were reviewed from a single ASC from 2018 to 2020 for two arthroplasty-trained surgeons for all patients with primary arthroplasties that had administration of low-dose hyperbaric bupivacaine. Data collected from the ASC records were then further evaluated for total spinal block time, length of blockade, time to discharge criteria, visual analog scale (VAS) scores, and time to discharge., Results: Two hundred twenty-seven patients undergoing 244 primary arthroplasties received SA with low-dose hyperbaric bupivacaine. The volume of 0.75% bupivacaine varied: 115 patients received 0.8 mL (6 mg), 111 patients received 1.0 mL (7.5 mg), and 17 patients received 1.2 mL (9 mg). Total SA time averaged 144 minutes with a mean of 30 minutes from post anesthesia care unit arrival to motor recovery. The mean time from post anesthesia care unit arrival to discharge criteria was 89 minutes. The average VAS at discharge was 1.44; the average VAS on POD1 was 3.0. No episodes of urinary retention and no reports of transient neurologic symptoms were noted in the study population., Conclusion: Low-dose, single-shot hyperbaric bupivacaine SA is an effective option in the ASC for arthroplasty, providing a fast return of motor function, facilitating rapid discharge, and is safe with a relatively low-risk profile., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: Carbohydrate (CHO) and carbohydrate-protein co-ingestion (CHO-P) have been shown to be equally effective for enhancing glycogen resynthesis and subsequent same-day performance when CHO intake is suboptimal (≤0.8 g/kg). Few studies have specifically examined the effect of isocaloric CHO vs CHO-P consumption on subsequent high-intensity aerobic performance with limited time to recover (≤2 hours) in masters class endurance athletes., Methods: This was a randomized, double-blind between-subject design. Twenty-two male masters class endurance athletes (age 49.1 ± 6.9 years; height 175.8 ± 4.8 cm; body mass 80.7 ± 8.6 kg; body fat (%) 19.1 ± 5.8; VO 2peak 48.6 ± 6.7 ml·kg·min -1 ) were assigned to consume one of three beverages during a 2-hour recovery period: Placebo (PLA; electrolytes and water), CHO (1.2 g/kg bm), or CHO-P (0.8 g/kg bm CHO + 0.4 g/kg bm PRO). All beverages were standardized to one liter (~32 oz.) of total fluid volume regardless of the treatment group. During Visit #1, participants completed graded exercise testing on a cycle ergometer to determine VO 2 peak and peak power output (PPO, watts). Visit #2 consisted of familiarization with the high-intensity protocol including 5 × 4 min intervals at 70-80% of PPO with 2 min of active recovery at 50 W, followed by a time to exhaustion (TTE) test at 90% PPO. During Visit#3, the same high-intensity interval protocol with TTE was conducted pre-and post-beverage consumption., Results: A one-way ANCOVA indicated a significant difference among the group means for the posttest TTE (F 2,18  = 6.702, p = .007, ƞ 2  = .427) values after adjusting for the pretest differences. TTE performance in the second exercise bout improved for the CHO (295.48 ± 24.90) and CHO-P (255.08 ± 25.07 sec) groups. The water and electrolyte solution was not effective in restoring TTE performance in the PLA group (171.13 ± 23.71 sec)., Conclusions: Both CHO and CHO-P effectively promoted an increase in TTE performance with limited time to recover in this sample of masters class endurance athletes. Water and electrolytes alone were not effective for restoring endurance capacity during the second bout of exhaustive exercise.

Objective: Considerations in traumatic brain injury (TBI) management include time to critical interventions and neurosurgical care, which can be influenced by the geographical location of injury. In Australia, these distances can be vast with varying degrees of first-responder experience. The present study aimed to evaluate the association that distance and/or time to a major trauma centre (MTC) had on patient outcomes with moderate to severe TBI., Methods: A retrospective cohort study was conducted using data from the Royal Adelaide Hospital's (RAH) Trauma Registry over a 3-year period (1 January 2018 to 31 December 2020). All patients with a moderate to severe TBI (Glasgow Coma Scale [GCS] ≤13 and abbreviated injury score head of ≥2) were included. The association of distance and time to the RAH and patient outcomes were compared by calculating the odds ratio utilising a logistic regression model., Results: A total of 378 patients were identified; of these, 226 met inclusion criteria and comprised our study cohort. Most patients were male (79%), injured in a major city (55%), with median age of 38 years old and median injury severity score (ISS) of 25. After controlling for age, ISS, ED GCS on arrival and pre-MTC intubation, increasing distance or time from injury site to the RAH was not shown to be associated with mortality or discharge destination in any of the models investigated., Conclusion: Our analysis revealed that increasing distance or time from injury site to a MTC for patients with moderate to severe TBI was not significantly associated with adverse patient outcomes., (© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Background Context: A computed tomography (CT) and magnetic resonance imaging (MRI) are used routinely in the radiologic evaluation and surgical planning of patients with lumbar spine pathology, with the modalities being complimentary. We have developed a deep learning algorithm which can produce 3D lumbar spine CT images from MRI data alone. This has the potential to reduce radiation to the patient as well as burden on the health care system., Purpose: The purpose of this study is to evaluate the accuracy of the synthetic lumbar spine CT images produced using our deep learning model., Study Design: A training set of 400 unpaired CTs and 400 unpaired MRI scans of the lumbar spine was used to train a supervised 3D cycle-Gan model. Evaluators performed a set of clinically relevant measurements on 20 matched synthetic CTs and true CTs. These measurements were then compared to assess the accuracy of the synthetic CTs., Patient Sample: The evaluation data set consisted of 20 patients who had CT and MRI scans performed within a 30-day period of each other. All patient data was deidentified. Notable exclusions included artefact from patient motion, metallic implants or any intervention performed in the 30 day intervening period., Outcome Measures: The outcome measured was the mean difference in measurements performed by the group of evaluators between real CT and synthetic CTs in terms of absolute and relative error., Methods: Data from the 20 MRI scans was supplied to our deep learning model which produced 20 "synthetic CT" scans. This formed the evaluation data set. Four clinical evaluators consisting of neurosurgeons and radiologists performed a set of 24 clinically relevant measurements on matched synthetic CT and true CTs in 20 patients. A test set of measurements were performed prior to commencing data collection to identify any significant interobserver variation in measurement technique., Results: The measurements performed in the sagittal plane were all within 10% relative error with the majority within 5% relative error. The pedicle measurements performed in the axial plane were considerably less accurate with a relative error of up to 34%., Conclusions: The computer generated synthetic CTs demonstrated a high level of accuracy for the measurements performed in-plane to the original MRIs used for synthesis. The measurements performed on the axial reconstructed images were less accurate, attributable to the images being synthesized from nonvolumetric routine sagittal T1-weighted MRI sequences. It is hypothesized that if axial sequences or volumetric data were input into the algorithm these measurements would have improved accuracy., Competing Interests: Declaration of Competing Interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Objective: Decompressive craniectomy (DC) following malignant ischaemic stroke is a potentially life-saving procedure. Event rates of ventriculomegaly following DC performed in this setting remain poorly defined. Accordingly, we performed a systematic review to determine the incidence of hydrocephalus and the need for cerebrospinal fluid (CSF) diversion following DC for malignant stroke., Methods: MEDLINE, EMBASE and Cochrane libraries were searched from database inception to 17 July 2021. Our search strategy consisted of "Decompressive Craniectomy", AND "Ischaemic stroke", AND "Hydrocephalus", along with synonyms. Through screening abstracts and then full texts, studies reporting on rates of ventriculomegaly following DC to treat ischaemic stroke were included for analysis. Event rates were calculated for both of these outcomes. A risk of bias assessment was performed to determine the quality of the included studies., Results: From an initial 1117 articles, 12 were included following full-text screening. All were of retrospective design. The 12 included studies reported on 677 patients, with the proportion experiencing hydrocephalus/ventriculomegaly being 0.38 (95% CI: 0.24, 0.53). Ten studies incorporating 523 patients provided data on the need for permanent CSF diversion, with 0.10 (95% CI: 0.07, 0.13) requiring a shunt. The included studies were overall of high methodological quality and rigour., Conclusion: Though hydrocephalus is relatively common following DC in this clinical setting, only a minority of patients are deemed to require permanent CSF diversion. Clinicians should be aware of the incidence of this complication and counsel patients and families appropriately., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Abstract: Renziehausen, JM, Bergquist, AM, Park, J-H, Hill, EC, Wells, AJ, Stout, JR, and Fukuda, DH. Time of day effects on anaerobic performance using a nonmotorized treadmill. J Strength Cond Res 37(10): 2002-2007, 2023-The purpose of this study was to determine the effects of time of day on performance during a maximal effort sprinting assessment (30nmt) and determine potential differences based on chronotype and sex. Twenty-six recreationally active men (n = 12) and women (n = 14) between the ages of 18 and 35 years old (21.5 ± 2.4 years) completed the 30nmt at 9:00 am, 2:00 pm, and 7:00 pm in a randomized order over a 24-hour period. Resting heart rate and temperature assessments were taken at each visit. A dietary recall and the Morningness-Eveningness Questionnaire were used to assess kilocalories (kcals) and chronotype, respectively. Two-way (time x sex) repeated measures analyses of variance were conducted to determine differences in peak/mean power, peak/mean velocity, distance, resting heart rate, temperature, and kcals at each time point. Paired sample t tests were used to assess peak and nadir of each performance variable. A significance level was set at p < 0.05. There was a significant main effect for temperature (p < 0.001), resting heart rate (p = 0.007), and pre-exercise caloric intake (p = 0.021) throughout the day. No significant main effects for time were found for peak power (p = 0.766), mean power (p = 0.094), peak velocity (p = 0.497), mean velocity (p = 0.193), or distance (p = 0.262). There were no significant time × sex interactions for any dependent performance variables (p > 0.05). Significant differences were shown between the peak and nadir of each performance variable (p < 0.001). There were no significant differences in performance during maximal effort anaerobic assessments shown throughout the day; however, peak/nadir of performance times may be individualized and differ between morning types and intermediate types., (Copyright © 2023 National Strength and Conditioning Association.)

The purpose of this study was to examine the effects of 14-days adenosine 5'-triphosphate (ATP) supplementation (PeakATP ® ) on reaction time (RT), multiple object tracking speed (MOT), mood and cognition. Twenty adults (22.3 ± 4.4 yrs., 169.9 ± 9.5 cm, 78.7 ± 14.6 kg) completed two experimental trials in a double-blind, counter-balanced, crossover design. Subjects were randomized to either PeakATP ® (400 mg) or placebo (PLA) and supplemented for 14-days prior to each trial. During each trial, subjects completed a three-minute all-out test on a cycle ergometer (3MT), with measures of visuomotor RT [Dynavision D2 Proactive (Mode A) and Reactive (Mode B) tasks], MOT (Neurotracker), mood (Profile of Mood States Questionnaire; POMS) and cognition (Automated Neuropsychological Assessment Metrics; ANAM) occurring before (PRE), immediately post (IP) and 60 min post-3MT (60P). Subjects ingested an acute dose of the assigned supplement 30 min prior to completing PRE assessments for each trial. Trials were separated by a 14-day washout period. PeakATP ® significantly attenuated declines in hits ( p = 0.006, η p 2 = 0.235) and average RT (AvgRT, p = 0.006, η p 2 = 0.236) in Mode A, significantly improved AvgRT ( p = 0.039, η p 2 = 0.174) in Mode B, and significantly reduced the total number of misses ( p = 0.005, η p 2 = 0.343) in Mode B. No differences between treatments were noted for MOT, POMS or ANAM variables. In conclusion, these results indicate that PeakATP ® maintains proactive RT and improves reactive RT following high-intensity sprint exercise suggesting that supplemental ATP may mitigate exercise induced cognitive dysfunction., 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., (Copyright © 2023 Moon, Dufner and Wells.)

Exogenous ATP has been shown to increase total weight lifted during resistance training interventions and attenuate fatigue during repeated Wingate assessments. However, the influence of exogenous ATP on single bout maximal effort performance has yet to be examined. The purpose of this study was to investigate the effects of PeakATP ® supplementation on performance during a 3-min all-out test (3MT). Twenty adults (22.3 ± 4.4 years, 169.9 ± 9.5 cm, 78.7 ± 14.6 kg) completed two identical 3MT protocols in a double-blind, counter-balanced, crossover design. Participants were randomized to either PeakATP ® (400 mg·day -1 ) or placebo (PLA) treatments and consumed their assigned supplement for 14 days and ingested an acute dose 30 min before each 3MT. A 14-day wash-out period was completed between each supplementation period and subsequent 3MT. Peak power, time to peak power, work above end power, end power, and fatigue index were assessed during each 3MT. Dependent t -tests and Hedge's g effect sizes were used to assess differences between treatments. No significant differences were observed between treatments for 3MT performance ( p > 0.05). These findings indicate that 3MT performance was not significantly impacted by PeakATP ® supplementation. This may be due in part to the continuous nature of the 3MT as disodium ATP has been shown to be beneficial for repeated bout activities., Competing Interests: The authors declare no conflict of interest.

Background: The demands of typical daily activities require a constant level of alertness and attention. Multi-ingredient, caffeine-containing supplements have been shown to improve measures of cognitive performance. As many of these supplements become readily available, efficacy of each should be evaluated. Therefore, the purpose of this study is to examine the effects of the 4D dietary supplement on cognition, reaction time, and reactive agility., Methods: Seventeen healthy males (n = 8) and females (n = 9) between the ages of 18-40 years old (22.8 ± 2.9 years; 167.3 ± 9.6 cm; 65.4 ± 10.9 kg) participated in this double-blind, randomized crossover study. Participants completed three baseline reaction time assessments on the Dynavision and one baseline multiple object tracking assessment on the Neurotracker. Participants then consumed the oral multi-ingredient supplement containing 150 mg of caffeine or non-caffeinated placebo, mixed with 24 ounces of water, and rested for 45 minutes. Following the rest period, participants completed an additional three reaction time assessments and one multiple object tracking (MOT) assessment, as well as 6-12 trials of the Y-reactive agility test. Repeated measures ANOVAs were used to evaluate YRA performance and change values for Dynavision RT, Dynavision score, and MOT speed with either 4D dietary supplement or placebo., Results: A significant time × supplement interaction was shown for MOT speed (p = .040, d =  .543). Change scores in MOT speed were significantly different from zero following 4D (mean: 0.224 au; 95% confidence interval: 0.050 to 0.398 au) but not placebo supplementation (mean: -0.046 au; 95% confidence interval: -0.220 to 0.127 au). No time × supplement interaction was shown for Dynavision RT (p = .056, d = -.499) or Dynavision score (p = .093, d = .434). No differences were shown for YRA scores following supplementation for the right side (p = .241, d = -.2 95) or left side (p = .378, d = -.2 20)., Conclusion: The 4D dietary supplement appears to improve measures of cognition, specifically attention/spatial awareness, but not reaction time or reactive agility. Future research should examine the effects of this supplement with a larger, less heterogeneous sample and/or in conjunction with an exercise intervention., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Symptomatic cerebral vasospasm following posterior fossa intra-axial tumor resection is a rare phenomenon with only seven cases previously reported in the literature. The condition appears distinct to vasospasm following supratentorial tumor resection and extra-axial tumor resection of the posterior fossa. It shares, however, similarities with vasospasm following aneurysmal subarachnoid hemorrhage., Observations: The authors describe their experience with a 23-year-old female who developed delayed symptomatic vasospasm following resection of a left parapontine cerebellar hemangioblastoma. Tumor resection was complicated by rupture of a fragile arterialized vein, resulting in significant hemorrhage. The patient developed several episodes of focal and variably reversible neurological deficit. These clinical signs corresponded with angiographically confirmed vasospasm, which responded to standard therapies for vasospasm post aneurysmal subarachnoid hemorrhage., Lessons: This case and literature review highlight that symptomatic vasospasm is a rare, potentially highly morbid complication of posterior fossa intra-axial tumor resection. This phenomenon may be related to significant intraoperative or postoperative hemorrhage. Postoperative radiological findings such as high risk modified Fisher scale hemorrhage could alert clinicians to this condition.

Background: The Hemophilia Joint Health Score (HJHS) was developed and validated to detect arthropathy in children. Additional evidence is required to show validity in adults. We studied the convergent and discriminant construct validity of the HJHS version 2.1(HJHSv2.1) in adults with hemophilia. A secondary aim was to define age-related normative adult HJHSv2.1 reference values., Methods: We studied 192 adults with hemophilia, and 120 healthy adults in four age-matched groups-18 to 29, 30 to 40, 41 to 50, and >50 years-at nine centers. Trained physiotherapists scored the HJHS and World Federation of Hemophilia (WFH) joint score. Health history, the Functional Independence Scale of Hemophilia (FISH), Hemophilia Activities List (HAL), and Short-Form McGill Pain Questionnaire (SF-MPQ) were also collected., Results: The median age was 35.0 years. Of participants with hemophilia, 68% had severe, 14% moderate, and 18% mild disease. The HJHS correlated strongly with WFH score (Spearman's rho [ r s ] = .95, P  < .001). Moderate correlations were seen between the FISH ( r s  = .50, P  < .001) and SF-MPQ Present Pain Intensity ( r s  = .50, P  < .001), while a modest correlation was found with the HAL ( r s  = -.37, P  < .001). The HJHS significantly differentiated between age groups (Kruskal-Wallis T = 35.02, P  < .001) and disease severity in participants with hemophilia. The HJHS had high internal reliability (Cronbach's α = .88). We identified duration of swelling as a redundant item in the HJHS., Conclusions: The HJHS shows evidence of strong convergent and discriminant construct validity to detect arthropathy in adults with hemophilia and is well suited for use in this population., (© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).)

The purpose of this study was to evaluate the effects of environmental conditions on running performance and performance efficiency index (Effindex). Performance data recorded using Polar Team Pro sensors from eight collegiate female soccer players in nine matches were analyzed during the 2019 competitive season. Effindex and running performance, including total distance covered (TD REL ) and distance covered in five speed thresholds relative to minutes played, were examined for indications of fatigue with respect to environmental conditions, including ambient temperature and relative humidity. Matches were separated into three groups based on environmental conditions: Low-Risk ( n = 2 matches), Moderate-Risk ( n = 3 matches), or High-Risk ( n = 4 matches). Speed thresholds were grouped as follows: walking (WALK REL ), jogging (JOG REL ), low-speed running (LSR REL ), high-speed running (HSR REL ), and sprinting (SPRINT REL ). A significant effect was observed for TD REL in all environmental conditions (η 2 = 0.614). TD REL was significantly lower in the High-Risk ( p = 0.002; 95.32 ± 12.04 m/min) and Moderate-Risk conditions ( p = 0.004; 94.85 ± 9.94 m/min) when compared to Low-Risk (105.61 ± 9.95 m/min). WALK REL ( p = 0.005), JOG REL ( p = 0.005) LSR REL ( p = 0.001), HSR REL ( p = 0.035), SPRINT REL ( p = 0.017), and Effindex ( p = 0.0004) were significantly greater in Low-Risk conditions when compared to Moderate-Risk conditions. WALK REL ( p = 0.005), HSR REL ( p = 0.029), SPRINT REL ( p = 0.005), and Effindex ( p = 0.0004) were significantly greater in Low-Risk conditions when compared to High-Risk conditions. High-Risk environmental conditions may result in adverse performance in female collegiate soccer players.

Background: In under-resourced settings, general surgeons may be called upon to perform emergency operations within other specialties. Accordingly, we aimed to characterise patient outcomes after emergency neurosurgery performed by a general surgeon or general surgery trainee., Methods: PubMed, Embase and the Cochrane Library were searched to 30 May 2021 for observational studies reporting outcomes after emergency neurosurgery performed by a general surgeon. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, mortality rates and complications were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42021258097., Results: From 632 records, 14 retrospective observational studies were included, covering a total sample of 1,988 operations. Four studies were from Australia, and the remaining 10 were, respectively, from 10 other countries. Most common operations performed were decompressive surgery with burr holes or craniectomy for head trauma and insertion of intracranial pressure monitors. Rural hospitals were the most common settings. Mortality rates for procedures performed by general surgeons at latest follow-up were heterogenous, ranging from 5% for evacuation of chronic subdural haematoma in Kenya to 81% in head injured patients in a Hong Kong study., Conclusions: This is the first systematic review that synthesises the literature to characterise patient outcomes after neurosurgical operations performed by a general surgeon. Findings from this study may benefit global surgery performed in rural, remote, military or humanitarian settings., (© 2021. Société Internationale de Chirurgie.)

Context: The Dynavision D2™ Mode A test (ModeA) is a 1-minute reaction time (RT) test commonly used in sports science research and clinical rehabilitation. However, there is limited data regarding the effect of repeated testing (ie, training) or subsequent periods of no testing (ie, detraining) on test-retest reliability and RT performance. Therefore, the purpose of this study was to examine the test-retest reliability, training, and detraining effects associated with the D2™ ModeA test., Design: Repeated measures/reliability., Methods: Twenty-four recreationally active men and women completed 15 training sessions consisting of 2 ModeA tests per session (30 tests). The participants were then randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 tests). The training and retraining periods were separated into 10 blocks for analysis (3 tests per block). The number of hits (hits) and the average RT per hit (AvgRT) within each block were used to determine RT performance. Intraclass correlation coefficients, SEM, and minimum difference were used to determine reliability. Repeated-measures analysis of variance/analysis of covariance were used to determine training and detraining effects, respectively., Results: The ModeA variables demonstrated excellent test-retest reliability (intraclass correlation coefficient2,3 > .93). Significant improvements in hits and AvgRT were noted within training blocks 1 to 5 (P < .05). No further improvements in RT performance were noted between training blocks 6 through 10. There was no effect of detraining period on RT. The RT performance was not different between blocks during retraining., Conclusions: It appears that 15 tests are necessary to overcome the training effect and establish reliable baseline performance for the ModeA test. Detraining for 1 to 2 weeks did not impact RT performance. The authors recommend that investigators and clinicians utilize the average of 3 tests when assessing RT performance using the D2 ModeA test.

Background: Small studies are prone to lower methodological quality and publication bias, and are more likely to report greater beneficial effects. A meta-epidemiological study was undertaken to investigate and quantify the impact of small study effects on meta-analyses in the neurosurgical literature., Methods: A PubMed search was used to procure meta-analyses from Journal of Neurosurgery, Neurosurgery, Spine, Acta Neurochirurgica and Journal of Neurotrauma. Outcome data were extracted from meta-analyses the effect of study size was estimated by calculating the ratio of odds ratios (RORs) between small and large studies., Results: 16 meta-analyses of 229 primary studies and 90,629 patients were included. All but two included pooled outcomes were significantly different from 1. On average small studies did not demonstrate greater beneficial effects, with an estimated pooled ROR of 1.32 (95% CI, 0.89 to 1.75). Stratification by meta-analysis effect size and heterogeneity yielded similar findings., Conclusions: The absence of small study effects in meta-analyses of neurosurgical studies may reflect widespread poor quality of the neurosurgical literature affecting both large and small studies, rather than an absence of publication bias., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: With the emergence of COVID-19, and the potential inclusion of dental benefits in Medicare, it is critical that dentists are able to engage in legislative advocacy to support public oral health. Dental education has an opportunity to teach advocacy skills to future dentists, although advocacy training in predoctoral dental education has been largely ignored. The purpose of this study was to evaluate fourth-year dental student's attitudes toward advocacy, identify the type and extent of advocacy experiences during dental school, and assess their future intentions to engage in advocacy. Methods: An electronic questionnaire was administered to fourth-year dental students enrolled in their final semester at Ohio State University. Results: Forty-seven students completed the survey (43% response rate). Most (84%) respondents agreed that advocacy training should be a required experience in accreditation standards for predoctoral dental education. Over half (58%) reported seldom or no exposure to legislative and regulatory processes in oral health policy development in the curriculum. Students who participated in grassroots advocacy efforts while in dental school were more likely to contact legislators regarding dental issues ( p = 0.005) or public insurance ( p = 0.037), and participate in future lobbying efforts ( p = 0.019). Students who contributed to PAC while in dental school were more likely to express intentions to contribute in future ( p = 0.005). Conclusions: There is limited exposure to legislative advocacy in predoctoral dental education. Dental students with advocacy experience are more likely to report intentions to participate in advocacy as dentists. Dental education has a critical role in preparing future dentist-advocates., 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., (Copyright © 2021 Amini, Wells, Boynton, Guo and Ni.)

The mechanical properties of knee flexors and extensors in 15 collegiate male soccer players following different warm-up protocols [small-sided games (SSG), dynamic (DYN), and plyometric (PLY)] were evaluated. Tensiomyography (TMG) was used to assess contraction time (Tc), delay time (Td) and maximal displacement (Dm) of the rectus femoris (RF) and biceps femoris (BF) of both legs before and after each warm-up, while countermovement jump height variables, 20 m sprint, t -test and sit-and-reach were measured following the warm-ups. TMG was analyzed using a three-way [condition × time × leg] ANOVA, while performance variables were analyzed with a repeated measures ANOVA. Main effects of time were observed for BF-Tc ( p = 0.035), RF-Td ( p < 0.001), and BF-Td, ( p = 0.008), and a main effect of condition was seen for RF-Tc ( p = 0.038). Moreover, participants' 20 m sprint improved following SSG ( p = 0.021) compared to DYN and PLY. Sit-and-reach was greater following PLY ( p = 0.021). No significant interactions were noted for the measured TMG variables. Warm-up-specific improvements were demonstrated in sprint speed and flexibility following SSG and PLY, respectively. The present study revealed changes in certain TMG measures following the warm-ups that suggest enhanced response of lower leg muscles regardless of specific activities used.

Background: Ultrasonography is used to evaluate muscle quality (i.e. echo intensity [EI]), but an attenuation of ultrasound waves occurs in deeper tissues, potentially affecting these measures., Purpose: To determine whether muscle thickness (MT) affects EI and if EI varies between the superficial and deep portions of the muscle., Materials and Methods: MT, EI, subcutaneous adipose tissue thickness (SAT), tissue depth (DIS DEEP ), and EI of the overall (EI FULL ) as well as deep (EI DEEP ) and superficial (EI SUPF ) portions of the vastus lateralis (VL) were assessed in 33 resistance-trained males using ultrasonography. The difference (EI DIFF ) between EI SUPF and EI DEEP was calculated. Mean differences between EI FULL , EI SUPF, and EI DEEP were analyzed using a repeated-measures analysis of variance (ANOVA). Relationships between measures of muscle depth/ thickness and EI were examined using Pearson's r ., Results: EI SUPF was greater than EI DEEP ( P  < 0.001) and EI FULL ( P  < 0.001). MT was negatively correlated with EI FULL ( P  < 0.001) and positively correlated with EI DIFF ( P  < 0.001). SAT was not correlated with any EI measure, but DIS DEEP was positively correlated with EI DIFF ( P  < 0.001)., Conclusion: EI of the VL is heterogeneous, as the deeper portion produces lower values than the superficial portion. Thicker muscles present lower EI but have greater discrepancies in EI between the superficial and deep portions. Although SAT was not correlated with EI, DIS DEEP was related to EI DIFF , demonstrating that the combination of MT and SAT should be considered when evaluating muscle quality. Future research is necessary to determine if changes in EI following resistance training are driven by increases in MT.

Introduction: β-alanine (BA) supplementation may improve cognition and mitigate symptoms of anxiety and depression associated with aging, neurological disorders, and physical exertion, which has been attributed to increases in brain carnosine and/or brain-derived neurotropic factor (BDNF). BA also provides beneficial effects on cognition, mood, and physical performance during military operations; however, whether BA can attenuate mood disruptions and cognitive dysfunction associated with the anticipatory stress prior to simulated military operations is unknown. Purpose: The present study examined the effects of 14 days of BA (12 g·day -1 ) supplementation on cognitive function, mood, and circulating BDNF concentrations in recreationally-active, healthy males with limited inflammation and oxidative stress prior to a 24h simulated military operation. Methods: Participants were randomized into BA ( n  = 10) or placebo ( n  = 9; PL) for 14 days. Cognitive function, mood, and circulating BDNF were assessed before (PRE) and after (POST) supplementation. Cognition was assessed via multiple object tracking (Neurotracker™), visuomotor reaction time (Dynavision™), mathematical processing (Serial Subtraction Test), and neuropsychological assessments (ANAM™). Mood was assessed using the Profile of Mood States (POMS) questionnaire. After POST testing, subjects underwent a 24h simulated military operation. Results: No change in measures of cognitive function or BDNF concentrations were observed ( p  > 0.05). However, BA experienced significant reductions ( p  = 0.046) in subjective feelings of depression, while PL experienced significant reductions ( p  = 0.021) in feelings of vigor from PRE to POST. Conclusions: High-dose, short-duration BA supplementation does not appear to affect cognitive function or circulating BDNF, but may mitigate the onset of negative mood states in healthy, recreationally-active males prior to a simulated military operation.

Wells, AJ, Varanoske, AN, Coker, NA, Kozlowski, GJ, Frosti, CL, Boffey, D, Harat, I, Jahani, S, Gepner, Y, and Hoffman, JR. Effect of β-alanine supplementation on monocyte recruitment and cognition during a 24-hour simulated military operation. J Strength Cond Res 34(11): 3042-3054, 2020-Sustained military operations (SUSOPs) result in psychological stress and cognitive dysfunction, which may be related to the recruitment of classical monocytes into the brain. This study examined the effect of beta-alanine (BA) on cognition and monocyte recruitment during a simulated 24-hour SUSOP. Nineteen healthy men ingested 12-g/d BA or placebo for 14 days before an SUSOP. Monocyte chemoattractant protein-1 (MCP-1), C-C chemokine receptor-2 (CCR2), and macrophage-1-antigen (CD11b) expression were assessed through multiplex assay and flow cytometry. Psychological stress and cognition were assessed through Automated Neuropsychological Assessment Metrics (ANAM). A composite measure of cognition (COGcomp) was generated from throughput scores extracted from 7 ANAM cognitive tests. Assessments occurred at baseline (0H), 12 hours (12H), 18 hours (18H), and 24 hours (24H). Significance was accepted at p ≤ 0.05. No significant effect of BA was noted for any variable (p's > 0.05). The frequency and severity of symptoms of psychological stress increased significantly at 18 and 24H compared with 0 and 12H (p's < 0.05). COGcomp decreased significantly at 18 and 24H compared with 0 and 12H (p's ≤ 0.001). MCP-1 peaked at 18H was significantly lower at 24H compared with 18H but remained elevated at 24H compared with 0H (p's < 0.001). CCR2 expression was significantly lower at 12 (p = 0.031), 18, and 24H (p's < 0.001). CD11b expression was significantly higher at 12H (p = 0.039) and 24H (p's = 0.003). MCP-1 was negatively associated with COGcomp (β = -0.395, p = 0.002, r2 = 0.174). Neither CCR2 or CD11b was related to COGcomp (p's > 0.05). Cognitive dysfunction during SUSOPs is related to serum concentrations of MCP-1 but is not influenced by BA supplementation.

Objectives: To perform fragility index (FI) analysis on the evidence that forms the basis of the guidelines for the management of severe traumatic brain injury (TBI), and develop a deeper understanding of the pitfalls associated with FI., Design: Meta-epidemiological analysis and numerical simulations., Methods: The Brain Trauma Foundation guidelines (4th edition) for management of severe TBI were used to identify relevant randomised controlled trials (RCTs). FI based on Fisher's exact test and relative risk was performed on eligible RCTs. The relationship between FI, event counts and P values was explored by exhaustively considering different combinations of outcomes for studies of total size ranging from 80 to 10000. Sample size calculations were also performed for a range of power, baseline risk and relative risk, to determine the influence of study design on FI., Results: FI analysis of the severe TBI management guidelines revealed that most studies were associated with a low FI. In the majority of studies, FI was of a similar magnitude to the number lost to follow-up. The simulations revealed that while FI was inversely related to P value, a wide range of FI may be associated with a given P value. FI is also affected by sample size, baseline risk and effect size. Sample size calculations suggest that aside from very high-powered studies, most are likely to yield low FI values in the range typically encountered in the literature., Conclusions: Many studies are underpowered and are expected to be associated with a small FI. Furthermore, FI over-simplifies the complex, non-linear relationships between sample size, effect size and P value, which hinder comparisons of FI between studies. FI places undue importance on the "significance" of P values and accordingly should only be used sparingly., Competing Interests: The authors have declared that no competing interests exist.

This study examined the cardiac autonomic responses, as measured by heart rate variability (HRV), during cycling exercise and short-term rest after energy drink consumption. Seventeen participants (seven males and 10 females; age: 22.8 ± 3.5 years; BMI: 24.3 ± 3.3 kg/m 2 ) completed this double-blind, placebo-controlled, counterbalanced crossover design study. Participants received an energy drink formula containing 140 mg of caffeine and a placebo in a randomized order before completing a 10-min steady-state warm up (WUP) and a graded exercise test to exhaustion (GXT) followed by a 15-min short-term rest (STR) period. Heartbeat intervals were recorded using a heart rate monitor. Data were divided into WUP, GXT, and STR phases, and HRV parameters were averaged within each phase. Additionally, root mean square of the standard deviation of R-R intervals (RMSSD) during GXT was analyzed to determine the HRV threshold. Separate two-way (sex (male vs. female) x drink (energy drink vs. placebo)) repeated measures ANOVA were utilized. Significant increases in high frequency (HF) and RMSSD were shown during WUP after energy drink consumption, while interactions between drink and sex were observed for HRV threshold parameters (initial RMSSD and rate of RMSSD decline). No significant differences were noted during STR. Energy drink consumption may influence cardiac autonomic responses during low-intensity exercise, and sex-based differences in response to graded exercise to exhaustion may exist.

Post-activation potentiation likely acutely improves power-based performance; however, few studies have demonstrated improved endurance performance. Forty collegiate female rowers performed isometric potentiating (ISO), dynamic potentiating (DYN) and control (CON) warm-up protocols on a rowing ergometer, followed by a three-minute all-out test to evaluate their total distance, peak power, mean power, critical power, anaerobic working capacity (W') and stroke rate. Fifteen-second splits were also analysed. ISO consisted of 5 × 5-second static muscle actions with the ergometer handle rendered immovable with a nylon strap, while DYN consisted of 2 × 10-second all-out rowing bouts, separated by a 2-minute rest interval. The participants were divided into high and low experience groups by median experience level (3.75 years) for statistical analysis. Significant differences (DYN > CON; p < 0.05) were found for distance (+5.6 m), mean power (+5.9 W) and W' (+1561.6 J) for more experienced rowers (n = 19) and no differences for less experienced rowers (n = 18). Mean power in DYN was significantly greater than CON and ISO in the 15-30, 30-45, 45-60 and 60-75 second intervals independent of experience level. These results suggest that DYN may benefit experienced female rowers and that these strategies might benefit a greater power output over shorter distances regardless of experience.

Background: Patients with titanium cranioplasties can develop skin defects and plate exposure requiring revision surgery to prevent infection. The management of these patients has historically been staged surgery to remove the exposed plate followed by re-implantation of a sterile plate at a later date. Objectives: We describe an alternative where the exposed plate is removed, sterilised by autoclaving and re-implanted, in one operation. Methods: Patients with exposed titanium cranioplasties who underwent single-stage revisions were identified over a 30-month period. All patients received antibiotics post-procedure and were followed up. Results: Between June 2015 and December 2017 four patients had five single-stage revision cranioplasties with intraoperative autoclave sterilisation (SSRC). The mean time from initial procedure to revision was 5.6years. The mean time from plate exposure to surgery was 7 days. Plate exposure recurred in 60% (3/5) of cases post-SSRC. Two of these had the plate removed. The other had a second SSRC. On average recurrent plate exposure developed 17 months after SSRC. The 2 cases who had the plate removed remained complication-free to last follow up at 25 and 52 months after SSRC. Conclusions: Single procedure revision cranioplasty with intra-operative autoclave following titanium plate exposure may be considered as an option in patients with plate exposure who do not have other evidence on infection but we found recurrent plate exposure occurred in 50%.

Coker, NA, Wells, AJ, and Gepner, Y. The effect of heat stress on measures of running performance and heart rate responses during a competitive season in male soccer players. J Strength Cond Res 34(4): 1141-1149, 2020-Measures of running performance and heart rate (HR) responses to match play during 3 different heat stress (HS) conditions were assessed in 7 National Collegiate Athletic Association (NCAA) Division I male soccer players. Total distance and distance covered within distinct velocity zones (walking [WALK], jogging [JOG], low-speed running, high-speed running, sprinting [SPRINT], low-intensity running [LIR], and high-intensity running [HIR]) were assessed using global positioning system units for more than 12 matches. Heat stress was monitored during each match, and matches were defined as low (HSlow, n = 4), moderate (HSmod, n = 4), or high (HShigh, n = 4) HS. Minutes played were significantly different across HS conditions (p = 0.03). Therefore, distance covered within each movement velocity was assessed relative to minutes played and as a percentage of total playing time. WALKrel was significantly greater during HShigh compared with HSlow (p = 0.035). LIRrel was significantly greater during HSmod (p = 0.015) compared with HSlow. A trend was observed for %WALK being higher during HShigh compared with HSlow (p = 0.066). %LIR was significantly greater during HShigh compared with HSlow (p = 0.048). High-intensity running was not significantly different across HS conditions. Percent of time spent >85% HRmax was significantly greater during HShigh (p = 0.002) and HSmod (p < 0.001) compared to HSlow. Percent of time spent between 65-84% HRmax was significantly greater during HSlow compared to HShigh (p < 0.001). Results indicate that HS resulted in increased LIR and %HR≥85, while HIR was maintained. High-intensity running performance may be conserved through decreased playing time or the adoption of pacing strategies. This may assist coaches in altering player management strategies to optimize team performance.