A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial.

BACKGROUND: The prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans. METHODS: We did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491. FINDINGS: 374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon). INTERPRETATION: The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity. FUNDING: Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06)

Development of a decision support tool to facilitate primary care management of patients with abnormal liver function tests without clinically apparent liver disease [HTA03/38/02]. Abnormal Liver Function Investigations Evaluation (ALFIE)

Liver function tests (LFTs) are routinely performed in primary care, and are often the gateway to further invasive and/or expensive investigations. Little is known of the consequences in people with an initial abnormal liver function (ALF) test in primary care and with no obvious liver disease. Further investigations may be dangerous for the patient and expensive for Health Services. The aims of this study are to determine the natural history of abnormalities in LFTs before overt liver disease presents in the population and identify those who require minimal further investigations with the potential for reduction in NHS costs

Comparing seated pressures in daily wheelchair and sports equipment and investigating the skin protective effects of padded shorts.

Background: Adaptive sports are promoted for individuals with spinal cord injury to increase overall health and prevent cardiovascular and metabolic diseases, but the potential risk of pressure ulcer development with adaptive equipment (AE) is a concern. Current research has found seated pressures in AE that exceed clinically accepted values but no studies have measured pressure with a padded short to assess for its potential pressure reducing effects. Objective: Our study sought to evaluate average and peak seating pressure in both static and dynamic sport-specific positions, with and without the presence of three types of over-the-counter padded bicycle shorts, in multiple types of adaptive equipment (AE): Hand cycle, quad rugby, basketball, and mountain hand cycle. Methods: Part One. Pre/Post test design with subjects as their own control. Eight adults with SCI (C5-T6) were pressure mapped under static and dynamic conditions in their daily use wheelchair (WC) and AE. Three conditions were mapped: Daily WC, AE without bicycle shorts, and AE with shorts. AE included: Hand-cycle, quad rugby, basketball, and mountain hand-cycle. Part Two. Static pressure readings in a hand-cycle were taken on 16 able-bodied subjects with and without an impact short and a full-coverage padded short. Part three. Single subject with T5 SCI was pressure mapped in static and dynamic conditions with and without the full-coverage padded short in a basketball chair and mountain hand-cycle. Average pressure (AP) and peak pressure (PP) recordings were taken for 60 seconds (400 frames) using the TekScan Pressure Mapping System. For static recordings the participants were instructed to sit still, while for dynamic recordings participants simulated sport or activity specific movements. Results: Part 1. Significant differences were found between the daily chair and AE for both AP and PP in the static condition (p \u3c 0.05), as well as AP in the dynamic condition (p Part 2. The impact short significantly increased static PP and AP (p0.05). Part 3. The full-coverage padded short increased AP and PP in the basketball chair, decreased AP in the mountain hand cycle and increased PP in the mountain hand cycle. Discussion: Pressure differences between daily WC and AE in static conditions suggests that athletes who are not moving or sitting on the sidelines in their AE may be at greater risk of tissue breakdown than athletes who are playing and experiencing pressure-relieving positions during movement. Padded shorts as a method to reduce PP and AP yielded variable results which may have been influenced by type of AE and posture in the AE. Thus seated posture may influence the pressure relieving capabilities of a padded short. Conclusion: Donning a padded short as a method of skin protection yields highly variable changes in PP and AP and pressure mapping should be performed prior to use in AE by the SCI population. Works Cited: Berthold, J., Dicianno, B.E. & Cooper, R.A. (2013). Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects. Disability and Rehabilitation. Assistive Technology, 8(5), 387-39http://doi.org/10.3109/17483107.2013.769123 Darrah, S.D., Dcianno, B.E., Berthold, J., McCoy, A., Haas, M., & Cooper, R.A. (2016). Measuring static seated pressure distributions and risk for skin pressure ulceration in ice sledge hockey players. Disability and Rehabilitation. Assistive Technology, 11(3), 241-246. http://doi.org/10.3109/17483107.2014.92193

Stationary Black Holes: Uniqueness and Beyond

The spectrum of known black-hole solutions to the stationary Einstein equations has been steadily increasing, sometimes in unexpected ways. In particular, it has turned out that not all black-hole-equilibrium configurations are characterized by their mass, angular momentum and global charges. Moreover, the high degree of symmetry displayed by vacuum and electro-vacuum black-hole spacetimes ceases to exist in self-gravitating non-linear field theories. This text aims to review some developments in the subject and to discuss them in light of the uniqueness theorem for the Einstein-Maxwell system.Comment: Major update of the original version by Markus Heusler from 1998. Piotr T. Chru\'sciel and Jo\~ao Lopes Costa succeeded to this review's authorship. Significantly restructured and updated all sections; changes are too numerous to be usefully described here. The number of references increased from 186 to 32

A standard, single dose of inhaled terbutaline attenuates hyperpnoea-induced bronchoconstriction and mast cell activation in athletes

Release of broncho-active mediators from mast cells during exercise hyperpnoea is a key factor in the pathophysiology of exercise-induced bronchoconstriction (EIB). Our aim was to investigate the effect of a standard, single dose of an inhaled β2-adrenoceptor agonist on mast cell activation in response to dry air hyperpnoea in athletes with EIB. Twenty-seven athletes with EIB completed a randomised, double blind, placebo-controlled, crossover study. Terbutaline (0.5 mg) or placebo was inhaled15 min prior to 8 min of eucapnic voluntary hyperpnoea (EVH) with dry air. Pre- and post-bronchial challenge, urine samples were analysed by enzyme immunoassay for 11β-prostaglandin(PG)F2α. The maximum fall in forced expiratory volume in 1 sec(FEV1) of 14 (12-20)% (median and interquartile range) following placebo was attenuated to 7 (5-9)% with the administration of terbutaline (P<0.001). EVH caused a significant increase in 11β-PGF2α from (27-57) ng·mmol creatinine-1 at baseline to (43-72) ng·mmol creatinine-1 at its peak post-EVH following placebo (P=0.002). The rise in 11β-PGF2α was inhibited with administration of terbutaline: 39 (28-44) ng·mmol creatinine-1 at baseline vs. 40 (33-58) ng·mmol creatinine-1 at its peak post-EVH (P=0.118). These data provide novel in vivo evidence of mast cell stabilisation following inhalation of a standard dose of terbutaline prior to bronchial provocation with EVH in athletes with EIB

Men’s Pelvic Health Content in Entry-Level Doctor of Physical Therapy Curricula: A Physical Therapy Clinician Perspective

Introducation Pelvic floor musculature is involved in sexual, bowel, and bladder function, organ support, breathing, and load transfer.1 Sixteen percent of males experience pelvic floor dysfunction (PFD).1 Therefore, it is important for physical therapists to adequately screen male patients to identify PFD either for proper treatment or referral to a men’s pelvic health (MPH) provider. The Academy of Pelvic Health (APH) offers Doctor of Physical Therapy (DPT) curricular guidelines for Women’s Health content, but to date has no published guidelines for MPH. Objective The purpose of this study was to gain clinician perspective to assist in the development of DPT curricular guidelines for MPH content. Participants Licensed physical therapists on the mailing list of the APH. Methods A mixed-methods survey was distributed via email newsletter. Question formats included: yes/no, multiple choice, select all that apply, 5-point Likert scale, and open- ended response(s). Questions regarding the incorporation of, and barriers to, inclusion of MPH content in DPT curricula were included. Descriptive statistics and frequencies were calculated using various functions in Microsoft Excel®. Qualitative data from free response questions were coded and categorized into themes using a grounded theory methodology. Results A total of 203 survey responses were received for quantitative and qualitative data analysis. Student physical therapists and physical therapy assistants were excluded from participation. Conclusion The majority of survey participants agreed that inclusion of MPH education in entry-level DPT curricula is important and that it would be best delivered through a pelvic health course within the curriculum. Clinical Relevance The data received through this survey may be used to assist in the development of MPH curricular guidelines. DPT programs should implement further MPH content to prepare students for proper screening and treatment or referral of patients with PFD. By doing so, patients will receive the necessary treatment more quickly and may experience improved outcomes

Capacity and Maximal Inspiratory Pressure in Healthy Adults

Introduction Diaphragmatic fatigue during maximal exercise causes decreased blood flow to exercising limbs. Inspiratory muscle strength training (IMST) may decrease diaphragm fatigue. Current studies use 50% of maximal inspiratory pressure (MIP) for IMST, but optimal dosing at higher intensities has not been well explored. Objective Investigate the impact of high intensity IMST on aerobic capacity and maximal inspiratory pressure in healthy adults. Methods This study was IRB approved by the university. All participants provided informed consent, and demographic information was collected. Results VO2 max did not change significantly in either intervention group after intervention period (p=0.143). Groups demonstrated significant improvement in MIP (p=0.011), but there was no significant difference between groups (p\u3c0.638). Conclusion VO2 max did not significantly change in the control or intervention groups. Post-intervention MIP measurements were significantly improved in both groups, but there was no significant difference between either group. High intensity IMST may not improve aerobic capacity in young, healthy adults after an 8-week intervention period. Clinical Relevance Maintaining diaphragmatic strength with IMST may help minimize respiratory fatigue and be useful for healthy adults with injuries limiting their mobility. Further research is needed to evaluate optimal IMST intensity for maximal benefit as 80% may be too intense

Framing the Value of Clinical and Field Education

Community/university partnerships play a critical role in higher education. Community-based research, service learning, guest lectures, internships, and a host of other activities illustrate the shared opportunities for students, educators, practitioners, employers, and consumers, as communities and institutions collaborate to educate the future workforce and develop an informed and engaged citizenry. Across the spectrum of health and professional disciplines, real world learning through community-based clinical/field education1 is essential to prepare practice-ready graduates. At St. Catherine University, for example, students complete over 7,000 clinical/field placements annually across multiple degrees and disciplines (see Appendix B). Without community/ university partnerships, our universities would not be able to provide high quality learning experiences and educate graduates who are both qualified and competitive in the workforce. Yet the long-standing model of clinical/field education is faced with pressures and competing demands. While universities strive to increase enrollment and meet rising competition and changing accreditation standards, providers face industry and regulatory reform, economic downturns, reduced funding and reimbursement, productivity demands, a retiring workforce, and a host of other pressures. This paper is intended to strengthen community/university partnerships by articulating the value that can come from clinical/field education. The authors of this paper serve as clinical/field educators for the Henrietta Schmoll School of Health at St. Catherine University and the School of Social Work at St. Catherine University - University of St. Thomas. We draw from our own experience, conversations with clinical and fieldwork partners, faculty and students, and existing literature to outline this complex issue. The goal of this paper is to provide information, a conceptual framework, and language that can inform stakeholders and foster dialogue as we work collaboratively to address the opportunities and challenges of workforce development

Evaluating the effects of bilingual traffic signs on driver performance and safety

Variable Message Signs (VMS) can provide immediate and relevant information to road users and bilingual VMS can provide great flexibility in countries where a significant proportion of the population speak an alternative language to the majority. The study reported here evaluates the effect of various bilingual VMS configurations on driver behaviour and safety. The aim of the study was to determine whether or not the visual distraction associated with bilingual VMS signs of different configurations (length, complexity) impacted on driving performance. A driving simulator was used to allow full control over the scenarios, road environment and sign configuration and both longitudinal and lateral driver performance was assessed. Drivers were able to read one and two-line monolingual signs and two-line bilingual signs without disruption to their driving behaviour. However, drivers significantly reduced their speed in order to read four-line monolingual and four-line bilingual signs, accompanied by an increase in headway to the vehicle in front. This implies that drivers are possibly reading the irrelevant text on the bilingual sign and various methods for reducing this effect are discussed

Telecare motivational interviewing for diabetes patient education and support : a randomised controlled trial based in primary care comparing nurse and peer supporter delivery

Background: There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services. Methods/Design: In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. Discussion and implications of the research: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications