What constitutes authorship?

For most authors of scientific papers, writing is a struggle. Crisp Introductions, clear Methods, and informative Results and Discussion sections are usually produced only after discarded drafts and with help from colleagues. But sometimes the greatest anxiety is associated with writing the cover page, because it is there that the authors are named

Achilles tendinopathy alters stretch shortening cycle behaviour during a sub-maximal hopping task

Objectives To describe stretch shortening cycle behaviour of the ankle and lower limb in patients with Achilles tendinopathy (AT) and establish differences with healthy volunteers. Design Between-subjects case-controlled. Methods Fifteen patients with AT (mean age 41.2 ± 12.7 years) and 11 healthy volunteers (CON) (mean age 23.2 ± 6.7 years) performed sub-maximal single-limb hopping on a custom built sledge-jump system. Using 3D motion analysis and surface EMG, temporal kinematic (lower limb stiffness, ankle angle at 80 ms pre-contact, ankle angle at contact, peak ankle angle, ankle stretch amplitude) and EMG measures (onset, offset and peak times relative to contact) were captured. Data between AT and CON were compared statistically using a linear mixed model. Results Patients with AT exhibited significantly increased lower limb stiffness when compared to healthy volunteers (p \u3c 0.001) and their hopping range was shifted towards a more dorsiflexed position (p \u3c 0.001). Furthermore, ankle stretch amplitude was greater in AT compared with healthy volunteers (p \u3c 0.001). A delay in muscle activity was also observed; soleus onset (p \u3c 0.001), tibialis anterior peak (p = 0.026) and tibialis anterior offset (p \u3c 0.001) were all delayed in AT compared with CON. Conclusions These findings indicate that patients with AT exhibit altered stretch-shortening cycle behaviour during sub-maximal hopping when compared with healthy volunteers. Patients with AT hop with greater lower limb stiffness, in a greater degree of ankle dorsiflexion and have a greater stretch amplitude. Likewise, delayed muscle activity is evident. These findings have implications in terms of informing the understanding of the pathoaetiology and management of AT

Trial of Dexamethasone for Chronic Subdural Hematoma

BACKGROUND: Chronic subdural hematoma is a common neurologic disorder that is especially prevalent among older people. The effect of dexamethasone on outcomes in patients with chronic subdural hematoma has not been well studied. METHODS: We conducted a multicenter, randomized trial in the United Kingdom that enrolled adult patients with symptomatic chronic subdural hematoma. The patients were assigned in a 1:1 ratio to receive a 2-week tapering course of oral dexamethasone, starting at 8 mg twice daily, or placebo. The decision to surgically evacuate the hematoma was made by the treating clinician. The primary outcome was a score of 0 to 3, representing a favorable outcome, on the modified Rankin scale at 6 months after randomization; scores range from 0 (no symptoms) to 6 (death). RESULTS: From August 2015 through November 2019, a total of 748 patients were included in the trial after randomization - 375 were assigned to the dexamethasone group and 373 to the placebo group. The mean age of the patients was 74 years, and 94% underwent surgery to evacuate their hematomas during the index admission; 60% in both groups had a score of 1 to 3 on the modified Rankin scale at admission. In a modified intention-to-treat analysis that excluded the patients who withdrew consent for participation in the trial or who were lost to follow-up, leaving a total of 680 patients, a favorable outcome was reported in 286 of 341 patients (83.9%) in the dexamethasone group and in 306 of 339 patients (90.3%) in the placebo group (difference, -6.4 percentage points [95% confidence interval, -11.4 to -1.4] in favor of the placebo group; P = 0.01). Among the patients with available data, repeat surgery for recurrence of the hematoma was performed in 6 of 349 patients (1.7%) in the dexamethasone group and in 25 of 350 patients (7.1%) in the placebo group. More adverse events occurred in the dexamethasone group than in the placebo group. CONCLUSIONS: Among adults with symptomatic chronic subdural hematoma, most of whom had undergone surgery to remove their hematomas during the index admission, treatment with dexamethasone resulted in fewer favorable outcomes and more adverse events than placebo at 6 months, but fewer repeat operations were performed in the dexamethasone group. (Funded by the National Institute for Health Research Health Technology Assessment Programme; Dex-CSDH ISRCTN number, ISRCTN80782810.)

Hip abduction weakness in elite junior footballers is common but easy to correct quickly: a prospective sports team cohort based study

Background: Hip abduction weakness has never been documented on a population basis as a common finding in a healthy group of athletes and would not normally be found in an elite adolescent athlete. This study aimed to show that hip abduction weakness not only occurs in this group but also is common and easy to correct with an unsupervised home based program. Methods: A prospective sports team cohort based study was performed with thirty elite adolescent under-17 Australian Rules Footballers in the Australian Institute of Sport/Australian Football League Under-17 training academy. The players had their hip abduction performance assessed and were then instructed in a hip abduction muscle training exercise. This was performed on a daily basis for two months and then they were reassessed.Results: The results showed 14 of 28 athletes who completed the protocol had marked weakness or a side-to-side difference of more than 25% at baseline. Two months later ten players recorded an improvement of ≥ 80% in their recorded scores. The mean muscle performance on the right side improved from 151 Newton (N) to 202 N (p<0.001) while on the left, the recorded results improved from 158 N to 223 N (p<0.001). Conclusions: The baseline values show widespread profound deficiencies in hip abduction performance not previously reported. Very large performance increases can be achieved, unsupervised, in a short period of time to potentially allow large clinically significant gains. This assessment should be an integral part of preparticipation screening and assessed in those with lower limb injuries. This particular exercise should be used clinically and more research is needed to determine its injury prevention and performance enhancement implications

A randomised, double blind, placebo-controlled trial of a two-week course of dexamethasone for adult patients with a symptomatic Chronic Subdural Haematoma (Dex-CSDH trial)

Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/15/02) and is published in full in Health Technology Assessment; Vol. 28, No. 12. See the NIHR Funding and Awards website for further award information.Peer reviewe

Trial of Dexamethasone for Chronic Subdural Hematoma

(Trial funded by NIHR, Dex-CSDH Current Controlled Trials number ISRCTN80782810). ACKNOWLEDGEMENTS In memory of Mrs. Kate Massey, who was the patient representative involved in study design. Peter Hutchinson is supported by a Research Professorship and Senior Investigator Award from the NIHR, the NIHR Cambridge Biomedical Research Centre, and the Royal College of Surgeons of England. Ellie Edlmann is supported by the Royal College of Surgeons of England. Angelos Kolias is supported by a Lectureship, School of Clinical Medicine, University of Cambridge and the Royal College of Surgeons of England. SUPPORT This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.Peer reviewedPublisher PD

Early mobilisation in intensive care units in Australia and Scotland:A prospective, observational cohort study examining mobilisation practises and barriers

Introduction: Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is\ud little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses.\ud Methods: The objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian\ud and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to\ud mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week\ud inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first.\ud Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU.\ud Results: Ten tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large\ud proportion of patients admitted for cardiothoracic surgery (43.3 %), whereas the Scottish cohort had none. Therefore,\ud comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2 % of the 347\ud patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay\ud (p < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard\ud ratio 1.83, 95 % confidence interval 1.38–2.42). However, the percentage of episodes of mobilisation where patients\ud were receiving mechanical ventilation was higher in the Scottish cohort (41.1 % vs 16.3 %, p < 0.001). Sedation was the\ud most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability\ud and the presence of an endotracheal tube were also frequently reported barriers.\ud Conclusions: This is the first study to benchmark baseline practise of early mobilisation internationally, and it\ud demonstrates variation in early mobilisation practises between Australia and Scotland

Barriers to Physical Activity in Individuals with Spinal Cord Injury: A Western Australian Study

This study examined barriers to physical activity reported individuals with spinal cord injury (SCI) and the degree to which these barriers differed across varying degrees of independence. Participants were 65 individuals recruited from the Western Australian Spinal Cord Injury database. Data on physical activity participation and perceived barriers to physical activity participation were collected using a cross-sectional survey and analysed using independent samples t-tests. We found that, regardless of level of ambulation or ability to transfer, few participants reported being physically active. While there were no significant differences in the amount of barriers reported by individuals with different levels of independence, the type of barriers reported varied across groups