The physical demands of mixed martial arts: A narrative review using the ARMSS model to provide a hierarchy of evidence.

The physical demands of mixed martial arts (MMA) training and competition is not yet well quantified. The Applied Research Model for the Sport Sciences (ARMSS) provides a framework through which to conduct sport science, determining pertinent questions to test research findings in real-world settings. The aim of this review was to evaluate MMA research within the context of ARMSS to critically analyse our understanding of the physical requirements of MMA training and competition. Research databases were searched, with 70 peer-reviewed articles being discussed in relation to the specific stage of the ARMSS in which their results best fit. MMA research was found to be mostly foundational and descriptive in nature and has generally not developed along systematic lines. The internal and external loads and responses to training and competition have not been adequately identified. Therefore, it is not currently possible to state which variables are key predictors of success, or how coaches can optimally manipulate these variables. We propose that MMA research be refocused to be conducted within ARMSS. Specifically, stage 2 studies describing the physical, physiological and technical demands of MMA training and competition, and stage 3 studies determining the physiological predictors of performance should be initially prioritised

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Desempenho de processo anaeróbio em dois estágios (reator compartimentado seguido de reator UASB) para tratamento de águas residuárias de suinocultura

Avaliou-se o efeito das águas residuárias de suinocultura com concentrações de sólidos suspensos totais em torno de 6.000 mg L-1 (DQOtotal variando de 7.557 a 11.640 mg L-1) no desempenho de processo anaeróbio em dois estágios compostos por reator compartimentado (ABR) e reator de fluxo ascendente com manta de lodo (UASB), instalados em série, em escala-piloto (volumes de 530 e 120 L, respectivamente), submetidos a tempos de detenção hidráulica (TDH) de 56 a 18 h no primeiro reator e de 13 a 4 h no segundo reator. As eficiências médias de remoção de DQOtotal variaram de 71,1 a 87,5% no reator ABR e de 41,5 a 50,1% no reator UASB, resultando em valores médios de 86,8 a 94,9% para o sistema de tratamento anaeróbio em dois estágios com carga orgânica volumétrica (COV), na faixa de 5,05 a 10,12 kg DQOtotal (m³ d)-1, no reator ABR, e de 2,83 a 9,63 kg DQOtotal (m³ d)-1, no reator UASB. As eficiências de remoção de SST e SSV foram da ordem de 95,6%. O teor de metano no biogás manteve-se acima de 70% para os dois reatores. A produção volumétrica de metano máxima de 0,755 m³ CH4 (m³ d)-1 ocorreu no reator 1, com COV de 10,12 kg DQOtotal (m³ d)-1 e TDH de 18 h. Os valores médios de pH variaram na faixa de 7,2 a 8,0 para os efluentes dos reatores 1 e 2. Os ácidos voláteis totais mantiveram-se estáveis com concentrações abaixo de 200 mg L-1. Com variações abruptas e acentuadas de concentrações de SST e DQOtotal do afluente, os reatores mantiveram as eficiências de remoção de DQO e sólidos suspensos, em torno de 70%, e a qualidade do biogás, com 80% de CH4.In this work it was evaluated the effect of swine wastewater with total suspended solid (TSS) concentration around 6000 mg L-1 (CODtotal from 7557 to 11640 mg L-1) on the performance of two stage anaerobic process constituted of anaerobic baffled reactors (ABR) and an upflow sludge blanket reactor (UASB) installed in series, in pilot scale testing (volumes of 530 L and 120 L, respectively) and with hydraulic detention times (HDT) of 56 to 18 h in the first reactor and 13 to 4 h in the second reactor. The mean CODtotal removal efficiency varied from 71.1 to 87.5% in ABR and from 41.5 to 50.1% in UASB reactor, resulting in average values ranging from 86.8 to 94.9% for the two stage anaerobic treatment system under organic volumetric load (OVL) of 5.05 to 10.12 kg CODtotal (m³ d)-1 in ABR and 2.83 to 9.63 kg CODtotal (m³ d)-1 in UASB reactor. The mean TSS and VSS removal efficiencies reached 95.6%. The methane concentration was over 70% for both reactors. The maximum volumetric methane production in the first reactor was obtained with OVL of 10.12 kg CODtotal (m³ d)-1 and HDT of 18 hours of 0.755 m³ CH4 (m³ d)-1. The average pH values in the effluents ranged from 7.2 to 8.0 in the first and second reactors. The total volatile acid concentration was kept below 200 mg L-1. The reactors tolerated shock organic loads maintaining COD and SS removal efficiencies around 70% and biogas quality with 80% of CH4