Anthropometric and Performance Characteristics of Elite Hurling Players

The purpose of the present study was to examine variations in the anthropometric and performance characteristics of elite hurling players in relation to playing position. Forty-one male, elite intercounty hurlers (25 ± 4 years), 4 goalkeepers, 8 full-backs, 8 halfback, 6 midfielders, 8 half-forwards and 7 full-forwards underwent measurements of standard anthropometric (stature, body mass, sum of five skinfolds and adipose tissue percentage estimates (%AT)) and performance characteristics (counter-movement jump (CMJ), CMJ peak power, CMJ relative peak power, 5-, 10-, 20-m sprint times and estimated V•O2max) during the later stages of the competitive season. A clear hierarchical anthropometric profile is evident with goalkeepers being the taller (184.3 ± 3.7 m), possessing the highest body mass (88.7 ± 5.7 kg) and adiposity (13.2 ± 3.1 %AT) than their outfield colleagues. Half-backs (47.4 ± 2.4 cm) and half-forwards (50.7 ± 5.9 cm) produced the highest CMJ scores; a similar profile was evident for sprint times. Midfielders (60.1 ± 1.4 mL.kg-1.min-1) exhibited a significantly (p<0.05) greater maximal oxygen uptake than all other playing positions. Differences in the anthropometric and performance characteristics of other playing positions whilst evident were non-significant. This study provides novel data, as it is the first report to present normative anthropometric and performance data for elite hurling players which to date has not been present in the literature. The enhanced maximal oxygen uptake in midfield players is likely due to different performance, technical and tactical demands associated with this position

Effect of Fat and CHO Meals on Intermittent Exercise in Soccer Players

Pre-exercise meals containing carbohydrates (CHO) are recommended to athletes, although there is evidence to suggest that a high fat meal prior to exercise increases utilisation of fats yet may not adversely affect performance. This study investigated the effect of a high fat and high CHO pre-exercise meal prior to high intensity intermittent exercise. Ten male recreational soccer players performed a soccer specific protocol followed by a 1 km time trial 3 ½ h after ingesting one of 2 test meals, high fat meal (HFM) or a high CHO meal (HCM). Blood glucose, fatty acids (FA), glycerol, β-hydroxybutyrate, lactate and insulin were assessed prior to the meal, pre-exercise, halftime, and post-exercise, whilst rates of CHO and fat oxidation were determined at 4 time points during the exercise as well as heart rate (HR) and rating of perceived exertion (RPE). Significant increases in FA, glycerol, β-hydroxybutyrate and fat oxidation after the HFM were observed, while CHO oxidation was significantly higher following the HCM (P < 0.05). No performance effect was found for the 1 km time trial (HFM: 228.6+14.4 s; HCM: 229.4+26.5 s) (mean+SD). These findings suggest that the type of meal ingested prior to soccer simulated exercise has an impact on metabolism, but not on the subsequent performance as determined in the present study

The Work-Rate of Elite Hurling Match-Play

This study describes the global work-rate of elite hurling match-play and the influence which positional difference has on workrate is considered. The movement of ninety-four players was recorded using global positioning system, sampling at 4 Hz in a total of 12 games. Data were classified according to the positional line on the field and period of the match. The total and high-speed distance of match-play was 7,617 6 1,219 m (95% confidence interval [CI], 7,367–7,866) and 1,134 6 358 m (95% CI, 1,060–1,206), respectively. The maximum speed attained was 29.8 6 2.3 km.h-1 with a mean speed of 6.1 6 1 kmh 21. The second {271 6 107 m (p = 0.001; effect size [ES] = 0.25)}, third (278 6 118 m [p = 0.001; ES = 0.21]), and fourth quarter (255 6 108 m [p = 0.001; ES = 0.31]) high-speed running distance differed significantly from that of the first quarter (330 6 120 m). There was a significant difference in total (p = 0.001; ES = 0.01–0.85), high-speed running (p = 0.001; ES = 0.21–0.76), and sprint (p = 0.013; ES = 0.01–0.39) distance across the positions, with midfielders undertaking the highest volume of work, followed by the half-forward and half-back lines and finally the full-forward and full-back lines. A decrease in high-speed running distance seems to occur through out the game and in particular at the latter stages of each half. Distinct positional work profiles are evident. The present finding provide a context on which training which replicates the work-rate of match-play may be formulated, thus helping to improve the physical preparation of elite players

Acute high-intensity interval running increases markers of damage and permeability but not gastrointestinal symptoms.

Purpose: To investigate the effects of high-intensity interval (HIIT) running on markers of gastrointestinal (GI) damage and permeability alongside subjective symptoms of GI discomfort. Methods: Eleven male runners completed an acute bout of HIIT (eighteen 400 m runs at 120%O2max ) where markers of GI permeability, intestinal damage and GI discomfort symptoms were assessed and compared with resting conditions. Results: Compared to rest, HIIT significantly increased serum lactulose:rhamnose ratio (0.051 ± 0.016 vs. 0.031 ± 0.021, p = 0.0047; 95% CI = 0.006 - 0.036) and sucrose concentrations (0.388 ± 0.217 vs 0.137 ± 0.148 mg.l-1; p < 0.001; 95% CI = 0.152 - 0.350). In contrast, urinary lactulose:rhamnose (0.032 ± 0.005 vs 0.030 ± 0.005; p = 0.3; 95% CI = -0.012 - 0.009) or sucrose concentrations (0.169 ± 0.168% vs 0.123 ± 0.120%; p = 0.54; 95% CI = -0.199 - 0.108) did not differ between HIIT and resting conditions. Plasma I-FABP was significantly increased (p < 0.001) during and in the recovery period from HIIT whereas no changes were observed during rest. Mild-symptoms of GI discomfort, were reported immediately- and 24 h post-HIIT, although these symptoms did not correlate to GI permeability or I-FABP. Conclusion Acute HIIT increased GI permeability and intestinal I-FABP release, although these do not correlate with symptoms of GI discomfort. Furthermore, by using serum sampling, we provide data showing that it is possible to detect changes in intestinal permeability that is not observed using urinary sampling over a shorter time-period

Glutamine supplementation reduces markers of intestinal permeability during running in the heat in a dose-dependent manner.

PURPOSE: To examine the dose-response effects of acute glutamine supplementation on markers of gastrointestinal (GI) permeability, damage and, secondary, subjective symptoms of GI discomfort in response to running in the heat. METHODS: Ten recreationally active males completed a total of four exercise trials; a placebo trial and three glutamine trials at 0.25, 0.5 and 0.9 g kg(-1) of fat-free mass (FFM) consumed 2 h before exercise. Each exercise trial consisted of a 60-min treadmill run at 70% of [Formula: see text] in an environmental chamber set at 30 °C. GI permeability was measured using ratio of lactulose to rhamnose (L:R) in serum. Plasma glutamine and intestinal fatty acid binding protein (I-FABP) concentrations were determined pre and post exercise. Subjective GI symptoms were assessed 45 min and 24 h post-exercise. RESULTS: Relative to placebo, L:R was likely lower following 0.25 g kg(-1) (mean difference: - 0.023; ± 0.021) and 0.5 g kg(-1) (- 0.019; ± 0.019) and very likely following 0.9 g kg(- 1) (- 0.034; ± 0.024). GI symptoms were typically low and there was no effect of supplementation. DISCUSSION: Acute oral glutamine consumption attenuates GI permeability relative to placebo even at lower doses of 0.25 g kg(-1), although larger doses may be more effective. It remains unclear if this will lead to reductions in GI symptoms. Athletes competing in the heat may, therefore, benefit from acute glutamine supplementation prior to exercise in order to maintain gastrointestinal integrity

The Cancer Hub Approach for Upper Gastrointestinal Surgery During COVID-19 Pandemic: Outcomes from a UK Cancer Centre.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused unprecedented disruption to global healthcare delivery. In England, the majority of elective surgery was postponed or cancelled to increase intensive care capacity. Our unit instituted the 'RM Partners Cancer Hub' at the Royal Marsden Hospital in London, to deliver ongoing cancer surgery in a 'COVID-lite' setting. This article describes the operational set-up and outcomes for upper gastrointestinal (UGI) cancer resections performed during this period. METHODS: From April 2020 to April 2021, the Royal Marsden Hospital formed the RM Partners Cancer Hub. This approach was designed to coordinate resources and provide as much oncological treatment as feasible for patients across the RM Partners West London Cancer Alliance. A UGI surgical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols, was adopted. RESULTS: A total of 231 patients underwent surgery for confirmed or suspected UGI cancer during the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year disease free survival (DFS) and overall survival (OS) for oesophageal (70.8% and 72.9%), gastric (66.7% and 83.3%) and pancreatic cancer resections (68.0% and 88.0%). One patient who developed perioperative COVID-19 during the RM Partners Cancer Hub operation made a full recovery with no lasting clinical sequelae. CONCLUSION: Our experience demonstrates that the RM Partners Cancer Hub approach is a safe strategy for continuing upper gastrointestinal (GI) resectional surgery during future periods of healthcare service disruption

Probiotic supplementation increases carbohydrate metabolism in trained male cyclists: a randomized, double-blind, placebo-controlled cross-over trial.

We hypothesised that probiotic supplementation (PRO) increases the absorption and oxidation of orally ingested maltodextrin during 2h endurance cycling, thereby sparing muscle glycogen for a subsequent time trial (simulating a road race). Measurements were made of lipid and carbohydrate oxidation, plasma metabolites and insulin, gastrointestinal permeability, and subjective symptoms of discomfort. Seven male cyclists were randomized to PRO (bacterial composition given in methods) or placebo (PLC) for four weeks, separated by a 14-day washout period. After each period, cyclists consumed a 10% maltodextrin solution (initial 8 mL·kg-1 bolus and 2 mL·kg-1 every 15 min) while exercising for 2h at 55% Wmax followed by a 100 kJ time trial. PRO resulted in small increases in peak oxidation rates of the ingested maltodextrin (0.84 ± 0.10 vs 0.77 ± 0.09 g·min-1, P = 0.016), and mean total carbohydrate oxidation (2.20 ± 0.25 vs 1.87 ± 0.39 g·min-1, P = 0.038), while fat oxidation was reduced (0.40 ± 0.11 vs 0.55 ± 0.10 g·min-1, P = 0.021) . During PRO small but significant increases were seen in glucose absorption, plasma glucose and insulin concentration and decreases in NEFA and glycerol. Differences between markers of GI damage and permeability and time trial performance were not significant (P > 0.05). In contrast to the hypothesis, PRO led to minimal increases in absorption and oxidation of the ingested maltodextrin and small reductions in fat oxidation, while having no effect on subsequent time trial performance

FIRE (facilitating implementation of research evidence) : a study protocol

Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids

Scalar-field Pressure in Induced Gravity with Higgs Potential and Dark Matter

A model of induced gravity with a Higgs potential is investigated in detail in view of the pressure components related to the scalar-field excitations. The physical consequences emerging as an artifact due to the presence of these pressure terms are analysed in terms of the constraints parting from energy density, solar-relativistic effects and galactic dynamics along with the dark matter halos.Comment: 26 pages, 3 figures, Minor revision, Published in JHE

Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed