Nystagmus during an acute Ménière's attack: From prodrome to recovery

OBJECTIVE: We are currently undertaking a clinical investigation to evaluate the diagnostic capability of a system for detecting periods of pathological dizziness. This article presents an analysis of the data captured during an acute attack of Ménière's disease. DESIGN: The Continuous Ambulatory Vestibular Assessment (CAVA) device is worn by patients in the community, and continuously records eye and head movement data (vestibular telemetry). STUDY SAMPLE: A 53-year-old lady with a fifteen-year history of left-sided unilateral Ménière's disease. RESULTS: The patient wore the device nearly continuously for thirty days. The data revealed a three-hour long attack of vertigo consisting of four separate phases of nystagmus. The duration, beat-direction and slow phase velocity of the nystagmus evolved through time. The first phase contained isolated nystagmus beats which preceded the patient's record of the vertigo attack onset but coincided with anticipation of an impending vertigo attack. CONCLUSIONS: CAVA provides a unique insight into the physiological parameters present during episodes of dizziness. Here, it has provided the first full example of an acute Ménière's attack, including a period of prodrome. These findings have implications for the prediction of vertigo attack onset, for the diagnosis of Ménière's disease and other diseases resulting in dizziness

Common Representation of Information Flows for Dynamic Coalitions

We propose a formal foundation for reasoning about access control policies within a Dynamic Coalition, defining an abstraction over existing access control models and providing mechanisms for translation of those models into information-flow domain. The abstracted information-flow domain model, called a Common Representation, can then be used for defining a way to control the evolution of Dynamic Coalitions with respect to information flow

The relationship between ventilatory threshold and repeated-sprint ability in competitive male ice hockey players

Background/objective The relationship between ventilatory threshold (VT1, VT2) and repeated-sprint ability (RSA) in competitive male ice hockey players was investigated. Methods Forty-three male ice hockey players aged 18–23 years competing in NCAA Division I, NCAA Division III, and Junior A level participated. Participants performed an incremental graded exercise test on a skate treadmill to determine V˙ role= presentation style= box-sizing: border-box; margin: 0px; padding: 0px; display: inline-block; line-height: normal; font-size: 14.4px; word-spacing: normal; overflow-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; position: relative; \u3eV˙O2peak, VT1, and VT2 using MedGraphics Breezesuit™ software (v-slope). Participants performed an on-ice repeated shift (RSA) test consisting of 8-maximal skating bouts, lasting approximately 25 s and interspersed with 90 s of passive recovery, to determine first gate, second gate, and total sprint decrement (%dec). Pearson product-moment correlations and multiple regressions were used to assess relationships between ventilatory threshold variables (VT1, VT2, Stage at VT1, and Stage at VT2) and RSA (first gate, second gate, and total course decrement). Results Stage at VT2 was the only variable substantially correlated with first gate (r = −0.35; P \u3c 0.05), second gate (r = −0.58; P \u3c 0.001) and total course decrement (r = −0.42; P \u3c 0.05). Conclusion The results of this study demonstrated that VT is substantially associated with RSA, and VT2 is more strongly correlated with RSA than V˙ role= presentation style= box-sizing: border-box; margin: 0px; padding: 0px; display: inline-block; line-height: normal; font-size: 14.4px; word-spacing: normal; overflow-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; position: relative; \u3eV˙O2peak. This study suggests that longer duration high-intensity interval training at intensities that increase workrate at VT2 may lead to possible improvements in RSA

Temporal trends in the handgrip strength of 2,592,714 adults from 14 countries between 1960 and 2017: A systematic analysis

Background: Handgrip strength (HGS) is an excellent marker of functional capability and health in adults, although little is known about temporal trends in adult HGS. Objectives: The aim of this study was to systematically analyze national (country-level) temporal trends in adult HGS, and to examine relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Methods: Data were obtained from a systematic search of studies reporting temporal trends in HGS for adults (aged ≥20 years) and by examining national fitness datasets. Trends in mean HGS were estimated at the country-sex-age group level by best-fitting sample-weighted linear/polynomial regression models, with national and sub-regional (pooled data across geographically similar countries) trends estimated by a post-stratified population-weighting procedure. Pearson’s correlations quantified relationships between national trends in adult HGS and national trends in health-related and socioeconomic/demographic indicators. Results: Data from 10 studies/datasets were extracted to estimate trends in mean HGS for 2,592,714 adults from 12 high- and 2 upper-middle-income countries (from Asia, Europe and North America) between 1960 and 2017. National trends were few, mixed and generally negligible pre-2000, whereas most countries (75% or 9/12) experienced negligible-to-small declines ranging from an effect size of 0.05 to 0.27, or 0.6 to 6.3%, per decade post-2000. Sex- and age-related temporal differences were negligible. National trends in adult HGS were not significantly related to national trends in health and socioeconomic/demographic indicators. Conclusions: While trends in adult HGS are currently limited to 14 high- and upper-middle-income countries from 3 continents, adult HGS appears to have declined since 2000 (at least among most of the countries in this analysis), which is suggestive of corresponding declines in functional capability and health. PROSPERO registration number: CRD42013003678. KEY POINTS National (country-level) trends in adult handgrip strength (HGS) were few, mixed and generally negligible pre-2000, and generally negligible and indicated declines post-2000 Sex- and age-related temporal differences in adult HGS were negligible-to-small at the country level and negligible at the regional level National trends in adult HGS were not significantly related to national trends in health and socioeconomic/demographic indicator

Association Between Vitamin D Status and Testosterone and Cortisol in Ice Hockey Players

The identification of the vitamin D receptor in tissues related to testosterone and cortisol production, in conjunction with the observed correlations between vitamin D levels and these hormones in the general population, suggest vitamin D may influence testosterone and cortisol concentrations in athletes. A crosssectional study design was used to evaluate the association between 25(OH)D and testosterone and cortisol concentrations in young male ice hockey players (n = 50). All athletes were recruited during October from the Sosnowiec area, Poland (50° N). Commercially available ELISA kits were used to determine total serum 25(OH)D, testosterone and cortisol concentrations. Serum 25(OH)D concentration was analyzed as both a continuous and dichotomous variable, binned at the criteria for deficiency (\u3c 20 ng·ml-1), to investigate a threshold effect. Neither continuous (r = 0.18, p = 0.20) nor dichotomous (r = 0.16, p = 0.27) 25(OH)D concentration was significantly correlated with testosterone concentration. A small, inverse correlation (r = -0.30, p = 0.04) was detected between 25(OH)D and cortisol concentrations when analyzed as a dichotomous variable only. Serum 25(OH)D concentration was neither associated with testosterone (p = 0.09) nor cortisol concentrations (p = 0.11) after adjusting for age, fat free mass and fat mass in sequential linear regression. The inability of vitamin D status to independently predict testosterone and cortisol concentrations suggests that any performanceenhancing effects of vitamin D in athletes are unlikely to be mediated primarily through these hormones, at least amongst young male ice-hockey players

Association Between Vitamin D Status and Testosterone and Cortisol in Ice Hockey Players

The identification of the vitamin D receptor in tissues related to testosterone and cortisol production, in conjunction with the observed correlations between vitamin D levels and these hormones in the general population, suggest vitamin D may influence testosterone and cortisol concentrations in athletes. A crosssectional study design was used to evaluate the association between 25(OH)D and testosterone and cortisol concentrations in young male ice hockey players (n = 50). All athletes were recruited during October from the Sosnowiec area, Poland (50° N). Commercially available ELISA kits were used to determine total serum 25(OH)D, testosterone and cortisol concentrations. Serum 25(OH)D concentration was analyzed as both a continuous and dichotomous variable, binned at the criteria for deficiency (\u3c 20 ng·ml-1), to investigate a threshold effect. Neither continuous (r = 0.18, p = 0.20) nor dichotomous (r = 0.16, p = 0.27) 25(OH)D concentration was significantly correlated with testosterone concentration. A small, inverse correlation (r = -0.30, p = 0.04) was detected between 25(OH)D and cortisol concentrations when analyzed as a dichotomous variable only. Serum 25(OH)D concentration was neither associated with testosterone (p = 0.09) nor cortisol concentrations (p = 0.11) after adjusting for age, fat free mass and fat mass in sequential linear regression. The inability of vitamin D status to independently predict testosterone and cortisol concentrations suggests that any performanceenhancing effects of vitamin D in athletes are unlikely to be mediated primarily through these hormones, at least amongst young male ice-hockey players

Test-retest reliability of TRIMP in collegiate ice hockey players

The utility of the heart rate derived variable TRaining IMPulse (TRIMP) for assessing internal training load in ice hockey players is not clear. Having a reliable measure of internal training load during on-ice training sessions would help coaches program exercise training. This study determined the reliability of TRIMP during on-ice training sessions in ice hockey players. Twelve Division I collegiate male ice hockey players (aged 18–23 years) had their heart rate (HR) data recorded during two on-ice practice sessions separated by two weeks. TRIMP and other descriptive HR variables were compared between sessions. TRIMP demonstrated moderate reliability during on-ice sessions. Systematic error, quantified as standardized change in means was negligible (–0.19); random error quantified as the percent typical error (%TE) was moderate (12.2%); and, test-retest correlation was very strong (0.75). TRIMP is suitable for quantifying training load during intermittent work in hockey athletes. The results from our study can be used to determine the threshold for meaningful change in TRIMP, which may aid in informing decisions by coaches and strength training staff regarding on-ice training session difficulty and composition

Temporal trends in the cardiorespiratory fitness of 2,525,827 adults between 1967 and 2016

Objective To estimate international and national temporal trends in the cardiorespiratory ftness (CRF) of adults, and to examine relationships between trends in CRF and trends in health-related, socioeconomic, and environmental indicators. Methods Data were obtained from a systematic search of studies that explicitly reported temporal trends in the CRF of apparently healthy adults aged 18–59 years. Sample-weighted temporal trends were estimated using best-ftting regression models relating the year of testing to mean CRF. Post-stratifed population-weighted mean changes in percent and standardized CRF were estimated. Pearson’s correlations were used to describe associations between linear trends in CRF and linear trends in health-related, socioeconomic, and environmental indicators. Results 2,525,827 adults representing eight high- and upper-middle-income countries between 1967 and 2016 collectively showed a moderate decline of 7.7% (95% CI −8.4 to −7.0) or 1.6% per decade (95% CI −1.7 to −1.5). Internationally, CRF improved in the 1960s and 1970s, and progressively declined at an increasing rate thereafter. Declines were larger for men than for women, and for young adults (\u3c40 \u3eyears) than for middle-aged adults (≥40 years). All countries experienced declines in CRF with a very strong negative correlation between CRF trends and obesity trends. Conclusions There has been a meaningful decline in the CRF of adults since 1980, which has progressively increased in magnitude over time, suggestive of a corresponding decline in population health. Continuous national and international surveillance systems are needed in order to monitor health and ftness trends, especially among low- and middle-income countries for which data do not currently exist. PROSPERO registration number: CRD42013003678

Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale

Background: The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire family as members adjust to living with a high lifetime cancer risk. The research base on how individuals and families adjust to genetic-linked diseases following predictive genetic testing has increased our understanding of short-term impacts but gaps continue to exist in knowledge of important factors that facilitate or impede long-term adjustment. The failure of existing scales to detect psychosocial adjustment challenges in this population has led researchers to question the adequate sensitivity of these instruments. Furthermore, we have limited insight into the role of the family in promoting adjustment. Methods: The purpose of this study was to develop and initially validate the Psychosocial Adjustment to Hereditary Diseases (PAHD) scale. This scale consists of two subscales, the Burden of Knowing (BK) and Family Connectedness (FC). Items for the two subscales were generated from a qualitative data base and tested in a sample of 243 participants from families with LS. Results: The Multitrait/Multi-Item Analysis Program-Revised (MAP-R) was used to evaluate the psychometric properties of the PAHD. The findings support the convergent and discriminant validity of the subscales. Construct validity was confirmed by factor analysis and Cronbach’s alpha supported a strong internal consistency for BK (0.83) and FC (0.84). Conclusion: Preliminary testing suggests that the PAHD is a psychometrically sound scale capable of assessing psychosocial adjustment. We conclude that the PAHD may be a valuable monitoring tool to identify individuals and families who may require therapeutic interventions

Temporal Trends in the Standing Broad Jump Performance of United States Children and Adolescents

Purpose: To estimate temporal trends in broad jump performance for United States youth, a marker of muscular fitness and health. Method: Electronic databases, topical systematic reviews, and personal libraries were systematically searched for studies reporting descriptive standing broad jump data for apparently healthy United States youth (age 10–17 years). Temporal trends at the sex-age level were estimated using sample-weighted regression models associating the year of testing to mean jump performance, with national trends standardized to the year 1985 using a post-stratified population-weighting procedure. Results: Collectively, there was a small increase of 12.6 cm (95%CI: 12.5 to 12.7) or 7.9% (95%CI: 7.1 to 8.6) in 65,527 United States youth between 1911 and 1990. Increases were greater for girls (change in means [95% CI]: 17.1 cm [16.9 to 17.3]; 11.4% [10.7 to 12.2]) compared to boys (change in means [95% CI]: 8.5 cm [8.3 to 8.7]; 4.6% [3.8 to 5.4]), but did not differ between children (10–12 years) and adolescents (13–17 years). Increases in broad jump performance were not always uniform across time, with steady and progressive increases observed for boys and children, respectively, and a diminishing rate of increase observed for girls and adolescents. Conclusions: Muscular fitness is a good marker of health, so greater broad jump performance from 1911 to 1990 may reflect corresponding changes in health. Routine assessment of broad jump performance may be useful to monitor trends in health and muscular fitness of United States youth due to its practicality, scalability, and predictive utility