Establishing comprehensive oral assessments for children with safeguarding concerns.

The dental profession is well placed to contribute important information in child protection cases but no previous research has been reported that assesses the volume or impact of this information. Comprehensive oral assessment clinics were introduced and established as an integral part of comprehensive medical assessments for children with welfare concerns in Greater Glasgow and Clyde. An assessment protocol and standardised paperwork for comprehensive oral assessments were developed to enhance information sharing and patient access to appropriate care. Two cases are presented and discussed to demonstrate the value of dental input

Degradation of haloaromatic compounds

An ever increasing number of halogenated organic compounds has been produced by industry in the last few decades. These compounds are employed as biocides, for synthetic polymers, as solvents, and as synthetic intermediates. Production figures are often incomplete, and total production has frequently to be extrapolated from estimates for individual countries. Compounds of this type as a rule are highly persistent against biodegradation and belong, as "recalcitrant" chemicals, to the class of so-called xenobiotics. This term is used to characterise chemical substances which have no or limited structural analogy to natural compounds for which degradation pathways have evolved over billions of years. Xenobiotics frequently have some common features. e.g. high octanol/water partitioning coefficients and low water solubility which makes for a high accumulation ratio in the biosphere (bioaccumulation potential). Recalcitrant compounds therefore are found accumulated in mammals, especially in fat tissue, animal milk supplies and also in human milk. Highly sophisticated analytical techniques have been developed for the detection of organochlorines at the trace and ultratrace level

WHOLE BODY VIBRATION AND BLOOD FLOW RESTRICTION FOR MUSCLE RECOVERY FOLLOWING EXERCISE-INDUCED MUSCLE DAMAGE

Matthew A. Chatlaong, Daphney M. Stanford, William M. Miller, Matthew B. Jessee. University of Mississippi, University, MS. BACKGROUND: Combined, whole-body vibration and blood-flow restriction (WBV+BFR) may elicit a reparative response in skeletal muscle, but it is unknown if it improves recovery from muscle damage. PURPOSE: To evaluate the effects of WBV+BFR on muscle recovery following unaccustomed resistance exercise. METHODS: To date, 16 participants completed 100 maximal unilateral eccentric knee extensions with each leg, followed by WBV+BFR on one leg (3 sets of 4 min, 1-3 mm at 30 Hz, 80% arterial occlusion pressure applied, 3 min inter-set rest), but not the other (CON). Pre-exercise and for 3 consecutive days after, measures of maximal voluntary contraction torque (MVC), muscle thickness (MT), and muscle soreness (MS) were assessed via dynamometry, ultrasound, and visual analog scale, respectively, followed by WBV+BFR (except day 4). Discomfort (0-10) was assessed during WBV+BFR. Bayesian RMANOVA were used to find the most probable model for each variable. Data are presented as mean ± SD. BF10= likelihood of most probable alternative model vs the null. RESULTS: A main effect of time (BF10=2249.0) indicated MVC (Nm) decreased from pre (193.6 ± 61.3) to post-exercise (163.5 ± 50.3, BF10=1557.4), and remained below pre at day 2 (177.3 ± 57.6, BF10=14.3) while still higher than post-exercise (BF10 =101.1). There was weak evidence that day 3 MVC (178.1 ± 53.7) was lower than pre (BF10=1.9), and anecdotal evidence that day 4 (185.5 ± 65.6) did not differ from pre (BF10=.4). For MT (cm) at 60% thigh length, the most probable model was the null (BF10=.7). There was strong evidence of a main effect of time at 70% MT (BF10=28.1). There was weak evidence that 70% MT increased from pre (3.4 ± .8) to day 2 (3.5 ± .8, BF10=2.6), moderate evidence that day 3 was higher than pre (3.5 ± .8, BF10=8.2), strong evidence that day 4 (3.5 ± .8) was higher than pre (BF10=12.8), and anecdotal evidence that days 2-4 did not differ (all BF10\u3c.5). A main effect of time (BF10=28526.5) indicated that MS (AU) increased from pre (1.0 ± 2.6) to day 2 (16.7 ± 17.1, BF10=1888.1), remained above pre at day 3 (13.6 ± 19.6, BF10=33.1), and moderate evidence that day 4 (7.5 ± 12.8) was higher than pre (BF10=5.3). Discomfort (AU) differed across days (BF10=22.1), (day 1=3.5 ± 2.2, day 2=3.2 ± 2.4, day 3=3.0 ± 2.4), where day 3 was lower than day 1 (BF10=16.1). CONCLUSION: Currently, WBV+BFR does not appear to improve recovery compared to CON

CHARACTERIZING POWER PRODUCTION AND CARDIOVASULAR RESPONSES TO 2 X 20 SECOND MAXIMAL CYCLING SPRINTS

Lori M. Keys, Matthew A. Chatlaong, Daphney M. Stanford, Matthew B. Jessee. University of Mississippi, University, MS. BACKGROUND: Training with 2 x 20s cycling sprints improves cardiorespiratory fitness but reducing this to 1 sprint does not. It is unclear if fatigue induced by the first sprint might lead to greater cardiovascular demand in the second sprint. PURPOSE: Characterize power production and cardiovascular responses to 1- and 2 - 20s maximal cycling sprints. METHODS: In a single lab visit, 43 participants completed 2 x 20 second maximal “Wingate” leg cycling sprints (5 min rest between) with no warm-up or cool-down. Peak and mean power for each sprint (S1 = sprint 1, S2 = sprint 2), were determined by Lode ergometer software. Heart rate (HR) was measured via telemetry and analyzed at baseline, during S1 and S2, in minutes 1 (M1), 3 (M3), and 5 (M5) of recovery after each sprint, and at 10- (M10) and 15- (M15) minutes post-exercise. Mean HR was averaged over windows of 1-min at baseline, 20s during S1 and S2, and for 30s at M1, M3, M5, M10, and M15. Peak HR was the highest value during each window. Bayesian paired t tests were used to compare peak and mean power between sprints. Bayesian rmANOVA were used to compare mean and peak HR between time points. BF10 = likelihood of alternative vs. null. Results are mean±SD. RESULTS: Mean power (W) was higher for S1 (577.7±171.8) than S2 (543.2±159.4, BF10=2101.2). Peak power (W) was also higher for S1 (935.3±326.5) than S2 (882.4±208.4, BF10=57.3). Mean HR (bpm) increased from baseline (89.1±15.3) and did not return by M10 (108.0±18.6, BF10=526390.3) or M15 (106.2±18.1, BF10=245115.2). Comparing mean HR during the sprints, S2 (129.4±18.0) was higher than S1 (119.2±18.8, BF10=100615.6). Peak HR (bpm) during S2 (149.5±20.0) was higher than S1 (143.9±22.3, BF10=28.3). Comparing the recovery from each sprint, mean HR was higher at S2M1 (152.1±21.9) vs S1M1 (144.7±23.3, BF10=1051.7), S2M3 (123.2±21.5) vs S1M3 (110.7±21.1, BF10=6.919e+7), and S2M5 (115.4±21.0) vs S1M5 (107.1±20.8, BF10=351.8). Peak HR followed the same pattern, being higher at S2M1 (158.4±20.8) vs S1M1 (154.2±23.4, BF10=11.0), S2M3 (129.7±19.8) vs S1M3 (118.6±20.0, BF10=1.938e+11), and S2M5 (120.6±19.8) vs S1M5 (114.1±18.9, BF10=22.4). CONCLUSION: The lower power production in sprint 2 suggests a robust, fatiguing stimulus was induced by sprint 1. This may have led to a cumulative increase in cardiovascular demand, as heart rate responses were also substantially higher after the second sprint than the first

COMPARING THE EXERCISE RESPONSE AND IMMEDIATE RECOVERY BETWEEN TWO DIFFERENT BLOOD FLOW RESTRICTION DEVICES

Daphney M. Stanford, Matthew A. Chatlaong, William M. Miller, Matthew B. Jessee. University of Mississippi, Oxford, MS. BACKGROUND: It is unknown if the exercise response to a common clinical (CLIN) blood flow restriction (BFR) device differs from a common research device (RES). The purpose of this study was to compare the BFR exercise response between devices. METHODS: On the first of two visits, 15 individuals had maximal strength (1RM) assessed. Visit 2 consisted of 4 sets (S1, S2, S3, S4) of bicep curls at 30% 1RM and 50% arterial occlusion pressure (AOP), one arm with CLIN and the other with RES. Device and arm order were counterbalanced. After a 5min rest, pre-exercise AOP (mmHg) was measured. Muscle thickness (MT, cm) at 70% of the upper arm and maximal isometric force (N) were assessed pre-exercise (Pre), immediately (Post), 5min (Post5), and 10min (Post10) after. Tissue saturation index (TSI, %) for sets was measured at the forearm. Ratings of perceived exertion (RPE) and discomfort (DIS) were assessed pre-exercise and after each set for RPE and 20 sec after each set for DIS. AOP was compared with a Bayesian paired t-test. All others were compared with Bayesian RMANOVA. Results presented as mean±SD. BF10=likelihood of the best model vs the null. RESULTS: AOP (RES=144.4±19.8; CLIN=138.3±25.8) did not differ (BF10=0.795). A time effect (BF10=1.942e+21) suggests force decreased Pre (230.7±77.9) to Post (145.2±50.5; BF10=2.088e+8), increased Post to Post5 (190.6±69.5; BF10=688721.630) and did not differ Post5 to Post10 (194.5±68.9; BF10=0.433). A time effect (BF10=1.566e+17) suggests MT increased Pre (4.0±.8) to Post (4.5±.9; all BF10=1.646e+10), decreased Post to Post5 (4.4±.9; BF10=80.411), and Post5 to Post10 (4.4±.9; BF10=0.268) did not differ. A time+condition model (BF10=435.966) suggests TSI increased from S1 (53.6±9.7) to S2 (56.9±10.8; BF10=322.137) but did not differ across S2, S3 (57.5±9.8), and S4 (57.6±9.3; all≤BF10=.341). CLIN (55.2±8.8) TSI was lower than RES (57.6±11.1; BF10=12.358). A time effect (BF10=7.776e+66) suggests RPE increased Pre (0±0) to S1 (7±2; BF10=1.534e+13), S1 to S2 (8±2; BF10=3.361), S2 to S3 (8±1; BF10=4.209), and S3 to S4 (9±1; BF10=6.491). A time effect (BF10=4.703e+30) suggests DIS increased Pre (0±0) to S1 (5±3; BF10=1.427e+7), S1 to S2 (5±2; BF10=2.662), but did not differ from S2 to S3 (6±2; BF10=0.436) or S3 to S4 (6±2; BF10=0.437). CONCLUSIONS: Overall the exercise response may not differ between devices, but tissue saturation index may be greater with the research device

THE MICROVASCULAR HYPEREMIC RESPONSE TO OCCLUSIVE OR PARTIAL BLOOD FLOW RESTRICTION

Brianna N. Cupp, Daphney M. Stanford, Matthew A. Chatlaong, Matthew B. Jessee. The University of Mississippi, University, MS. BACKGROUND. Blood flow restriction (BFR) alone decreases muscle atrophy following immobilization. It is unknown what effect BFR alone has on microvasculature. The purpose of this study is to determine the acute effect of BFR alone on oxygen extraction rate (Slope 1, S1) and reactive hyperemia (Slope 2, S2) when compared to a protocol known to improve vascular function. METHODS. 9 females and 11 males (height: 164.2±21.1 cm; weight: 72.7±29.0 kg; age: 27.6±10.6 y) completed 3 protocols (separate visits), on the right arm, while supine. For all conditions a cuff was secured on the upper arm. First, after a 5min rest, AOP was measured. After another 5min rest, the protocol started. For control (CON), the cuff remained deflated. For BFR, a cuff was inflated to 80% arterial occlusion pressure (AOP) for 5 cycles (5min inflation/3min deflation). For ischemic preconditioning (IPC), a cuff was inflated to 105% AOP for 4 cycles (5min inflation/5min deflation). A near-infrared spectroscopy device (NIRS) continuously estimated deoxy(Hb, µM∙s-1)/oxy(O2,µM∙s-1) heme and tissue saturation index (TSI, %∙s-1) at the forearm. S1 was the 60s following cuff inflation and S2 was the 30s immediately after cuff deflation. The regression slopes from each cycle were averaged and compared across conditions with Bayesian RMANOVA. Results presented as mean±SD. BF10=likelihood of the best model vs the null. RESULTS. S1 for TSI (Condition: BF10=4.518e+13) was steeper in BFR (-0.07±0.04) when compared to CON (0.01±0.01; BF10=202810.265), but flatter than IPC (-0.10±0.03; BF10=7.330). IPC was steeper compared to CON (BF10= 1.524e+8). S1 for O2 (Condition: BF10=6.682e+11) was positive and steeper in BFR (0.17±0.11) than CON (0.01±0.01; BF10=24409.937) and IPC (-.05±0.07; BF10=407178.004). IPC was negative compared to CON (BF10=32.242). S1 for Hb (Condition: BF10=3.856e+22) was positive and steeper in BFR (0.21±0.05) than CON (-0.01±0.0; BF10=4.626e+10) and IPC (0.15±0.05; BF10=226.453). IPC was positive compared to CON (BF10=3.097e+9). TSI for S2 (Condition: BF10=7.977e+15) was steeper for BFR (0.76±0.30; BF10=1.495e+7) and IPC (1.06±0.39; BF10=3.947e+7) compared to CON (0.0±0.01). BFR was typically flatter than IPC (BF10=42.285). CONCLUSION. The current data suggests BFR has a lower extraction rate and hyperemic response than IPC. Chronic application of BFR alone may elicit vascular adaptations, but the magnitude may be lower than IPC

ACUTE HYPEREMIC RESPONSE TO BLOOD FLOW RESTRICTION AND ISCHEMIC PRECONDITIONING PROTOCOLS

Daphney M. Stanford, Brianna N. Cupp, Matthew A. Chatlaong, Matthew B. Jessee. University of Mississippi, Oxford, MS. BACKGROUND: Ischemic preconditioning (IPC) typically improves vascular health, but it is unknown if a non-ischemic protocol would have a similar acute stimulus. The purpose of this study was to compare the acute hyperemic response of IPC and blood flow restriction (BFR). METHODS: 20 subjects (45% female) completed 3 conditions over 3 visits (randomized and counterbalanced). While supine, a pneumatic cuff was placed on the upper right arm, and following 5min rest, arterial occlusion pressure (AOP, mmHg) was measured, then following a second 5min rest the protocol started. For IPC, a cuff inflated (105%AOP) for 5min with 5min of rest for 4 cycles. For BFR, a cuff inflated (80%AOP) for 5min with 3min rest for 5 cycles. CON had a deflated cuff on for 40min. Using duplex ultrasound distal to the cuff, brachial artery blood velocity (cm/s) and diameter (cm) were recorded at baseline (Pre) and after cuff deflation. The first 30s of blood velocity after cuff deflation was averaged, and the last 30s of artery diameter after cuff deflation was averaged. AOP was measured immediately after (Post) the protocol. Discomfort (DIS, A.U.) was asked with a 0-10 scale at Pre and Post. Changes in artery diameter and blood velocity (last cycle-Pre), and changes in AOP and DIS (Post-Pre) were compared across conditions using Bayesian repeated measures ANOVAs. Results presented as mean±SD. BF10=likelihood of the best model vs the null. RESULTS: The change in artery diameter (Condition: BF10=400.697) for BFR (.01±.02) was higher than CON (-.01±.02; BF10=2.651), and lower than IPC (.02±.03; BF10=1.569). IPC was higher than CON (BF10=82.853). The hyperemic response (Condition: BF10=5.887e+15) for BFR (6.7±7.3) was higher than CON (-3.1±5.1; BF10=148.630), and lower than IPC (34.2±14.2; BF10=156409.519). IPC was higher than CON (BF10=3.128e+7). The change in AOP (Condition: BF10=1.296) was higher in BFR (-8.95±10.83) when compared to CON (-2.26±9.69; BF10=1.268), but similar to IPC (-6.53±5.81; BF10=.345). IPC and CON were similar (BF10=.576). The change in DISC (Condition: BF10= 19526.876) was higher in BFR (4.08±2.6) when compared to CON (1.3±2.1; BF10=195.289), but similar to IPC (4.03±2.63; BF10=.244). IPC was higher than CON (BF10=141.363). CONCLUSION: Individuals may want to implement bouts of IPC instead of BFR for vascular health because the acute stimulus is stronger while the discomfort is similar between protocols

COMPARING POST-OCCLUSIVE REACTIVE HYPEREMIA IN HABITUAL CAFFEINE USERS WHEN CONSUMING AND ABSTAINING FROM CAFFEINE

Chance J. Davidson, Matthew A. Chatlaong, Daphney M. Stanford, Matthew B. Jessee. University of Mississippi, University, MS. BACKGROUND: Since caffeine affects cardiovascular responses, studies measuring post-occlusive reactive hyperemia (PORH) commonly require caffeine abstinence. For habitual users, effects may be attenuated, and it is unknown if abstinence alters PORH. PURPOSE: Compare PORH in habitual caffeine users when they consume or abstain from daily caffeine intake. METHODS: 28 participants completed a 3 visit within-subject study. Visit 1 consisted of familiarization and caffeine intake assessment. Visits 2-3 (1h after typical dose) consisted of PORH measures, one with (CAFF) and one without (ABS) typical caffeine doses (counterbalanced). Beginning of visits 2-3, arterial occlusion pressure (AOP) was measured via handheld Doppler probe. Heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure were measured simultaneously on the opposite arm. Testing consisted of 2 min of baseline, followed by 5 min of cuff inflation at 130% AOP, then 3 min of PORH measured with Doppler ultrasound and near-infrared spectroscopy (NIRS). Peak hyperemic velocity was the highest value of a 3s moving average after cuff deflation. Baseline velocity was the average of the 2 min period. NIRS tissue saturation index rate of change during ischemia (Slope 1) and for 30s after cuff deflation (Slope 2) was quantified via linear regression. Bayesian paired t tests were used to compare all variables between conditions. BF10= likelihood of alternative vs null. Results are mean±SD. RESULTS: There was moderate evidence that baseline velocity was the same for CAFF (9.3±4.8) and ABS (7.5±4.9, BF10=1.0). There was moderate evidence that peak hyperemic velocity (cm/s) was the same for CAFF (77.3±16.7) and ABS (77.6±19.0, BF10=.20). There was moderate evidence that Slope 2 (%/s) was the same for CAFF (1.9±.46) and ABS (1.8±.42, (BF10=.20). There was moderate evidence that Slope 1 was the same for CAFF (-.11±.04) and ABS (-.12±.03, (BF10=.20). There was moderate evidence that SBP (mmHg) was the same for CAFF (116.0±9.8) and ABS (115.5±10.7, (BF10=.220). For DBP (mmHg) evidence was weak (BF10=1.1) when comparing CAFF (69.6±5.8) and ABS (69.5±5.4). For AOP (mmHg) evidence was weak (BF10=.46) when comparing CAFF (146.6±15.0) and ABS (143.0±16.4). There was moderate evidence that HR (bpm) was the same for CAFF (66.5±12.3) and ABS (66.9±13.0, BF10 =.2). CONCLUSION: In habitual users, consuming typical caffeine doses does not appear to affect post-occlusive reactive hyperemia

EFFECTS OF CAFFEINE ABSTINENCE ON THE ACUTE RESPONSE TO LOW-LOAD BLOOD FLOW RESTRICTION EXERCISE

William M. Miller, Matthew A. Chatlaong, Daphney M. Stanford, Matthew B. Jessee. University of Mississippi, University, MS. BACKGROUND: Caffeine (CAFF) ingestion is known to enhance muscular responses to exercise. Blood flow restriction (BFR) studies typically require CAFF abstinence (ABS) prior to BFR exercise (BFR-ex). Yet, this hasn’t been tested in habituated CAFF users. The aim of this study was to compare the acute muscular responses to BFR-ex following habitual CAFF intake and acute ABS. METHODS: 10 participants completed a 3 visit within-subjects (2-14d apart) study. Visit 1 involved familiarization, CAFF intake form, and one-repetition maximum (1RM). Visits 2-3 consisted of dominant arm BFR-ex (3 sets of biceps curls to failure at 30% 1RM, 40% AOP, 30s inter-set rest). In a counterbalanced order, one visit was with CAFF and the other ABS (both 1hr after typical intake). Maximal voluntary contractions (MVC, N) were taken pre- and post-BFR-ex. Electromyography amplitude (EMGa) of the biceps brachii was measured during MVCs and BFR-ex and normalized as a percentage of peak activation during pre-MVC (%Pre). Normalized EMGa during BFR-ex was averaged over the first 3 and last 3 repetitions for each set. Repetitions (REP) completed were recorded for each set. Bayesian RMANOVAs were conducted for all variables to find the most probable alternative model vs. the null (BF10). EMGa for MVC was compared with a Bayes paired t-test. Data are mean±SD. RESULTS: A main effect of time (BF10=6.740e+6) suggests MVC decreased from pre- (234.8±56.0) to post (143.8±54.2). Anecdotal evidence suggests there may be no difference (BF10=.374) in MVC EMGa between CAFF (93.1±54.3%) and ABS (82.1±40.2%). A main effect of time (BF10=1.923e+22) for REPs indicated higher REPs completed in set 1 (33.7±9.7) vs. 2 (11.2±3.2, BF10=1.143e+8) and 3 (8.9±3.0, BF10=1.159e+9); and set 2 vs. 3 (BF10=217.4). A main effect of time (BF10=38.213) indicated that exercise EMGa increased from the beginning (112.7±45.4) to the end of set 1 (209.1±114.9, BF10=486.856), and from the beginning (168.1±73.2) to the end of set 2 (198.2±103.5, BF10=3.221). However, weak evidence suggests no difference from the beginning (175.4±79.6) to end of set 3 (186.2±99.1, BF10=0.576). CONCLUSION: Muscular responses to BFR-ex appear to not differ between ABS vs. CAFF. Future studies may not require participants to ABS from CAFF prior to BFR-ex