Power profiles of competitive and noncompetitive mountain bikers

© 2017 National Strength and Conditioning Association. The performance of Olympic distance cross-country mountain bikers (XCO-MTB) is affected by constraints such as erosion of track surfaces and mass start congestion which can affect race results. Standardized laboratory assessments quantify interseasonal and intraseasonal cycling potential through the assessment of multiple physiological capacities. Therefore, this study examined whether the power profile assessment (PPA) could discriminate between competitive XCO-MTB and noncompetitive mountain bikers (NC-MTB). Second, it aimed to report normative power profile data for competitive XCO-MTB cyclists. Twenty-nine male participants were recruited across groups of XCO-MTB (n = 14) and NC-MTB (n = 15) mountain bikers. Each cyclist completed a PPA that consisted of increasing duration maximal efforts (6, 15, 30, 60, 240, and 600 seconds) that were interspersed by longer rest periods (174, 225, 330, 480, and 600 seconds) between efforts. Normative power outputs were established for XCO-MTB cyclists ranging between 13.8 ± 1.5 W·kg -1 (5-second effort) and 4.1 ± 0.6 W·kg -1 (600-second effort). No differences in absolute peak power or cadence were identified between groups across any effort length (p > 0.05). However, the XCO-MTB cyclists produced greater mean power outputs relative to body mass than the NC-MTB during the 60-second (6.9 ± 0.8 vs 6.4 ± 0.6 W·kg -1 ; p = 0.002), 240-second (4.7 ± 0.7 vs. 3.8 ± 0.4 W·kg -1 ; p < 0.001), and 600-second (4.1 ± 0.6 vs. 3.4 ± 0.3 W·kg -1 ; p < 0.001) efforts. The PPA is a useful discriminative assessment tool for XCO-MTB and highlights the importance of aerobic power for XCO-MTB performance

Validation of methods for converting the original Disease Activity Score (DAS) to the DAS28

© The Author(s) 2018.The Disease Activity Score (DAS) is integral in tailoring the clinical management of rheumatoid arthritis (RA) patients and is an important measure in clinical research. Different versions have been developed over the years to improve reliability and ease of use. Combining the original DAS and the newer DAS28 data in both contemporary and historical studies is important for both primary and secondary data analyses. As such, a methodologically robust means of converting the old DAS to the new DAS28 measure would be invaluable. Using data from The Early RA Study (ERAS), a sub-sample of patients with both DAS and DAS28 data were used to develop new regression imputation formulas using the total DAS score (univariate), and using the separate components of the DAS score (multivariate). DAS were transformed to DAS28 using an existing formula quoted in the literature, and the newly developed formulas. Bland and Altman plots were used to compare the transformed DAS with the recorded DAS28 to ascertain levels of agreement. The current transformation formula tended to overestimate the true DAS28 score, particularly at the higher end of the scale. A formula which uses all separate components of the DAS was found to estimate the scores with a higher level of precision. A new formula is proposed that can be used by other early RA cohorts to convert the original DAS to DAS28.Peer reviewedFinal Published versio

Identification and evaluation of self-reported physical activity instruments in adults with osteoarthritis: A systematic review.

Objective: To identify and evaluate the measurement properties of self‐report physical activity (PA) instruments suitable for those with osteoarthritis (OA). Methods: A comprehensive two‐stage systematic review using multiple electronic databases from inception until July 2018. Stage One sought to identify all self‐reported PA instruments used in populations with joint pain attributable to OA in the foot, knee, hip or hand. Stage Two searched for and appraised studies investigating the measurement properties of the instruments identified. For both stages all articles were screened for study eligibility criteria, completed data extraction using the Qualitative Attributes and Measurement Properties of Physical Activity Questionnaires (QAPAQ) checklist, and conducted methodology quality assessments using a modified COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement properties for each physical activity instrument were evaluated and combined using narrative synthesis. Results: Stage One identified 23 unique self‐report PA instruments. Stage Two identified 53 studies that evaluated the measurement properties of 13 of the 23 instruments identified. Instrument reliability varied from inadequate to adequate (ICC=≥0.7). Instrument construct and criterion validity assessment demonstrated small to moderate correlations with direct measures of PA. Responsiveness was assessed in only 1 instrument and was unable to detect changes in comparison to accelerometers. Conclusion: While many instruments were identified as potentially suitable for use in individuals with OA, none demonstrated adequate measurement properties across all domains of reliability, validity and responsiveness. Further high‐quality assessment of self‐reported PA instruments is required before such measures can be recommended for use in OA research

Safety and effectiveness of adalimumab in a clinical setting that reflects Canadian standard of care for the treatment of rheumatoid arthritis (RA): Results from the CanACT study

<p>Abstract</p> <p>Background</p> <p>This multicenter, open-label, prospective, single cohort study evaluated the effectiveness and safety of adalimumab in a clinical setting reflecting the Canadian standard of care for the treatment of patients with rheumatoid arthritis (RA).</p> <p>Methods</p> <p>Patients ≥ 18 years of age with a history of active RA ≥ 3 months and fulfilling Canadian requirements for biological therapy received adalimumab 40 mg subcutaneously every other week for 12 weeks. Pre-study DMARD treatment regimens, corticosteroids, or NSAIDs were allowed throughout the study. The primary effectiveness outcome measure was the mean change in 28-joint disease activity score (DAS28) from baseline to Week 12. Secondary measures included the proportion of patients achieving joint remission (DAS28 < 2.6) and low-disease activity (DAS28 < 3.2) at Week 12, and European League Against Rheumatism (EULAR: moderate and good) and American College of Rheumatology (ACR: ACR20, 50, and 70) responses, as well as responses in ACR core components at Weeks 4, 8, and 12. Subgroup analysis included a comparison of patients naïve to biological DMARD (BDMARD) therapy versus BDMARD-experienced patients. Safety was assessed in terms of adverse and serious adverse events.</p> <p>Results</p> <p>A total of 879 patients (mean disease duration > 12 years) were enrolled; 772 (87.9%) completed the 12-week period. Adalimumab treatment was associated with rapid and sustained improvements in the signs and symptoms of RA. Significant improvements in mean DAS28 score were observed as early as Week 4. After 12 weeks of adalimumab treatment, 15.3% and 28.9% of patients achieved clinical remission and low-disease activity, respectively. Similarly, significant improvements in ACR core components were observed as early as Week 4, with continued improvements occurring through 12 weeks. Patients naïve to BDMARD therapy demonstrated numerically greater clinical responses when compared with patients who had experienced prior BDMARD therapy, although both subgroups were associated with significant improvements from baseline. The rates and types of adverse events, as well as the results of laboratory measures, demonstrated that adalimumab was generally safe and well-tolerated.</p> <p>Conclusions</p> <p>This study demonstrated that, under conditions reflective of the normal clinical practice in Canada, adalimumab is an effective and safe treatment for patients with RA.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00649545">NCT00649545</a>.</p

Autism as a disorder of neural information processing: directions for research and targets for therapy

The broad variation in phenotypes and severities within autism spectrum disorders suggests the involvement of multiple predisposing factors, interacting in complex ways with normal developmental courses and gradients. Identification of these factors, and the common developmental path into which theyfeed, is hampered bythe large degrees of convergence from causal factors to altered brain development, and divergence from abnormal brain development into altered cognition and behaviour. Genetic, neurochemical, neuroimaging and behavioural findings on autism, as well as studies of normal development and of genetic syndromes that share symptoms with autism, offer hypotheses as to the nature of causal factors and their possible effects on the structure and dynamics of neural systems. Such alterations in neural properties may in turn perturb activity-dependent development, giving rise to a complex behavioural syndrome many steps removed from the root causes. Animal models based on genetic, neurochemical, neurophysiological, and behavioural manipulations offer the possibility of exploring these developmental processes in detail, as do human studies addressing endophenotypes beyond the diagnosis itself

Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods

<p>Abstract</p> <p>Background</p> <p>While US studies show a higher risk of adverse events (AEs) for ethnic minorities in hospital care, in Europe ethnic inequalities in patient safety have never been analysed. Based on existing literature and exploratory research, our research group developed a conceptual model and empirical study to increase our understanding of the role ethnicity plays in patient safety. Our study is designed to (1) assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; (2) analyse what patient-related determinants affect the risk of AEs; (3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; and (4) explore possible strategies to prevent inequalities in patient safety.</p> <p>Methods</p> <p>We are conducting a prospective mixed methods cohort study in four Dutch hospitals, which began in 2010 and is running until 2013. 2000 patients (1000 ethnic Dutch and 1000 of non-Western ethnic origin, ranging in age from 45-75 years) are included. Survey data are collected to capture patients’ explanatory variables (e.g., Dutch language proficiency, health literacy, socio-economic status (SES)-indicators, and religion) during hospital admission. After discharge, a two-stage medical record review using a standardized instrument is conducted by experienced reviewers to determine the incidence of AEs. Data will be analysed using multilevel multivariable logistic regression. Qualitative interviews with providers and patients will provide insight into the mechanisms of AEs and potential prevention strategies.</p> <p>Conclusion</p> <p>This study uses a robust study plan to quantify the risk difference of AEs between ethnic minority and Dutch patients in hospital care. In addition we are developing an in-depth description of the mechanisms of excess risk for some groups compared to others, while identifying opportunities for more equitable distributions of patient safety for all.</p

Sex differences in rheumatoid arthritis: more than meets the eye...

Sex differences in the prevalence of autoimmune diseases such as rheumatoid arthritis (RA) are well described, but the literature is not as clear about sex differences in RA disease course and prognosis. A recent study from a very large cross-sectional international cohort demonstrated slightly worse levels of disease activity and function in female patients with RA, compared with men. These findings are discussed in the context of our evolving knowledge of sex differences in the expression of this prototypic autoimmune disease, both in terms of the actual disease activity level, the effects that the disease has on physical function, and our ability accurately to measure these aspects

Increased Fluorodeoxyglucose Uptake Following Endovascular Abdominal Aortic Aneurysm Repair: A Predictor of Endoleak?

The main criterion for abdominal aortic aneurysm (AAA) repair is an AAA diameter ≥5.5 cm. However, some AAAs rupture when they are smaller. Size alone may therefore not be a sufficient criterion to determine rupture risk. Fluorodeoxyglucose (FDG) uptake is increased in the presence of inflammation and it was suggested that this may be a better predictor of rupture risk than AAA size. Furthermore, increased FDG uptake following endovascular AAA repair may be an indirect predictor of continuous AAA sac enlargement due to the presence of an endoleak (even if this is not detected by imaging modalities) and/or increased AAA rupture risk. The role of FDG uptake needs to be explored further in the management of AAAs