The effect of swilling carbohydrate, menthol or a combination on 40km cycling time trial in the heat.

Introduction: Both carbohydrate and menthol mouth swills have shown ergogenic effects under a variety of settings. The aim of the current study was to compare the effect of the aforementioned mouth swill solutions on 40 km time trial (TT) performance in the heat (32°C, 40% humidity, 300kw radiant load) and investigate associated subjective measures (thermal comfort, thermal sensation, thirst, and RPE) every 5km. Methods: Six (6) recreationally trained male cyclists (31.8 ± 5.9 years, 178.2 ± 6.0 cm, 75.7 ± 10.0 kg) completed 3 trials, swilling either menthol (MEN), carbohydrate (CHO), or a combination (BOTH) at 10km intervals (5, 15, 25, 35km). Results: There was no statistically significant difference in 40km TT performance between mouth swills (P = 1.00), with MEN producing slightly quicker times on average (MEN 65:43 ± 4:48, CHO 66:09 ± 4:13, BOTH 65:57 ± 3:58 min:sec). Subjective measures were not significantly different, however MEN showed small (0.2-0.6) and moderate (0.6-1.2) effect size increases on thermal comfort compared to CHO and BOTH 5km post swill. Discussion: The ability to activate receptors in the oral cavity may be responsible for improved athletic performance due to potential central activation. The ability to perceptually cool and or fuel an athlete while exercising, especially in the heat, may allow for improved levels of thermal comfort and subsequently enhanced performance Take Home Message: Results, however, indicate that while MEN showed a beneficial effect on making participants feel more comfortable while exercising in the heat compared to CHO or BOTH, 40km TT was not significantly difference between solutions

The effects of morning preconditioning protocols on testosterone, cortisol and afternoon sprint cycling performance [conference presentation]

Opportunities exist for athletes to undertake morning exercise protocols in an attempt to potentate afternoon performance. Four sub elite track sprint cyclists completed a morning cycling (Cyc) or weights-based protocol (WP) prior to an afternoon cycling time trial (500m) in a repeated measures, counterbalance crossover design. Measured variables included heart rate, blood lactate, cycling peak power, salivary testosterone (T) and cortisol levels along with time trial performance. Standardised differences in means via magnitude-based inferences were calculated using paired samples T-tests in SPSS version 24 with statistical significance set at p < 0.05. The WP produced significantly faster times in the final 250m in comparison to CycP. The anticipated circadian decline of T was observed after the CycP but was however mitigated following the WP. While slight decreases in 500m times were experienced during the WP, they were not significant and were considered within the normal variations experienced between performances by elite athletes. The effect of the WP on the circadian rhythm of T could be linked to a greater recruitment of muscle fibres. Results suggest a morning resistance protocol can positively affect testosterone levels for afternoon performance. Possible gender and individual responses from conducting a W over Cyc protocol were observed and require further investigation

Qualitative investigation of the role of collaborative football and walking football groups in mental health recovery

Efforts to increase physical activity levels in people with serious mental health conditions are viewed as desirable but little is known about how best to support this group to engage in exercise over extended periods. From a personal recovery perspective, the dominant paradigm in current mental health service delivery, one promising route involves participation with, rather than administration to or supervision of, mental health service users in team sports, usually football, in order to foster sharing of common interests and experiences. We aimed to explore the factors underlying the success of four collaborative mental health football (soccer) projects and the role played by football in mental health care delivery and in personal recovery. We held semi-structured focus groups with service user (n = 18) and staff (n = 7) participants from four football groups (two 'walking' football and two regular football) in two geographical National Health Service Boards in Scotland. Thematic analysis revealed that, central to success, were perceived relational, and personal and physical recovery-related benefits; competition and collaboration-related aspects were important drivers of interest in and commitment to the groups. Further, participants identified barriers to and concerns for continued success; specifically, they expressed that they need more explicit support from senior management. The clear emerging message was that collaborative football groups were perceived by participants as a conduit for recovery and an important aspect of mental healthcare delivery. Playing football was associated with a sense of wellbeing, and enhanced relationships between service users and staff

The effects of menthol on a modified three-minute maximal test in the heat.

Previous menthol studies have been demonstrated alongside endurance-based physical activity. However, in current literature there is a need for research with athletes participating in sports that require short bouts of exercise that exceed aerobic capacity. The aim of this study was to trial 0.1% menthol concentrate with participants completing a modified 3-minute maximal test in an environmental heat chamber (33.0 ± 3.0° with RH 46.0 ± 5.0%). In a randomised crossover single blind placebo-controlled study, 11 participants completed 3 modified maximal tests, and each trial included a different mouth rinse; either menthol (A), cold water (B) or placebo (C). Participants were asked their thermal comfort (TC), sensation (TS) and rating of perceived exertion (RPE) throughout the test while being measured for heart rate, core temperature, oxygen uptake (V̇O2), ventilatory equivalent (VE) and respiratory exchange ratio (RER) for the entirety of the test. Blood lactate (BLa) was taken before and after the test. Results reported small to moderate effects through effects sizes (Cohen’s d) accompanying a 90% confidence interval. Main effects between solutions A, B and C in relation to relative power towards the end of the test. During 75-105 seconds between solutions A vs B (ES:0.795; 90% CI: 0.204 to 1.352) and A vs C (ES:1.059; 90% CI: 0.412 to 1.666) also between A vs B (ES:0.729; 90% CI: 0.152 to 1.276) and A vs C (ES:0.791; 90% CI: 0.202 to 1.348) for seconds 105-135 while also for 135-165 seconds there was a moderate effect seen for A vs B solution (ES:1.058; 90% CI: 0.411 to 1.665). This alludes to participants producing higher power for a longer duration at high intensities with the addition of the menthol mouth rinse. The use of menthol (0.1%) as a mouth rinse has shown small performance benefits for short bouts of high intensity exercise in the heat

Repeated menthol mouth swilling affects neither strength nor power performance

This study aimed to assess the effects of repeated menthol mouth swilling upon strength and power performance. Nineteen (10 male) participants completed familiarisation and experimental trials of repeated menthol mouth swilling (0.1% concentration) or control (no swill) in a randomised crossover design. Participants performed an isometric mid-thigh pull (IMTP; peak and mean force; N), vertical jump (peak; cm) and six second sprint (peak and mean power; W) under each condition. Participants completed three efforts per exercise task interspersed with three-minute recoveries. Mean best values were analysed via a two-way mixed repeated measures ANOVA, and differences reported as effect sizes ± 95% confidence intervals, with accompanying descriptors and p values. Differences in peak IMTP values were unclear between familiarisation and experimental trials, and between menthol and control conditions. Mean IMTP force differed between familiarisation and control (0.51; −0.15 to 1.14; p = 0.001) and familiarisation and menthol conditions (0.50; −0.15 to 1.14; p = 0.002) by a small degree, but were unclear between control and menthol conditions. Unclear differences were also noted on vertical jump performance compared to familiarisation and between experimental conditions, with repeated six second peak and average power performance also showing unclear effects across all comparisons. We conclude that repeated menthol mouth swilling does not improve strength or power performance

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework

Contains fulltext : 96936.pdf (publisher's version ) (Open Access)BACKGROUND: Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). METHODS: The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. RESULTS: Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. CONCLUSIONS: This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

High rates of albuminuria but not of low eGFR in Urban Indigenous Australians: the DRUID Study

<p>Abstract</p> <p>Background</p> <p>Indigenous Australians have an incidence of end stage kidney disease 8-10 times higher than non-Indigenous Australians. The majority of research studies concerning Indigenous Australians have been performed in rural or remote regions, whilst the majority of Indigenous Australians actually live in urban settings. We studied prevalence and factors associated with markers of kidney disease in an urban Indigenous Australian cohort, and compared results with those for the general Australian population.</p> <p>Methods</p> <p>860 Indigenous adult participants of the Darwin Region Urban Indigenous Diabetes (DRUID) Study were assessed for albuminuria (urine albumin-creatinine ratio≥2.5 mg/mmol males, ≥3.5 mg/mmol females) and low eGFR (estimated glomular filtration rate < 60 mls/min/1.73 m²). Associations between risk factors and kidney disease markers were explored. Comparison was made with the AusDiab cohort (n = 8,936 aged 25-64 years), representative of the general Australian adult population.</p> <p>Results</p> <p>A high prevalence of albuminuria (14.8%) was found in DRUID, whilst prevalence of low eGFR was 2.4%. Older age, higher HbA1c, hypertension, higher C-reactive protein and current smoking were independently associated with albuminuria on multiple regression. Low eGFR was independently associated with older age, hypertension, albuminuria and higher triglycerides. Compared to AusDiab participants, DRUID participants had a 3-fold higher adjusted risk of albuminuria but not of low eGFR.</p> <p>Conclusions</p> <p>Given the significant excess of ESKD observed in Indigenous versus non-Indigenous Australians, these findings could suggest either: albuminuria may be a better prognostic marker of kidney disease than low eGFR; that eGFR equations may be inaccurate in the Indigenous population; a less marked differential between Indigenous and non-Indigenous Australians for ESKD rates in urban compared to remote regions; or that differences in the pathophysiology of chronic kidney disease exist between Indigenous and non-Indigenous populations.</p

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention