Amino acid intake & body protein synthesis

Cover title."Lecture presented Feb. 7, 1967, at the University of Missouri-Columbia"--P. 4.Includes bibliographical references (pages 23-24)

An investigation into potential methods of improving the fitness stimulus associated with small-sided games in soccer.

Background: Methods that simultaneously target physical, technical and tactical components of soccer could be an efficient use of training time. Small-sided games (SSGs) have previously been investigated demonstrating that variables, such as player numbers and pitch dimensions, can significantly influence the physical response (Aguiar et al. 2012). Inconsistent study designs limit precise conclusions about the influences separate variables have on game intensity, with authors only speculating that game intensity can be controlled through different methods or variable manipulation (Hill-Haas et al. 2011). A lack of evidence in the literature examining if the training load exerted from SSGs can be regulated warrants for research expansion in this area. Objectives: The present investigation is designed to test the hypothesis that the physical response from SSGs can be regulated based on real time objective heart rate (HR) data without being detrimental to the frequency of technical actions. Design: Cross sectional, repeated measures design. Method: Fourteen male semi-professional soccer players were recruited from a Scottish Junior North Super League club. Players were randomly separated into two teams of six, with a reserve pool of four. The same teams were played whenever possible. Every player performed a Yo-Yo Intermittent level 2 test. Eight testing sessions were performed thereafter consisting of 3 x 6 vs. 6 SSGs. Four conditions were each tested twice; baseline (BL), after game sprint (AGS), in game sprint (IGS) and self monitoring (SM). Results: Each intervention prescribed, resulted in a significant increase in HR and rate of perceived exertion (RPE) compared to BL, yet no significant differences were established between interventions. Percentage of maximum HR = BL (86.6 ± 4.6%), IGS (89.6 ±3.2), SM (89.91 ± 3.7) and AGS (90.1 ± 3.3). The AGS intervention recorded a significantly greater mean value for time spent in HR zone 90-100% compared to BL. RPE values across all games was significantly lower in BL displaying the lowest recorded mean (6.2 ± 0.68) followed by AGS (6.73 ± 0.45), IGS (6.73 ± 0.69) and SM (6.90 ± 0.50). Percentage of forward passes for IGS recorded the only notable difference between technical actions, resulting in 11.8% more passes towards the opponents goal in comparison to BL. Conclusion: The present study has investigated innovative methods that present clear evidence to strongly suggest that the interventions could be beneficial to improve soccer performance. Each intervention may also produce specific intensities due to multiple direct and indirect mechanisms, which may further influence game dynamics and increase the complexity of the training response. All interventions used in the current study require further testing to more clearly assess whether they should routinely be used

Effects of self-monitoring of heart rate and additional sprint running on exercise intensity and technical performance during small-sided games in soccer.

The purpose of this study was to assess whether relatively simple interventions including self monitoring of heart rate and the use of targeted sprints for those with the lowest relative HR values (%HRmax) could be used to increase exercise intensity during small sided games (SSGs) in soccer. A secondary aim of the study was to assess the effect of these interventions on overall gameplay. Fourteen male semi-professional players performed SSGs (6 vs. 6) under four conditions including a control, a self-monitoring approach where players monitored their own HR via a wristwatch, and two sprint conditions where players with HR values below 90%HRmax performed sprints either during the game or during the recovery period between games. A linear mixed effects model was used to test for main effects whilst accounting for covariances between observations made on the same player. The results identified relatively small but significant differences in average %HRmax (p<0.001) and RPE values (p<0.001) between the three modified conditions and the control. No significant differences were found between any of the modified conditions for measures of exercise intensity. On average, the modified conditions resulted in a 3.7% increase in %HRmax values and a 9.3% increase in RPE. The results from this study demonstrate that exercise intensity of SSGs in soccer can be increased by relatively simple and practical manipulations, the most basic of which requires only the use of inexpensive HR monitors

Expansion of HCV treatment access to people who have injected drugs through effective translation of research into public health policy:Scotland's experience

Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan – a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multi-disciplinary multi-agency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by non-clinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as “an impressive example of a national strategy” by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme