The effect of carbohydrate dose and timing on timed effort and time to exhaustion within a simulated cycle race in male professional cyclists

A key performance limitation affecting professional endurance cycling is carbohydrate storage and utilisation (Pöchmüller, Schwingshack, Colombani & Hoffmann, 2016, Journal of the International Society of Sports Nutrition, 13). Muscle glycogen stores alone are inefficient at maintaining optimal blood glucose levels beyond two hours of exercise; consequently, exogenous CHO is commonly used to counteract this (Jeukendrup, 2011, Journal of Sports Sciences, 21, 91-99). High concentrations of CHO can cause drops in blood glucose, excessive glycogen utilisation and gastrointestinal discomfort (GID) (Jeukendrup, 2011). Therefore, the aim of this study was to determine if frequent, smaller CHO feedings would be preferable to large, bolus CHO feedings on time trial cycling performance. With institutional ethics approval, 5 professional cyclists completed a 4h simulated cycle ride with 3 timed efforts in a randomised, cross-over, double blind design study. Each timed effort occurred in the last 10 min of each hour (TE1, TE2, TE3); participants were asked to cycle with maximum effort for this time. There was also a final effort at the end of the 4th hour to replicate a sprint finish. This was measured as time to exhaustion (TTE). Two interventions were used; a frequent feed (F) where participants drank 20g maltodextrin in 300ml flavoured water solution 3 times per hour and a bolus feed (B) where participants drank 60g maltodextrin solution once per hour. Heart rate, power output, GID, perceived exertion (RPE), blood lactate and blood glucose were recorded before and after TE1, TE2, TE3 and TTE. Wilcoxen signed rank test and Cohen’s D was performed to study differences between interventions and effect sizes.In the F intervention, average watts were significantly higher at TE2 (P<0.05 d=0.75) and TE3 (P<0.05 d=1.21) and the RPE was lower TE1 (P≥0.05 d=1.12), TE2 (P<0.05, d=1.12) and TTE (P≥0.05 d=1.12) compared to B. There was no significant difference between any other variables. The results suggest that despite power output being higher, RPE was lower in the F intervention. Gut absorption of CHO is limited to 1g/h (Jeukendrup, 2011), which may help explain these findings. This is one of the first studies to look at concentration and timing of CHO consumption in endurance cycling. Regular feeds of 20g CHO may be more beneficial on power output and RPE in endurance cycling compared to hourly 60g feeds

Rainfall-induced differential settlements of foundations on heterogeneous unsaturated soils

This study stochastically investigates the rainfall-induced differential settlement of a centrally loaded, rigid strip foundation on an unsaturated soil with spatially varying values of either preconsolidation stress or porosity. The differential settlement (between the two foundation ends) is calculated at various times during rainfall by way of a coupled, hydro-mechanical, finite-element analysis. The Barcelona basic model describes the mechanical behaviour of the soil, and the van Genuchten relationships describe water retention and permeability. The variability of soil properties is modelled by means of random fields with spatial correlation in the framework of a Monte Carlo simulation. The study demonstrates that the occurrence of rainfall-induced differential settlements can be consistently analysed using concepts of unsaturated soil mechanics and random field theory. Results show that differential settlements can be vastly underpredicted (or even completely missed) if random heterogeneity and partial saturation are not simultaneously considered. The variation of differential settlements and their statistics during the rainfall depend on the magnitude of the applied load and the statistics of soil variability. Moreover, the transient phase of infiltration and a spatial correlation length equal to the width of the foundation pose the highest risk of differential settlement

Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control

Purpose: Cryotherapy is an increasingly popular recovery strategy used in an attempt to attenuate the negative impact of strenuous physical activity on subsequent exercise. Therefore, this study aimed to assess the effects of whole body cryotherapy (WBC) and cold water immersion (CWI) on markers of recovery following a marathon. Methods: Thirty-one endurance trained males completed a marathon. Participants were randomly assigned to a CWI, WBC or placebo group. Perceptions of muscle soreness, training stress and markers of muscle function were recorded before the marathon and at 24 and 48 h post exercise. Blood samples were taken at baseline, post intervention and 24 and 48 h post intervention to assess inflammation and muscle damage. Results: WBC had a harmful effect on muscle function compared to CWI post marathon. WBC positively influenced perceptions of training stress compared to CWI. With the exception of C-reactive protein (CRP) at 24 and 48 h, neither cryotherapy intervention positively influenced blood borne markers of inflammation or structural damage compared to placebo. Conclusion: The findings show WBC has a negative impact on muscle function, perceptions of soreness and a number of blood parameters compared to CWI, contradicting the suggestion that WBC may be a superior recovery strategy. Further, cryotherapy is no more effective than a placebo intervention at improving functional recovery or perceptions of training stress following a marathon. These findings lend further evidence to suggest that treatment belief and the placebo effect may be largely responsible for the beneficial effects of cryotherapy on recovery following a marathon

A combination of cherry juice and cold water immersion does not enhance marathon recovery compared to either treatment in isolation: a randomized placebo-controlled trial

Purpose: Cherry juice (CJ) and cold water immersion (CWI) are both effective recovery strategies following strenuous endurance exercise. However, athletes routinely combine recovery interventions and less is known about the impact of a combined CJ and CWI protocol. Therefore, this study investigated the effects of combining CWI and CJ (a “cocktail” (CT)) on inflammation and muscle damage following a marathon. Methods: A total 39 endurance trained males were randomly assigned to a placebo (PL), CWI, CJ, or CT group before completing a trail marathon run. Muscle damage (creatine kinase (CK)), muscle function (maximal voluntary isometric contraction (MVIC)), and inflammation (interleukin-6 (IL-6); C-reactive protein (CRP)) were measured at baseline, immediately after marathon (only IL-6), 24 h, and 48 h after marathon. Results: There were no statistically significant differences between groups and no group × time interaction effects for any of the dependent variables. Confidence intervals (CI) illustrated that CT had unclear effects on inflammation (IL-6; CRP) and MVIC, but may have increased CK to a greater extent than PL and CJ conditions. Conclusion: There is no evidence of an additive effect of CJ and CWI when the treatments are used in conjunction with each other. On the contrary, combining CJ and CWI may result in slightly increased circulating CK

Core competencies for pain management: results of an interprofessional consensus summit.

ObjectiveThe objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.MethodsAn interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached.ResultsThe consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain.ConclusionsThese competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain

Tutorial on model selection and validation of model input into precision dosing software for model-informed precision dosing

There has been rising interest in using model-informed precision dosing to provide personalized medicine to patients at the bedside. This methodology utilizes population pharmacokinetic models, measured drug concentrations from individual patients, pharmacodynamic biomarkers, and Bayesian estimation to estimate pharmacokinetic parameters and predict concentration-time profiles in individual patients. Using these individualized parameter estimates and simulated drug exposure, dosing recommendations can be generated to maximize target attainment to improve beneficial effect and minimize toxicity. However, the accuracy of the output from this evaluation is highly dependent on the population pharmacokinetic model selected. This tutorial provides a comprehensive approach to evaluating, selecting, and validating a model for input and implementation into a model-informed precision dosing program. A step-by-step outline to validate successful implementation into a precision dosing tool is described using the clinical software platforms Edsim++ and MwPharm++ as examples.</p

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety