Effective But Not Adhered to:How Can We Improve Adherence to Evidence-Based Hamstring Injury Prevention in Amateur Football?

Objectives: To investigate adherence to a Nordic hamstring exercise (NHE) program in a real-world context of male amateur football, and the perceptions of end users (players) and intervention deliverers (coaches and medical staff) about adherence to this proven effective program. Design: Retrospective cohort study. Setting: Dutch amateur football. Participants: Two hundred sixty-four players, 23 coaches, and 29 medical staff from Dutch amateur football teams that participated in a national randomized controlled trial 2 years earlier. Independent Variables: Nordic hamstring exercise program. Main Outcome Measures: Nordic hamstring exercise program adherence during 2014 and 2015. Intervention or control group allocation during the trial, transfers, and personal perception about adherence to the program were also examined. Results: Of all players, 69% reported never, 16% sometimes, 6% frequently, 5% often, and 4% always performing exercises of the NHE program. Adherence to the NHE program was higher among players who had been in the NHE arm of the previous trial and among players who had not been transferred to another club compared with players who had been transferred. Key factors in stimulating players to adhere to the NHE program were knowledge of the NHE and personal motivation. Coaches and medical staff members also mentioned personal motivation and consensus with team staff as key factors to encourage NHE adherence. Conclusions: Among high-level male amateur football players, adherence to an evidence-based hamstring injury-prevention program was very low. It is essential to recognize factors that stimulate or limit adherence to injury-prevention programs for effective programs to actually lead to a reduction in hamstring injuries in a real-world context

11β-Hydroxysteroid dehydrogenase type 1 contributes to the balance between 7-keto- and 7-hydroxy-oxysterols in vivo

Abstract11β-Hydroxysteroid dehydrogenase 1 (11βHSD1; EC 1.1.1.146) generates active glucocorticoids from inert 11-keto metabolites. However, it can also metabolize alternative substrates, including 7β-hydroxy- and 7-keto-cholesterol (7βOHC, 7KC). This has been demonstrated in vitro but its consequences in vivo are uncertain. We used genetically modified mice to investigate the contribution of 11βHSD1 to the balance of circulating levels of 7KC and 7βOHC in vivo, and dissected in vitro the kinetics of the interactions between oxysterols and glucocorticoids for metabolism by the mouse enzyme.Circulating levels of 7KC and 7βOHC in mice were 91.3±22.3 and 22.6±5.7nM respectively, increasing to 1240±220 and 406±39nM in ApoE−/− mice receiving atherogenic western diet. Disruption of 11βHSD1 in mice increased (p<0.05) the 7KC/7βOHC ratio in plasma (by 20%) and also in isolated microsomes (2 fold). The 7KC/7βOHC ratio was similarly increased when NADPH generation was restricted by disruption of hexose-6-phosphate dehydrogenase.Reduction and oxidation of 7-oxysterols by murine 11βHSD1 proceeded more slowly and substrate affinity was lower than for glucocorticoids. in vitro 7βOHC was a competitive inhibitor of oxidation of corticosterone (Ki=0.9μM), whereas 7KC only weakly inhibited reduction of 11-dehydrocorticosterone. However, supplementation of 7-oxysterols in cultured cells, secondary to cholesterol loading, preferentially slowed reduction of glucocorticoids, rather than oxidation.Thus, in mouse, 11βHSD1 influenced the abundance and balance of circulating and tissue levels of 7βOHC and 7KC, promoting reduction of 7KC. In health, 7-oxysterols are unlikely to regulate glucocorticoid metabolism. However, in hyperlipidaemia, 7-oxysterols may inhibit glucocorticoid metabolism and modulate signaling through corticosteroid receptors

Chapter six - transformation of agricultural landscapes in the Anthropocene: nature's contributions to people, agriculture and food security

Multiple anthropogenic challenges threaten nature's contributions to human well-being. Agricultural expansion and conventional intensification are degrading biodiversity and ecosystem functions, thereby undermining the natural foundations on which agriculture is itself built. Averting the worst effects of global environmental change and assuring ecosystem benefits, requires a transformation of agriculture. Alternative agricultural systems to conventional intensification exist, ranging from adjustments to efficiency (e.g. sustainable intensification) to a redesign (e.g. ecological intensification, climate-smart agriculture) of the farm management system. These alternatives vary in their reliance on nature or technology, the level of systemic change required to operate, and impacts on biodiversity, landscapes and agricultural production. Different socio-economic, ecological and political settings mean there is no universal solution, instead there are a suite of interoperable practices that can be adapted to different contexts to maximise efficiency, sustainability and resilience. Social, economic, technological and demographic issues will influence the form of sustainable agriculture and effects on landscapes and biodiversity. These include: (1) the socio-technical-ecological architecture of agricultural and food systems and trends such as urbanisation in affecting the mode of production, diets, lifestyles and attitudes; (2) emerging technologies, such as gene editing, synthetic biology and 3D bioprinting of meat; and (3) the scale or state of the existing farm system, especially pertinent for smallholder agriculture. Agricultural transformation will require multifunctional landscape planning with cross-sectoral and participatory management to avoid unintended consequences and ultimately depends on people's capacity to accept new ways of operating in response to the current environmental crisis

Comparison of single-port and conventional laparoscopic abdominoperineal resection

Background: Within the last two decades, surgical treatment of colorectal cancer has changed dramatically from large abdominal incisions to minimal access surgery. In the recent years, single port (SP) surgery has spawned from conventional laparoscopic surgery. The purpose of this study was to compare conventional with SP laparoscopic abdominoperineal resection (LAPR) for rectal cancer. Patients and Methods: This was a single-center non-randomised retrospective comparative study of prospectively collected data on 53 patients who underwent abdominoperineal resection for low rectal cancer; 41 with conventional laparoscopy and 12 with SP surgery. Results: Patients' characteristics were in general comparable, but patients in the conventional laparoscopy-group had a significantly higher American Society of Anesthesiologists-score. The operative time was slightly shorter in the conventional laparoscopy-group, but no differences were found in oncological margins of the resected specimen, in length of stay or readmission rate. Conclusions: SP LAPR appeared to be safe and feasible in selected patients. Adequate oncologic resections can be performed with acceptable morbidity and mortality. Larger randomised controlled trials with longer follow-up are needed to determine the beneficial role of this new procedure