Cerebral Lactate Correlates with Early Onset Pneumonia after Aneurysmal SAH

Pneumonia is a significant medical complication following aneurysmal subarachnoid hemorrhage (aSAH). The aSAH may initiate immune interactions leading to depressed immunofunction, followed by an increased risk of infection. It remains unclear as to whether there is a possible association between cerebral metabolism and infections. Clinical and microdialysis data from aSAH patients prospectively included in the CoOperative Study on Brain Injury Depolarisations protocol Berlin were analyzed. Levels of glucose, lactate, pyruvate, and glutamate were measured hourly using microdialysis in the cerebral extracellular fluid. The occurrence of pneumonia (defined by positive microbiological cultures) and delayed ischemic neurological deficits (DIND) was documented prospectively. Eighteen aSAH patients (52.7 ± 10.7years), classified according to the World Federation of Neurological Surgeons in low (I-III, n = 9) and high (IV-V, n = 9) grades, were studied. Eight patients (45%) experienced DIND, 10 patients (56%) pneumonia (mean onset day 2.6). Lactate was elevated at day 3 in infected patients (n = 9, median = 6.82mmol/L) vs. patient without infections (n = 6, median = 2.90mmol/L, p = 0.036). The optimum cut-off point to predict pneumonia at day 3 was 3.57mmol/L with a sensitivity of 0.77, and a specificity of 0.66 (area under curve was 0.833 with p = 0.034). Lactate at day 7 was higher in DIND patients compared to no-DIND-patients (p = 0.016). Early elevated lactate correlated with occurrence of bacterial pneumonia, while late elevations with DIND after aSAH. Future investigations may elucidate the relationship between cerebral lactate and markers of immunocompetence and more detailed to identify patients with higher susceptibility for infections

Non-assisted versus neuro-navigated and XperCT-guided external ventricular catheter placement: a comparative cadaver study

Background and purpose: Accurate placement of an external ventricular drain (EVD) for the treatment of hydrocephalus is of paramount importance for its functionality and in order to minimize morbidity and complications. The aim of this study was to compare two different drain insertion assistance tools with the traditional free-hand anatomical landmark method, and to measure efficacy, safety and precision. Methods: Ten cadaver heads were prepared by opening large bone windows centered on Kocher's points on both sides. Nineteen physicians, divided in two groups (trainees and board certified neurosurgeons) performed EVD insertions. The target for the ventricular drain tip was the ipsilateral foramen of Monro. Each participant inserted the external ventricular catheter in three different ways: 1) free-hand by anatomical landmarks, 2) neuronavigation-assisted (NN), and 3) XperCT-guided (XCT). The number of ventricular hits and dangerous trajectories; time to proceed; radiation exposure of patients and physicians; distance of the catheter tip to target and size of deviations projected in the orthogonal plans were measured and compared. Results: Insertion using XCT increased the probability of ventricular puncture from 69.2 to 90.2% (p = 0.02). Non-assisted placements were significantly less precise (catheter tip to target distance 14.3 ± 7.4mm versus 9.6 ± 7.2mm, p = 0.0003). The insertion time to proceed increased from 3.04 ± 2.06min. to 7.3 ± 3.6min. (p < 0.001). The X-ray exposure for XCT was 32.23mSv, but could be reduced to 13.9mSv if patients were initially imaged in the hybrid-operating suite. No supplementary radiation exposure is needed for NN if patients are imaged according to a navigation protocol initially. Conclusion: This ex vivo study demonstrates a significantly improved accuracy and safety using either NN or XCT-assisted methods. Therefore, efforts should be undertaken to implement these new technologies into daily clinical practice. However, the accuracy versus urgency of an EVD placement has to be balanced, as the image-guided insertion technique will implicate a longer preparation time due to a specific image acquisition and trajectory planning

A Review of Controlling Motivational Strategies from a Self-Determination Theory Perspective: Implications for Sports Coaches

The aim of this paper is to present a preliminary taxonomy of six controlling strategies, primarily based on the parental and educational literatures, which we believe are employed by coaches in sport contexts. Research in the sport and physical education literature has primarily focused on coaches’ autonomysupportive behaviours. Surprisingly, there has been very little research on the use of controlling strategies. A brief overview of the research which delineates each proposed strategy is presented, as are examples of the potential manifestation of the behaviours associated with each strategy in the context of sports coaching. In line with self-determination theory (Deci & Ryan, 1985; Ryan & Deci, 2002), we propose that coach behaviours employed to pressure or control athletes have the potential to thwart athletes’ feelings of autonomy, competence,and relatedness, which, in turn, undermine athletes’ self-determined motivation and contribute to the development of controlled motives. When athletes feel pressured to behave in a certain way, a variety of negative consequences are expected to ensue which are to the detriment of the athletes’ well-being. The purpose of this paper is to raise awareness and interest in the darker side of sport participation and to offer suggestions for future research in this area

Positive youth development in swimming: clarification and consensus of key psychosocial assets

The purpose of this study was to gain a more cohesive understanding of the assets considered necessary to develop in young swimmers to ensure both individual and sport specific development. This two stage study involved (a) a content analysis of key papers to develop a list of both psychosocial skills for performance enhancement and assets associated with positive youth development, and (b) in-depth interviews involving ten expert swim coaches, practitioners and youth sport scholars. Five higher order categories containing seventeen individual assets emerged. These results are discussed in relation to both existing models of positive youth development and implications for coaches, practitioners and parents when considering the psychosocial development of young British swimmers

Developing individuals whilst managing teams: perspectives of under 21 coaches within English Premier League football

The aim of this study was to explore under 21 Development coaches’ thoughts, perspectives, and approaches within this phase of development at English Premier League (EPL) football clubs. Data were collected via one-to-one semi-structured interviews with six under 21 development coaches from six different EPL clubs. Data were subjected to thematic analysis. Findings suggested that under 21 development coaches were situated, culturally and sometimes physically, in-between the academy and first team environments, trapped between two distinct cultures. Under 21 coaches also had contrasting views and approaches with regards to the development of under 21 players and the importance of winning at this stage of development. Participants appeared to favour creating environments that can replicate the first team environment to prepare under 21 players for the transition. The study concludes by proposing more support for under 21 development coaches is required from key stakeholders, regarding clarity of the role and players developmen

Relação treinador-atleta e exercício da liderança no desporto: a percepção de treinadores de alta competição

Neste artigo apresentamos os resultados de quatro entrevistas levadas a cabo com treinadores de alta competição portugueses, onde se procurou recolher informações sobre as competências necessárias para exercer a actividade de treinador, os princípios e filosofia adoptada no trabalho, as principais áreas de exercício da liderança e os valores defendidos na modalidade e na prática profissional. Os resultados permitiram verificar um acordo quanto à importância de possuírem boas competências conceptuais e pessoais, princípios claros e aceites pelos atletas, boas condições de trabalho e atletas com qualidade para a alta competição. Paralelamente, foi evidente a complexidade de tarefas assumidas na orientação dos atletas (nove dimensões do exercício da liderança). Por último, é de salientar a importância dada à obtenção dos resultados competitivos (objectivo principal) em conjunto com a análise satisfatória do trabalho realizado e a valorização do desenvolvimento pessoal, tanto no treinador como nos atletas (objectivos “periféricos”).Coach-athlete relationship and leadership practice: the perceptions of four high level competition coaches. On this article we present the results on interviewing four high level competition Portuguese coaches. The aim was to look for information on the essential coaching competences, the working principles and philosophy, the main leadership exercise areas and the defended values on sports and professional practice. The results showed the relevancy of gathering good conceptual and personal competencies, clear and accepted principals, good working conditions and qualified athletes. Also evident were the complex tasks assumed on guiding the athletes (nine leadership exercise dimensions were found). Finally, it is essential to point out the importance given to obtaining sporting results (main goal) as well as the satisfactory working analyses and the value given to coaches’ and athletes’ self-development (side goals).(undefined

Medulloblastoma Exome Sequencing Uncovers Subtype-Specific Somatic Mutations

Medulloblastomas are the most common malignant brain tumors in children1. Identifying and understanding the genetic events that drive these tumors is critical for the development of more effective diagnostic, prognostic and therapeutic strategies. Recently, our group and others described distinct molecular subtypes of medulloblastoma based on transcriptional and copy number profiles2–5. Here, we utilized whole exome hybrid capture and deep sequencing to identify somatic mutations across the coding regions of 92 primary medulloblastoma/normal pairs. Overall, medulloblastomas exhibit low mutation rates consistent with other pediatric tumors, with a median of 0.35 non-silent mutations per megabase. We identified twelve genes mutated at statistically significant frequencies, including previously known mutated genes in medulloblastoma such as CTNNB1, PTCH1, MLL2, SMARCA4 and TP53. Recurrent somatic mutations were identified in an RNA helicase gene, DDX3X, often concurrent with CTNNB1 mutations, and in the nuclear co-repressor (N-CoR) complex genes GPS2, BCOR, and LDB1, novel findings in medulloblastoma. We show that mutant DDX3X potentiates transactivation of a TCF promoter and enhances cell viability in combination with mutant but not wild type beta-catenin. Together, our study reveals the alteration of Wnt, Hedgehog, histone methyltransferase and now N-CoR pathways across medulloblastomas and within specific subtypes of this disease, and nominates the RNA helicase DDX3X as a component of pathogenic beta-catenin signaling in medulloblastoma

Exploring the value of a coach intervention process within women's youth soccer: A case study

A coach intervention process was explored with a 38-year-old female youth soccer coach. The experimental research design consisted of a baseline assessment, intervention and follow-up phase. Within each phase, the coaching practices were assessed using the Coaching Behaviour Assessment System. Additionally, measures of both coach and athlete perceptions and attitudes were also recorded. The results revealed no significant change in coach behaviours from the baseline assessment to the follow-up assessment. However, although not significant, a meaningful change particularly regarding the use of Reinforcement, General Technical Instruction and Mistake Contingent Encouragement was evident. Results of the descriptive-analytic data generated from the cognitive investigations highlighted generally positive although not statistically significant changes, particularly those concerning the athletes' attitudes towards their coach, teammates and soccer, following the intervention process. The findings of this study are discussed in line with the existing coach behaviour literature

A Social Identity Approach to Sport Psychology: Principles, Practice, and Prospects.

Drawing on social identity theory and self-categorization theory, we outline an approach to sport psychology that understands groups not simply as features of sporting contexts but rather as elements that can be, and often are, incorporated into a person's sense of self and, through this, become powerful determinants of their sport-related behavior. The underpinnings of this social identity approach are outlined, and four key lessons for sport that are indicative of the analytical and practical power of the approach are presented. These suggest that social identity is the basis for sports group (1) behavior, (2) formation and development, (3) support and stress appraisal, and (4) leadership. Building on recent developments within sport science, we outline an agenda for future research by identifying a range of topics to which the social identity approach could fruitfully contribute