Reflection and the art of coaching: fostering high-performance in olympic ski cross

In preparation for the 2010 Vancouver Winter Olympic Games, the lead author engaged in systematic reflection in an attempt to implement coaching behaviours and create practice environments that promoted athlete development (psycho-social and physical performance). The research was carried out in relation to his work as head Ski Cross coach working with (primarily) three athletes in their quest for Olympic qualification and subsequent performance success in the Olympic Games. This project sought to examine coach-athlete interactions. Of particular interest were coach and athlete responses regarding the implementation of autonomy supportive coaching behaviours in a high context. Autonomy supportive coaching behaviours have previously been strongly associated with positive athlete psycho-social and performance outcomes, however, a paucity of research has examined its implementation in high-performance contexts. Through the use of participant ethnography, it was possible to gain considerable insights regarding athletes' perceptions of choice, implications of perceived athletic hierarchies, as well as cultural and experience-related influences on training and performance expectations

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Vascular Remodeling in Health and Disease

The term vascular remodeling is commonly used to define the structural changes in blood vessel geometry that occur in response to long-term physiologic alterations in blood flow or in response to vessel wall injury brought about by trauma or underlying cardiovascular diseases.1, 2, 3, 4 The process of remodeling, which begins as an adaptive response to long-term hemodynamic alterations such as elevated shear stress or increased intravascular pressure, may eventually become maladaptive, leading to impaired vascular function. The vascular endothelium, owing to its location lining the lumen of blood vessels, plays a pivotal role in regulation of all aspects of vascular function and homeostasis.5 Thus, not surprisingly, endothelial dysfunction has been recognized as the harbinger of all major cardiovascular diseases such as hypertension, atherosclerosis, and diabetes.6, 7, 8 The endothelium elaborates a variety of substances that influence vascular tone and protect the vessel wall against inflammatory cell adhesion, thrombus formation, and vascular cell proliferation.8, 9, 10 Among the primary biologic mediators emanating from the endothelium is nitric oxide (NO) and the arachidonic acid metabolite prostacyclin [prostaglandin I2 (PGI2)], which exert powerful vasodilatory, antiadhesive, and antiproliferative effects in the vessel wall

A theory of challenge and threat states in athletes

We propose a Theory of Challenge and Threat States in Athletes (TCTSA) which is an amalgamation and extension of the biopsychosocial model of challenge and threat, the model of adaptive approaches to competition and the debilitative and facilitative competitive state anxiety model. In the TCTSA we posit that selfefficacy, perceptions of control, and achievement goals determine challenge or threat states in response to competition. Distinct patterns of neuroendocrine and cardiovascular responses are indicative of a challenge or threat state. Increases in epinephrine and cardiac activity, and a decrease in total peripheral vascular resistance (TPR) characterise a challenge state and increases in cortisol, smaller increases in cardiac activity and either no change or an increase in TPR characterise a threat state. Positive and negative emotions can occur in a challenge state while a threat state is associated with negative emotions only. Emotions are perceived as helpful to performance in a challenge state but not in a threat state. Challenge and threat states influence effort, attention, decision?making and physical functioning and accordingly sport performance. The TCTSA provides a framework for practitioners to enhance performance, through developing a challenge state, and encourages researchers to explore the mechanisms underlying performance in competition