CHANGES IN BACK SQUAT BAR VELOCITY AND PERCEIVED MUSCLE SORENESS FOLLOWING A STANDARDISED RUGBY LEAGUE MATCH SIMULATION

This study examined changes in back squat bar velocity and perceived muscle soreness following a rugby league match simulation protocol. Twenty male rugby league players (age: 19.8 ± 0.7 yrs) were recruited for this study. Back squat bar velocity and perceived muscle soreness of the lower body were collected on four days surrounding a match simulation: -24 h (prior to match simulation), +0 h (after the match simulation), +24 h and +48 h. Compared to baseline (-24h), there were non-significant decreases in maximum (dz=-0.50, moderate) back squat bar velocity +0 h. There was a significant increase in perceived muscle soreness at +0h only (p=0.003). Results suggest that elevated muscle soreness may not indicate impaired neuromuscular performance and highlight the importance of monitoring fatigue via multiple measures to ensure appropriate coaching decisions are made

MEASURING INSTANTANEOUS VELOCITY IN FOUR SWIM STROKES USING AN AUTOMATIC HEAD TRACKING SYSTEM: A COMPARISON STUDY

This study compared instantaneous swimming velocity from an automated video-based system to a tethered speedometer. Twenty-two state- and national-level swimmers (7 M, 15 F; 14.5 ± 2.5 yrs) swam 25 m of each stroke at maximal intensity. Bland-Altman plots showed good agreement between systems for backstroke and freestyle but poorer agreement for butterfly and breaststroke. The RMS error was also lower in backstroke and freestyle compared to butterfly and breaststroke. The differences in systems may be explained by the different body segments tracked by each system (head vs hips) and with differences being more apparent during butterfly and breaststroke due to the wave-like motion of these strokes. While the automated video-based system is suitable for measuring instantaneous swimming velocity, coaches, sports scientists, and swimmers should be aware of larger discrepancies between systems when assessing butterfly and breaststroke

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

FIXED FOOT BALANCE TRAINING INCREASES RECTUS FEMORIS ACTIVATION DURING LANDING AND JUMP HEIGHT IN RECREATIONALLY ACTIVE WOMEN

The objective of this study was to determine the effects of fixed foot and functionally directed balance training on static balance time, muscle activation during landing, vertical jump height and sprint time. Twenty-four recreationally active females were tested pre- and post-training (fixed foot balance training, n= 11, functionally directed balance training, n = 7 and control group, n = 6). Experimental subjects completed either fixed foot or functionally directed balance exercises 4 times/week for 6 weeks. Surface electromyography (EMG) was used to assess preparatory and reactive muscle activity of the rectus femoris (RF), biceps femoris (BF), and the soleus during one- and two-foot landings following a jump. Maximum vertical jump height, static balance and 20-meter sprint times were also examined. The fixed foot balance-training group showed a 33% improvement (p < 0.05) in static balance time and 9% improvement in jump height. Neither type of training improved sprint times. Further analysis revealed significant (p < 0.05) overall (data collapsed over groups and legs) increases in reactive RF activity when landing. Independently, the fixed foot balance group showed a 33% increase in reactive RF activity (p < 0.01). Overall, there was also significantly less reactive co-activation following training (p < 0.05). It appears that fixed foot balance training for recreationally active women may provide greater RF activity when landing and increased countermovement jump heigh

Therapeutic tape use for lateral elbow tendinopathy: A survey of Australian healthcare practitioners

Heales, LJ ORCiD: 0000-0002-4510-3324; Kean, C ORCiD: 0000-0003-0135-7178; Stanton, R ORCiD: 0000-0002-6684-5087Background: Lateral elbow tendinopathy (LET) is a common musculoskeletal condition that can be treated with therapeutic tape. However, little is known of taping practices for LET in a clinical setting. Objectives: To examine Australian healthcare practitioners’ taping techniques, clinical reasoning, and information sources regarding therapeutic tape use for LET. Design: Cross-sectional survey. Methods: An anonymous online survey was distributed between September 2018 and February 2019. Respondents answered questions about demographics, frequency of tape use, techniques, reasons for application, factors influencing clinical decision-making, and information sources, related to tape for LET. Results/findings: 188 Australian healthcare practitioners completed the survey. The majority of respondents were physiotherapists (n = 132, 70%) with the remainder of respondents being chiropractors (21%), myotherapists (3%), exercise physiologists (3%), or osteopaths (3%). 51% of respondents use tape as part of their management for LET at least half the time. The most popular taping technique used is a transverse band of rigid tape across the forearm (n = 78, 55% of respondents who use tape). The most common reasons for tape application are to reduce pain during occupational tasks (n = 123, 65%), and during sport/hobbies (n = 101, 54%). Respondents predominately rely on experience and patient preference to guide tape use. 63% of all respondents (n = 118) sought information about tape from professional development courses. Conclusion: A wide range of tape techniques are used to treat LET, despite limited evidence for efficacy. Justification for tape is largely based on experience and patient preference; with information mostly gained from professional development courses. More research is required to understand the relationship between the evidence and clinical use of tape to treat LET. © 2020 Elsevier Lt

Five-Year Changes in Gait Biomechanics after Concomitant High Tibial Osteotomy and ACL Reconstruction in Patients with Medial Knee Osteoarthritis

© 2015 The Author(s). Background: Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA). Purpose: To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction. Study Design: Controlled laboratory study. Methods: A total of 33 patients (mean ± SD age, 40 ± 9 years) with varus malalignment (mean mechanical axis angle, \u275.9° ± 2.9°), medial compartment knee OA, and ACL deficiency completed 3-dimensional gait analysis preoperatively and 2 and 5 years postoperatively. Primary outcomes were the peak external knee adduction (first peak) and flexion moments. Secondary outcomes were the peak external knee extension and transverse plane moments, peak knee angles in all 3 planes, radiographic static knee alignment measures (mechanical axis angle and posterior tibial slope), and the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: There was a substantial decrease in the knee adduction moment in the surgical limb (%BW × H, \u271.49; 95% CI, \u271.75 to \u271.22) and a slight increase in the nonsurgical limb (%BW × H, 0.16; 95% CI, 0.03 to 0.30) from preoperatively to 5 years postoperatively. There was also a decrease in the knee flexion moment for both the surgical (%BW × H, \u270.67; 95% CI, \u271.19 to \u270.15) and nonsurgical limbs (%BW × H, -1.06; 95% CI, -1.49 to \u270.64). Secondary outcomes suggested that substantial improvements were maintained at 5 years, although smaller declines were observed in several measures and in both limbs from 2 to 5 years. Conclusion: Changes in the peak external moments about the knee in all 3 planes during walking were observed 5 years after concomitant medial opening wedge HTO and ACL reconstruction. These findings are consistent with an intended, sustained shift in the mediolateral distribution of knee loads. Clinical Relevance: These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure

Resistance training for medial compartment knee osteoarthritis and malalignment

Purposes: 1) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength, pain, and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2) to generate pilot data for change in dynamic knee joint load, patent-reported outcomes, and self-efficacy after training

Patient knowledge and beliefs about knee osteoarthritis after ACL injury and reconstruction

Objective: To explore 1) patients' knowledge and beliefs about osteoarthritis (OA) and OA risk following anterior cruciate ligament (ACL) injury, 2) extent to which information about these risks is provided by health professionals, and 3) associations amongst participant characteristics, knowledge and risk beliefs and health professional advice.Methods: A custom-designed survey was conducted in Australian and American adults who sustained an ACL injury, with or without reconstruction, one to five years prior. The survey comprised three sections: 1) participant characteristics, 2) knowledge about OA and OA risk, and 3) health professional advice.Results: Complete datasets from 233 eligible respondents were analyzed. Most (n=164, 70%) rated themselves as being at greater risk of OA than healthy peers, although only 56% (n=130) were able to identify the correct OA definition. While most agreed that ACL (n=168, 73%) and/or meniscal injuries (n=181, 78%) increase the risk of OA, 65% (n=152) believed that ACL reconstruction reduced the risk of OA or did not know. Twenty seven percent (n=62) recalled discussing their OA risk with a health professional. Participants who were female, younger, had a lower body mass index or higher physical activity level were more likely to recognise meniscal tears and meniscectomy as risk factors of OA. History of professional advice was associated with beliefs about increased OA risks.Conclusion: Patients sustaining an ACL injury require better education from health professionals about OA as a disease entity and their elevated risk of OA, irrespective of whether they undergo surgical reconstruction or not

The influence of different methods to determine maximum heart rate on training load outcomes in basketball players

The summated-heart-rate-zones (SHRZ) approach utilizes heart rate (HR) responses relative to maximum HR (HRmax) to calculate the internal training load (TL). Age-predicted, test-derived, and session-based approaches have all been utilized to determine HRmax in team sports. The purpose of this study was to determine the effects of using age-predicted, test-derived, and session-based HRmax responses on SHRZ TL in basketball players. Semiprofessional, male basketball players (N = 6) were analyzed during the preparatory training phase. Six age-based approaches were used to predict HRmax including: Fox (220 - Age); Hossack (206 - [0.567 x age]); Tanaka (208 - [0.7 x age]); Nikolaidis (223 - [1.44 x age]); Nes (211 - [0.64 x age]); and Faff (209.9 - [0.73 x age]). Test-derived HRmax was taken as the highest HR during the Yo-Yo Intermittent Recovery Test (Yo-Yo IRT), while session-based HRmax was taken as the higher HR seen during the Yo-Yo IRT or training sessions. Comparisons in SHRZ TL were made at group and individual levels. No significant group differences were evident between SHRZ approaches. Effect size analyses revealed moderate (d = 0.60 to 0.79) differences apparent between age-predicted, test-derived, and session-based methods across the group and individually in two players. The moderate differences between approaches suggests age-predicted, test-derived, and session-based methods to determine HRmax are not interchangeable when calculating SHRZ. Basketball practitioners are encouraged to use individualized HRmax directly measured during field-based tests supplemented with higher HR responses evident during training sessions and games when calculating the SHRZ TL to ensure greatest accuracy