Performance Benefits of Customised Seating Interfaces for Elite Wheelchair Racing Athletes

The limited customisation in commercially available wheelchairs does not always appropriately accommodate the anthropometric variations resulting from specific impairment. Wheelchair racing athletes demonstrate up to 3.8% total body mass greater in the upper extremities, and up 9.8% total body mass reductions in their lower extremities, and between-limb asymmetries of 62.4%. As a consequence, athletes may not have the stable base of support required for optimal propulsion. The optimisation of an entire wheelchair to match unique athlete geometry is both time consuming and costly, as wheelchairs cost over $2000 each. The use of assistive technology can provide an efficient transition between the commercially available equipment and the unique athlete anthropometry. Customised seating interfaces offer a time and cost effective solution, facilitating regular modifications to satisfy athlete growth. These solutions have been used extensively in clinical applications for enhanced stress distribution and injury prevention at the seating interface; however, they have not yet been applied to sporting contexts. The goal of this research was to investigate the performance impact of customised seating interfaces on wheelchair racing propulsion technique. Supplementary goals included the development of practically viable instrumentation solutions and a musculoskeletal model representative of the unique wheelchair racing athlete anthropometries and physical capabilities to assess injury risk to analyse performance impact holistically. The research was split into four main themes: 1. Verification of the importance of the seating interface relative to other key performance parameters such as aerodynamics and glove selection. 2. Instrumentation of the hand-pushrim and seating interfaces 3. Development of a musculoskeletal model 4. Computational modelling of performance and injury risk Computational modelling was performed in the OpenSim environment which coupled kinematic inputs from 3D motion capture (VICON Bonita V16; Oxford Metrics, Oxford, United Kingdom), with kinetic inputs from a pressure mat at the seating interface (XSensor LX100; Calgary, Alberta, Canada) and inertial measurement units (IMUs) (I Measure U; New Zealand) to estimate the hand-interface interactions. This was achieved using Newton’s Second Law, incorporating athlete-specific mass data (from the analysis DXA scans), and acceleration measured from the IMU. Customised seating interfaces reduced the undesirable peak translations of the knee by up to 41.8% and lateral translation of the spine by 33.4%. These translated towards enhanced performance, with an average performance time reduction of 29.8 s (3.7% race time) in the eight international competitions following the inclusion of the customised seating interface. Additionally, athletes using cushioned seating interfaces had reduced peak pressures at the seating interface as compared to those without the interface. Instrumentation can be used outside the laboratory environments, and can, therefore, be applied in the daily training environment to optimise performance preparation. This research provided foundation work for the use of computational biomechanical analyses for the holistic assessment of wheelchair racing performance. Whilst this research has demonstrated the potential impact computational modelling approaches can have on the performance preparation of athletes, some areas for further refinement have been identified. Future research into the processing of IMU data and the validation of musculoskeletal models for wheelchair racing athletes are the critical areas for improvement. Once achieved, the computational modelling approaches explored in this research can positively impact performance outcome, particularly when coupled with the optimisation of equipment, such as customised seating interfaces.Thesis (Ph.D.) -- University of Adelaide, School of Mechanical Engineering, 201

Faculty String Quartet: Sarah Gentry, Violin; Rebecca Cutler, Violin; Katherine Lewis, Viola; Amy Flores, Cello; October 22, 2009

Kemp Recital HallOctober 22, 2009Thursday Evening7:30 p.m

Financial incentives often fail to reconcile agricultural productivity and pro-conservation behavior.

Paying resource users to preserve features of their environment could in theory better align production and conservation goals. We show, however, that across a range of conservation dilemmas, they might not. We conduct a synthesis of dynamic games experiments built around collective action dilemmas in conservation, played across Europe, Africa, and Asia. We find, across this range of dilemmas, that while payments can encourage pro-conservation behavior, they often fail to capitalize on the potential for jointly improving productive and environmental outcomes, highlighting the more nuanced challenge of reconciling livelihoods with conservation goals. We further find production (yield) and the joint production-environment product (i.e., a measure of agricultural production multiplied by a measure of pro-conservation practice) are better preserved in groups that are more educated, more gender diverse and that better represent women. We discuss how the design of incentive programs can better align livelihood and environment goals

Evaluating Diuretics in Normal Care (EVIDENCE):Protocol of a cluster randomised controlled equivalence trial of prescribing policy to compare the effectiveness of thiazide-type diuretics in hypertension

Abstract Introduction Healthcare systems must use treatments that are effective and safe. Regulators licensed many currently used older medications before introducing the stringent evidential requirements imposed on modern treatments. Also, there has been little encouragement to carry out within-class, head-to-head comparisons of licensed medicines. For commonly prescribed drugs, even small differences in effectiveness or safety could have significant public health implications. However, conventional clinical trials that randomise individual subjects are costly and unwieldy. Such trials are also often criticised as having low external validity. We describe an approach to rapidly generate externally valid evidence of comparative safety and effectiveness using the example of two widely used diuretics for the management of hypertension. Methods and analysis The EVIDENCE (Evaluating Diuretics in Normal Care) study has a prospective, cluster-randomised, open-label, blinded end-point design. By randomising prescribing policy in primary care practices, the study compares the safety and effectiveness of commonly used diuretics in treating hypertension. Participating practices are randomised 1:1 to a policy of prescribing either indapamide or bendroflumethiazide when clinically indicated. Suitable patients who are not already taking the policy diuretic are switched accordingly. All patients taking the study medications are written to explaining the rationale for changing the prescribing policy and notifying them they can opt-out of any switch. The prescribing policies’ effectiveness and safety will be compared using rates of major adverse cardiovascular events (hospitalisation with myocardial infarction, heart failure or stroke or cardiovascular death), routinely collected in national healthcare administrative datasets. The study will seek to recruit 250 practices to provide a study population of approximately 50,000 individuals with a mean follow-up time of two years. A primary intention-to-treat time-to-event analysis will be used to estimate the relative effect of the two policies. Ethics and dissemination EVIDENCE has been approved by the East of Scotland Research Ethics Service (17/ES/0016, current approved protocol version 5, 26 August 2021). The results will be disseminated widely in peer reviewed journals, guideline committees, National Health Service (NHS) organisations and patient groups. Trial registration ISRCTN 46635087 . Registered on 11 August 2017 (pre-recruitment)

Calcium supplements and risk of CVD: A meta-analysis of randomized trials

Background: Vitamin D supplements may only be beneficial for the prevention of osteoporotic fractures when administered with calcium and in individuals with low blood levels of 25(OH)D, but possible hazards of calcium supplements on CVD cannot be excluded. Objectives: We conducted a meta-analysis of all placebo-controlled randomized trials assessing the effects of calcium supplements alone or with vitamin D on CHD, stroke, and all-cause mortality. Methods: A meta-analysis of 11 trials included 7 comparisons of calcium alone compared with control (n = 8634) and 6 comparisons of calcium plus vitamin D compared with control (n = 46,804). Aggregated study-level data were obtained from individual trials and combined using a fixed-effects meta-analysis. The main outcomes included MI, CHD death, any CHD, stroke, and all-cause mortality. Results: Among trials of calcium alone (mean daily dose 1 g), calcium was not significantly associated with any excess risk of MI (RR, 1.15; 95% CI: 0.88, 1.51; n = 219 events), CHD death (RR, 1.24; 95% CI: 0.89, 1.73; n = 142), any CHD (RR, 1.01; 95% CI: 0.75, 1.37; n = 177), or stroke (RR, 1.15; 95% CI, 0.90, 1.46, n = 275). Among 6 trials of combined treatment, supplementation with calcium plus vitamin D was not significantly associated with any excess risk of MI (RR, 1.09; 95% CI: 0.95, 1.25; n = 854), CHD death (RR, 1.04; 95% CI: 0.85, 1.27; n = 391), any CHD (RR, 1.05; 95% CI: 0.93, 1.19; n = 1061), or stroke (RR, 1.02; 95% CI: 0.89, 1.17; n = 885). Likewise, calcium alone, or with vitamin D had no significant associations with all-cause mortality. Conclusions: This meta-analysis demonstrated that calcium supplements were not associated with any significant hazard for CHD, stroke, or all-cause mortality and excluded excess risks above 0.3%–0.5% per year for CHD or stroke. Further trials of calcium and vitamin D are required in individuals with low blood levels of 25(OH)D for the prevention of fracture and other disease outcomes

Patients' views and experiences of live supervised tele-exercise classes following bariatric surgery during the COVID-19 pandemic: The BARI-LIFESTYLE qualitative study.

The BARI-LIFESTYLE trial is a randomized controlled trial evaluating the efficacy of a post-surgery nutritional and behavioural tele-counselling, and supervised exercise programme to maximize the health benefits of bariatric surgery. Due to the coronavirus disease 2019 (COVID-19) pandemic, the in-person supervised exercise component had to be converted to remote tele-exercise. However, patients' acceptability of this method of exercise provision is unknown. Between 3 and 6 months following bariatric surgery, 13 adults participated in weekly, structured, 60-min supervised exercise classes delivered via Zoom by a trained exercise therapist. A total of 12 participants (n = 8 female), with a mean age of 46.3 (range 33-63) years, who had undergone either sleeve gastrectomy (n = 8) or Roux-en-Y gastric bypass (n = 4) surgery, participated in one-to-one semi-structured interviews following the tele-exercise classes. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described how the tele-exercise classes helped them to cope with the changes to their lives brought about by the COVID-19 pandemic. Participants found the tele-exercise schedule, content and intensity to be acceptable, and were satisfied with the privacy, security and safety of the technology and classes. Professional supervision and guidance from an exercise therapist were described as central to the tele-exercise provision. Importantly, participation in the tele-exercise provided physical, emotional and social benefits. Few participants reported barriers to participation. Overall, the tele-exercise classes were deemed acceptable and compared favourably to in-person exercise classes

Longitudinal T1 relaxation rate (R1) captures changes in short-term Mn exposure in welders

We demonstrated recently that the T1 relaxation rate (R1) captured short-term Mn exposure in welders with chronic, relatively low exposure levels in a cross-sectional study. In the current study, we used a longitudinal design to examine whether R1 values reflect the short-term dynamics of Mn exposure

Financial incentives often fail to reconcile agricultural productivity and pro-conservation behavior

Paying resource users to preserve features of their environment could in theory better align production and conservation goals. We show, however, that across a range of conservation dilemmas, they might not. We conduct a synthesis of dynamic games experiments built around collective action dilemmas in conservation, played across Europe, Africa, and Asia. We find, across this range of dilemmas, that while payments can encourage pro-conservation behavior, they often fail to capitalize on the potential for jointly improving productive and environmental outcomes, highlighting the more nuanced challenge of reconciling livelihoods with conservation goals. We further find production (yield) and the joint production-environment product (i.e., a measure of agricultural production multiplied by a measure of pro-conservation practice) are better preserved in groups that are more educated, more gender diverse and that better represent women. We discuss how the design of incentive programs can better align livelihood and environment goals