Task‐specific strength increases after lower‐limb compound resistance training occurred in the absence of corticospinal changes in vastus lateralis

Neural adaptations subserving strength increases have been shown to be task‐specific, but responses and adaptation to lower‐limb compound exercises such as the squat are commonly assessed in a single‐limb isometric task. This two‐part study assessed neuromuscular responses to an acute bout (Study A) and 4 weeks (Study B) of squat resistance training at 80% of one‐repetition‐maximum, with measures taken during a task‐specific isometric squat (IS) and non‐specific isometric knee extension (KE). Eighteen healthy volunteers (25 ± 5 years) were randomised into either a training (n = 10) or a control (n = 8) group. Neural responses were evoked at the intracortical, corticospinal and spinal levels, and muscle thickness was assessed using ultrasound. The results of Study A showed that the acute bout of squat resistance training decreased maximum voluntary contraction (MVC) for up to 45 min post‐exercise (−23%, P < 0.001). From 15–45 min post‐exercise, spinally evoked responses were increased in both tasks (P = 0.008); however, no other evoked responses were affected (P ≥ 0.240). Study B demonstrated that following short‐term resistance training, participants improved their one repetition maximum squat (+35%, P < 0.001), which was reflected by a task‐specific increase in IS MVC (+49%, P = 0.001), but not KE (+1%, P = 0.882). However, no training‐induced changes were observed in muscle thickness (P = 0.468) or any evoked responses (P = 0.141). Adjustments in spinal motoneuronal excitability are evident after acute resistance training. After a period of short‐term training, there were no changes in the responses to central nervous system stimulation, which suggests that alterations in corticospinal properties of the vastus lateralis might not contribute to increases in strength

Differences in force normalising procedures during submaximal anisometric contractions

Eccentric contractions are thought to require a unique neural activation strategy. However, due to greater intrinsic force generating capacity of muscle fibres during eccentric contraction, the understanding of neural modulation of different contraction types during submaximal contractions may be impeded by the force normalisation procedure employed. In the present experiment, subjects performed maximal isometric dorsiflexion at shorter (80°), intermediate (90°) and longer (100°) muscle lengths, and maximal concentric and eccentric contractions. Thereafter, submaximal concentric and eccentric contractions were performed normalised to either isometric maximum at 90° (ISO), contraction type specific maximum (CTS) or muscle length specific maximum (MLS). When using ISO or MLS for normalisation, mean submaximal eccentric torque levels were significantly lower when compared to CTS normalisation (11 and 7% lower compared to CTS; p = 0.003 and p = 0.018 for ISO and MLS, respectively). These experimentally observed differences closely matched those expected from the predictive model. During submaximal concentric contraction, mean torque levels were similar between ISO and CTS normalisation with similar discrepancies noted in EMG activity. These findings suggest that normalising to ISO and MLS might not be accurate for assessment and prescription of submaximal eccentric contractions

INTER-, TRANS-, MULTI, PLUR-, SUPRA-, KROS-: INOVATIVNI POJMOVI ILI STARI SADRŽAJ U NOVOM PAKIRANJU? RAZMATRANJA IZ DAF-ove PERSPEKTIVE

Im DaF-Unterricht sowie im Fremdsprachenunterricht schlechthin spielte die Vermittlung kulturbezogener Inhalte seit immer eine wichtige Rolle, und zwar zunächst in Form der sog. faktografisch orientierten Landeskunde, deren Ziel ein reiner Informationstransfer war. Mit der Kulturwende in der zweiten Hälfte des 20. Jahrhunderts wurde der Fokus erstmals auf die pragmatisch-kommunikative Ebene, da-nach aber auch auf die interkulturell konzipierten Fremdsprachenlehr- und -lernmodelle verlagert, deren Ziele Sensibilisierung und Bewusstmachung von Unterschieden und Andersartigkeiten waren. Neben diesem Kon-zept entfalten sich in den letzten Jahren und Jahrzehnten auch weitere neue Modelle, die Unzulänglichkeiten und Defizite des interkul-turellen Ansatzes zu überwinden versuchen: transkulturelle, multikulturelle, plurikulturelle, suprakulturell, crosskulturelle, katakulturelle. Die Realität der Unterrichtsprozesse sowie konzeptuelle Einschränkungen der Lehrmate-rialien stellen jedoch Möglichkeiten zur praktischen Umsetzung aller angeführten Konzepte unmissverständlich in Frage. Der Unterricht bleibt mehr oder weniger der Idee von Kultur als einem essentialistischen, homogenen und statischen Konstrukt treu. Daher scheint das Plädieren für eine kulturwissenschaftliche Landeskunde als Bezugsdisziplin berechtigt, die sich um Operationalisierungen von Theoriemodellen und Forschungsergebnissen zu möglichst differenzierten Unterrichtszwecken bemühen würde. Aufgrund von zwei mittler-weile bekannt gewordenen Konzepten (von Jean-Claude Beacco und Claus Altmayer) wird hier abschließend ein eigener Didaktisierungsvorschlag zur Thematisierung von Kulturinhalten unterbreitet.U nastavi stranih jezika, a time i njemačkog kao stranog jezika, usvajanje sadržaja povezanih s kulturom ciljnog jezika uvijek je imalo svoje mjesto, izvorno u vidu faktografske Landeskunde, koja je imala za cilj informiranje o kulturnim činjenicama. Kulturni zaokret u drugoj polovici XX. stoljeća pomaknuo je fokus na pragmatično-komunikacijske situacije, a zatim i na interkulturalno koncipiranu gloto-didaktiku, čiji je cilj senzibilizacija i svjesnost za drugo i drugačije. Pored ovog koncepta, poslednjih godina i desetljeća formirani su neki novi modeli koji pokušavaju prevladati nedostatke interkulturalnog pristupa: transkulturni, multikulturni, plurikulturni, suprakulturni, kroskulturni, katakulturni. Međutim, stvarnost nastavnog procesa i udžbeničkog materijala dovodi u pitanje mogućnost operacionaliziranja ovih koncepata u okviru nastavnog procesa, koji i dalje ostaje značajno vezan za ideju kulture kao esencijalistički, homogeno i statički shvaćenog konstrukta. Stoga se čini opravdanim zalagati se za postuliranje kulturološki zasnovane Landeskunde kao referentne znanstvene discipline koja bi se bavila operacionaliziranjem teorijskih modela i istraživačkih rezultata za potrebe nastavnog procesa. Na osnovi poznatih modela čiji su autori Jean-Claude Beacco i Claus Altmayer na kraju ovog članka prikazan je vlastiti prijedlog za tematiziranje kulturnih sadržaja u nastavi

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Background: It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.Objectives: To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.Design: Multicentre, prospective diagnostic cohort study.Setting and participants: Children &lt; 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.Methods: One hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ? 105 colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used toidentify optimal urine sampling strategy compared with ‘clinical judgement’.Results: A total of 7163 children were recruited, of whom 50% were female and 49% were &lt; 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ? 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were &lt; 2 years old and 1.3% met the UTI definition.‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.Conclusions: Clinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.Funding: The National Institute for Health Research Health Technology Assessment programme.<br/

Long term condition morbidity in English general practice:a cross-sectional study using three composite morbidity measures

Background: The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices. This study aimed to determine the characteristics of general practices with high morbidity burden. Method: Retrospective cross-sectional study; general practices in England, 2014/15. Three composite morbidity measures (MMs) were constructed to quantify LTC morbidity at practice level: a count of LTCs derived from the 20 LTCs included in the UK Quality and Outcomes Framework (QOF) disease registers, expressed as 'number of QOF LTCs per 100 registered patients'; the % of patients with one or more QOF LTCs; the % of patients with one or more of 15 broadly defined LTCs included in the GP Patient Survey (GPPS). Determinants of MM scores were analysed using multi-level regression models. Analysis was based on a national dataset of English general practices (n = 7779 practices); GPPS responses (n = 903,357); general practice characteristics (e.g. list size, list size per full time GP); patient demographic characteristics (age, deprivation status); secondary care utilisation (out-patient, emergency department, emergency admission rates). Results: Mean MM scores (95% CIs) were: 57.7 (±22.3) QOF LTCs per 100 registered patients; 22.8% (±8.2) patients with a QOF LTC; 63.5% (±11.7) patients with a GPPS LTC. The proportion of elderly patients and social deprivation scores were the strongest predictors of each MM score; scores were largely independent of practice characteristics. MM scores were positive predictors of secondary care utilization and negative predictors' access, continuity of care and overall satisfaction. Conclusions: Wide variation in LTC morbidity burden was observed across English general practice. Variation was determined by demographic factors rather than practice characteristics. Higher rates of secondary care utilisation in practices with higher morbidity burden have implications for resource allocation and commissioning budgets; lower reported satisfaction in these practices suggests that practices may struggle with increased workload. There is a need for a readily available metric to define the burden of morbidity and multimorbidity in general practice.</p

Applying resolved and remission codes reduced prevalence of multimorbidity in an urban multi-ethnic population

Objective: To estimate the prevalence and determinants of multimorbidity in an urban, multi-ethnic area over 15-years and investigate the effect of applying resolved/remission codes on prevalence estimates. Study design and setting: This is a population-based retrospective cross-sectional study using electronic health records of adults registered between 2005 –2020 in general practices in one inner London borough (n = 826,936). Classification of resolved/remission was based on clinical coding defined by the patient's general practitioner. Results: The crude and age-adjusted prevalence of multimorbidity over the study period were 21.2% (95% CI: 21.1 –21.3) and 30.8% (30.6 –31.0), respectively. Applying resolved/remission codes decreased the crude and age-adjusted prevalence estimates to 18.0% (95% CI: 17.9 –18.1) and 27.5% (27.4 –27.7). Asthma (53.2%) and depression (20.2%) were responsible for most resolved and remission codes. Substance use (Adjusted Odds Ratio 10.62 [95% CI: 10.30 –10.95]), high cholesterol (2.48 [2.44 –2.53]), and moderate obesity (2.19 [2.15 –2.23]) were the strongest risk factor determinants of multimorbidity outside of advanced age. Conclusion: Our study highlights the importance of applying resolved/remission codes to obtain an accurate prevalence and the increased burden of multimorbidity in a young, urban, and multi-ethnic population. Understanding modifiable risk factors for multimorbidity can assist policymakers in designing effective interventions to reduce progression to multimorbidity.</p

Hypertension and cardiovascular risk factor management in a multi-ethnic cohort of adults with CKD: a cross sectional study in general practice

Background: Hypertension, especially if poorly controlled, is a key determinant of chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD). Aim: To assess hypertension and risk factor management, and determinants of systolic blood pressure control in individuals with CKD and hypertension. Design and setting: Cross-sectional survey using primary care electronic health records from 47/49 general practice clinics in South London. Methods: Known effective interventions, management of hypertension and cardiovascular disease (CVD) risk in patients with CKD Stages 3–5 were investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure control status as outcome. Individuals with diabetes were excluded. Results: Adults with CKD Stages 3–5 and hypertension represented 4131/286,162 (1.4%) of the total population; 1984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed hypertension, 23.0% had systolic blood pressure > 140 mmHg compared with 39.8% hypertensives, p < 0.001. Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years. African ethnicity and obesity were associated with poorer systolic blood pressure control. Conclusion: We found both underdiagnosed CKD and underdiagnosed hypertension in patients with CKD. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases

Identifying multimorbidity clusters with the highest primary care use:15 years of evidence from a multi-ethnic metropolitan population

BACKGROUND: People with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use. AIM: To assess the association between multimorbidity clusters and primary care consultations over time. DESIGN AND SETTING: A retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826 166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020. METHOD: Primary care consultation rates were modelled using generalised estimating equations. Key controls included the total number of long-term conditions, five multimorbidity clusters, and their interaction effects, ethnic group, and polypharmacy (proxy for disease severity). Models were also calibrated by consultation type and ethnic group. RESULTS: Individuals with multimorbidity used two to three times more primary care services than those without multimorbidity (incidence rate ratio 2.30, 95% confidence interval = 2.29 to 2.32). Patients in the alcohol dependence, substance dependence, and HIV cluster (Dependence+) had the highest rate of increase in primary care consultations as additional long-term conditions accumulated, followed by the mental health cluster (anxiety and depression). Differences by ethnic group were observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity. CONCLUSION: This study identified multimorbidity clusters with the highest primary care demand over time as additional long-term conditions developed, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes.</p

Does COPD risk vary by ethnicity?:A retrospective cross-sectional study

Background: Lower risk of COPD has been reported in black and Asian people, raising questions of poorer recognition or reduced susceptibility. We assessed prevalence and severity of COPD in ethnic groups, controlling for smoking.Method: A retrospective cross-sectional study using routinely collected primary care data in London. COPD prevalence, severity (% predicted forced expiratory volume in 1 second [FEV1]), smoking status, and treatment were compared between ethnic groups, adjusting for age, sex, smoking, deprivation, and practice clustering.Results: Among 358,614 patients in 47 general practices, 47.6% were white, 20% black, and 5% Asian. Prevalence of COPD was 1.01% overall, 1.55% in whites, 0.58% in blacks, and 0.78% in Asians. COPD was less likely in blacks (adjusted odds ratio [OR], 0.44; 95% confidence interval [CI] 0.39–0.51) and Asians (0.82; CI, 0.68–0.98) than whites. Black COPD patients were less likely to be current smokers (OR, 0.56; CI, 0.44–0.71) and more likely to be never-smokers (OR, 4.9; CI, 3.4–7.1). Treatment of patients with similar disease severity was similar irrespective of ethnic origin, except that long-acting muscarinic antagonists were prescribed less in black COPD patients (OR, 0.53; CI, 0.42–0.68). Black ethnicity was a predictor of poorer lung function (% predicted FEV1: B coefficient, -7.6; P,0.0001), an effect not seen when ethnic-specific predicted FEV1 values were used.Conclusion: Black people in London were half as likely as whites to have COPD after adjusting for lower smoking rates in blacks. It seems likely that the differences observed were due either to ethnic differences in the way cigarettes were smoked or to ethnic differences in susceptibility to COPD.Keywords: COPD, smoking, ethnicit

Corticospinal responses during passive shortening and lengthening of tibialis anterior and soleus in older compared to younger adults

Corticospinal responses have been shown to increase and decrease with passive muscleshortening and lengthening, respectively, as a result of changes in muscle spindle afferentfeedback. The ageing sensory system is accompanied by a number of alterations that mightinfluence the processing and integration of sensory information. Consequently, corticospinalexcitability might be modulated differently whilst changing muscle length. In 10 older adults(66 ± 4 years), corticospinal responses (MEP/Mmax) were evoked in a static position, and duringpassive shortening and lengthening of soleus (SOL) and tibialis anterior (TA), and these datawere compared to the re-analysed data pool of 18 younger adults (25 ± 4 years) published previously. Resting motor threshold was greater in SOL compared to TA (P < 0.001), but did not differbetween young and older (P = 0.405). No differences were observed in MEP/Mmax between thestatic position, passive shortening or lengthening in SOL (young: all 0.02±0.01; older: 0.05±0.04,0.03 ± 0.02 and 0.04 ± 0.01, respectively; P = 0.298), and responses were not dependent on age(P = 0.090). Conversely, corticospinal responses in TA were modulated differently between theage groups (P = 0.002), with greater MEP/Mmax during passive shortening (0.22 ± 0.12) comparedto passive lengthening (0.13 ± 0.10) and static position (0.10 ± 0.05) in young (P < 0.001), butunchanged in older adults (0.19 ± 0.11, 0.22 ± 0.11 and 0.18 ± 0.07, respectively; P ≥ 0.867).The present experiment shows that length-dependent changes in corticospinal excitability in TAof the young are not evident in older adults. This suggests impaired sensorimotor response duringmuscle length changes in older age that might only be present in ankle flexors, but not extensors