Effect of environmental constraints on multi-segment coordination patterns during the tennis service in expert performers

The aims of this study were to examine the effect of different environmental constraints on kinematic multi-segment coordination patterns during the service and its coordination with service time variability. Ten expert tennis players (Age: 34.1±5.3) volunteered to take part in this study. Participants served 30 times in 3 different conditions: control, target and opposition. The order of conditions was counterbalanced between participants. A wireless 3D motion capture system (STT Co, Spain) was used to measure 7 joint motions, with a 17 degrees of freedom biomechanical model created to capture the entire service action. Results of the principal component analysis showed that 4 synergies were created; however, their roles were changed relative to the perception of the environment. The results of repeated-measures analysis of variance did not show any significant difference on total variance and individual principal components between conditions; however, one synergy pattern significantly predicted the service time variability in both control and opposition conditions. In conclusion, the findings demonstrated that expert performers reduce the joint dimensionality by creating functional synergies in different phases of service and adapt the service action according to the perception of the environment

Predicting success in graduate entry medical students undertaking a graduate entry medical program (GEM)

Background: Success in undergraduate medical courses in the UK can be predicted by school exit examination (A level) grades. There are no documented predictors of success in UK graduate entry medicine (GEM) courses. This study looks at the examination performance of GEM students to identify factors which may predict success; of particular interest was A level score. Methods: Data was collected for students graduating in 2004, 2005 and 2006, including demographic details (age and gender), details of previous academic achievement (A level total score and prior degree) and examination results at several points during the degree course. Results: Study group comprised 285 students. Statistical analyses identified no significant variables when looking at clinical examinations. Analysis of pass/fail data for written examinations showed no relationship with A level score. However, both percentage data for the final written examination and the analysis of the award of honours showed A level scores of AAB or higher were associated with better performance (p < 0.001). Discussion: A prime objective of introducing GEM programs was to diversify admissions to medical school. In trying to achieve this, medical schools have changed selection criteria. The findings in this study justify this by proving that A level score was not associated with success in either clinical examinations or passing written examinations. Despite this, very high achievements at A level do predict high achievement during medical school. Conclusions: This study shows that selecting graduate medical students with the basic requirement of an upper-second class honours degree is justifiable and does not disadvantage students who may not have achieved high scores in school leaver examinations

Effect of fluid restriction on hydration status in man.

Hydration status and the effects of hypohydration have been the topic of much public and scientific debate in recent years. While many physiological responses to hypohydration have been studied extensively, the subjective responses to hypohydration have largely been ignored. The present investigation was designed to investigate the physiological responses and subjective feelings resulting from 13, 24 and 37 h of fluid restriction (FR) and to compare these with a euhydration (EU) trial of the same duration in fifteen healthy volunteers. The volunteers were nine men and six women of mean age 30 (sd 12) years and body mass 71.5 (sd 13.4) kg. Urine and blood samples were collected and subjective feelings recorded on a 100 mm verbally anchored questionnaire at intervals throughout the investigation. In the EU trial the subjects maintained their normal diet. Body mass decreased by 2.7 (sd 0.6) % at 37 h in the FR trial and did not change significantly in the EU trial. Food intake in the FR trial (n 10) provided an estimated water intake of 487 (sd 335) ml and urinary losses (n 15) amounted to 1.37 (sd 0.39) litres. This is in comparison with an estimated water intake of 3168 (sd 1167) ml and a urinary loss of 2.76 (sd 1.11) litres in the EU trial. Plasma osmolality and angiotensin II concentrations increased from 0-37 h with FR. Plasma volume decreased linearly throughout the FR trial amounting to a 6.2 (sd 5.1) % reduction by 37 h. Thirst increased from 0-13 h of FR then did not increase further (P>0.05). The subjects reported feelings of headache during the FR trial and also that their ability to concentrate and their alertness were reduced

Stepping stones to the Neolithic? Radiocarbon dating the Early Neolithic on islands within the ‘western seaways’ of Britain

The western seaways – an arc of sea stretching from the Channel Islands in the south, up through the Isles of Scilly, the Isle of Man and the Outer Hebrides to Orkney in the north – have long been seen as crucial to our understanding of the processes which led to the arrival of the Neolithic in Britain and Ireland in the centuries around 4000 BC. The western seaways have not, however, been considered in detail within any of the recent studies addressing the radiocarbon chronology of the Earliest Neolithic in that wider region. This paper presents a synthesis of all existing 5th and 4th millennia cal BC radiocarbon dates from islands within the western seaways, including 50 new results obtained specifically for this study. While the focus here is insular in a literal sense, the project’s results have far reaching implications for our understanding of the Mesolithic-Neolithic transition across Britain and Ireland and beyond. The findings broadly fit well with Whittle et al.’s (2011) Gathering Time model, suggesting that the earliest dated Neolithic in this zone falls into the c. 3900-3700 cal BC bracket. However, it is also noted that our current chronological understanding is based on comparatively few dates spread across a large area. Consequently, it is suggested that both further targeted work and an approach that incorporates an element of typo-chronology (as well as absolute dating) is necessary if we are to move our understanding of the process of transition in this key region forward

Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS)

Background Bronchiolitis imposes the largest health care burden on non-elective paediatric hospital admissions worldwide, with up to 15 % of cases requiring admission to intensive care. A number of previous studies have failed to show benefit of pharmaceutical treatment in respect to length of stay, reduction in PICU admission rates or intubation frequency. The early use of non-invasive respiratory support devices in less intensive scenarios to facilitate earlier respiratory support may have an impact on outcome by avoiding progression of the disease process. High Flow Nasal Cannula (HFNC) therapy has emerged as a new method to provide humidified air flow to deliver a non-invasive form of positive pressure support with titratable oxygen fraction. There is a lack of high-grade evidence on use of HFNC therapy in bronchiolitis. Methods/Design Prospective multi-centre randomised trial comparing standard treatment (standard subnasal oxygen) and High Flow Nasal Cannula therapy in infants with bronchiolitis admitted to 17 hospitals emergency departments and wards in Australia and New Zealand, including 12 non-tertiary regional/metropolitan and 5 tertiary centres. The primary outcome is treatment failure; defined as meeting three out of four pre-specified failure criteria requiring escalation of treatment or higher level of care; i) heart rate remains unchanged or increased compared to admission/enrolment observations, ii) respiratory rate remains unchanged or increased compared to admission/enrolment observations, iii) oxygen requirement in HFNC therapy arm exceeds FiO2 ≥ 40 % to maintain SpO2 ≥ 92 % (or ≥94 %) or oxygen requirement in standard subnasal oxygen therapy arm exceeds >2L/min to maintain SpO2 ≥ 92 % (or ≥94 %), and iv) hospital internal Early Warning Tool calls for medical review and escalation of care. Secondary outcomes include transfer to tertiary institution, admission to intensive care, length of stay, length of oxygen treatment, need for non-invasive/invasive ventilation, intubation, adverse events, and cost. Discussion This large multicenter randomised trial will allow the definitive assessment of the efficacy of HFNC therapy as compared to standard subnasal oxygen in the treatment of bronchiolitis

Measurement of autoantibodies against osteoprotegerin in adult human serum: development of a novel ELISA assay

Introduction: In 2009, neutralizing autoantibodies against OPG (α-OPGAb) blocking the inhibitory effect of OPG on RANK signaling pathway were identified in a man with celiac disease associated with severe osteoporosis. Although this finding was not reproduced in thirty patients presenting coeliac disease and low bone mineral density, Hauser et al (2013) recently detected the presence of α-OPGAb in patients presenting Rheumatoid Arthritis, Systemic Lupus Erythematosus, Spondyloarthritis and Osteoporosis. There is a growing focus on OPG autoantibodies as primary cause of high bone turnover in disorders with unknown etiology. Objective: To develop an enzyme linked immunosorbent assay (ELISA) for detection and quantification of α-OPGAb in patient serum samples. Method: A full-length human recombinant OPG is immobilized on a plate to allow capture of the antibodies from the sera. In a two-step reaction, the αOPGAb is detected using a biotinylated antibody and a horseradish peroxidase-labelled streptavidin. Substrate is incubated in a timed reaction and color development measured in a spectrophotometric microtiter plate reader. The concentration of human α-OPGAb in the samples is determined directly from a 4PL-fit standard curve. Results: Intra-assay imprecision was <5% at 274.4 ± 18.8 and 98.5 ± 2.9 ng/mL. Inter-assay imprecision was <20% at 324.2 ± 53.3 and 166.8 ± 30.6 ng/mL. Linear range was 0-500ng/mL. Lower and upper limit of quantification were 3.9 and 500 ng/mL. Cross reactivity was assessed against human sera containing raised thyroid antibody and RANKL to ensure assay specificity. Using the method presented, we established that the adult population would be considered positive with a titer above the cut-off limit (95%) of 68ng/mL. Our preliminary data suggested that 14% of our sample population (n=136) presented elevated α-OPGAb. Conclusion: We presented a novel ELISA assay for the detection and measurement of anti-OPG autoantibodies in human serum. The validated method showed excellent assay characteristics and is suitable for use in research and clinical hospital laboratories. In patients with severe form of osteoporosis, measurement of OPG autoantibodies could help clinicians identify appropriate treatment options for this particular subgroup of patients

Mulberry extract to modULate Blood glucosE Responses in noRmoglYcaemic adults (MULBERRY): study protocol for a randomized controlled trial

Background: worldwide sugar consumption has tripled during the last fifty years. High sugar intake is associated with weight gain and increased incidence of diabetes and has been linked with increased cardiovascular mortality. Reducing the health impact of dietary sugar and poor quality carbohydrate intake is a public health priority. IminoNorm®, a proprietary mulberry leaf extract (ME), may reduce blood glucose responses following dietary sugar and carbohydrate intake by reducing absorption of glucose from the gut. Previous research has shown that ME can reduce blood glucose and improve insulin responses in healthy subjects and also in subjects with raised fasting blood glucose levels. Mulberry leaf has an excellent safety profile. This pilot study will test a novel, safe, water soluble product in normoglycaemic adults in the UK to determine if it can reduce glucose absorption without increasing plasma insulin concentration.Methods/design: the trial will be a double-blind, individually randomised, four-arm single-dose crossover design to test the effect of three doses of ME in order to determine efficacy, dose response relationship and gastrointestinal side effects with respect to placebo. A total of 40 subjects will participate in this study and attend for four visits receiving each of the four interventions in random order.Discussion: we aim to test the evidence that mulberry leaf extract can reduce blood glucose without a disproportionate increase in blood insulin responses in healthy individuals in a high-quality research study based in the UK. It is hoped that this will lead to further randomised controlled trials and an effective dietary supplement to lower blood glucose concentration

The impact of neurological disorders on healthcare for children and young people

Introduction Neurological conditions are a major and increasing cause of hospitalisation among children and young people, but little is known about the impact of neurological conditions on hospital services in England, nor the factors that influence length of stay and bed days per year. Objectives To quantify the hospital usage in children and young people related to neurological conditions, trends over time and variation by ethnicity and deprivation status. Methods An ICD10 coding framework identified a cohort of individuals aged 0-19 years with neurological conditions from linked routinely collected healthcare data from England (The Hospital Episode Statistics Admitted Patient Care dataset), from 1 April 2003 to 31 March 2015. Linked outpatient and accident and emergency data were used to supplement missing demographic data. Length of stay and bed days per year per person were calculated. These were separately modelled using random intercept multivariable negative binomial regressions with gender, age, ethnic group, diagnostic group, region of residence and deprivation category as predictors. Results 524,442 individuals were identified over the study period, increasing from 49,928 in 2003/04 to 102,840 in 2014/15. Neurological conditions account for 8.8% of inpatient bed days in the 0-14 year old age group. Length of stay and bed days per year vary primarily by age group – e.g. Under 1 year olds had 1.85 times (95%CI 1.83-1.86%) longer stays and over double (2.36 times, 95%CI 2.34-2.37 times) the number of bed days per person per year compared to 5 to 9 year olds – and main diagnostic group, with smaller variations by ethnic group, deprivation and region. Conclusions Neurological conditions in children and young people have a significant and increasing impact on the NHS in England. Falls in length of stay and bed days per person are more than offset by increasing numbers of children and young people with neurological diagnoses. Variations in length of stay and bed days per year by diagnostic group, ethnic group, age group, deprivation category and region should be taken into account in resource planning