The Effects of Palm Cooling on Physiological and Metabolic Responses, Exercise Performance, and Total Volume During High-Intensity Bench Press Exercise in Resistance-Trained Men.

ABSTRACT: McMahon, G, and Kennedy, R. The effects of palm cooling on physiological and metabolic responses, exercise performance, and total volume during high-intensity bench press exercise in resistance-trained men. J Strength Cond Res 37(11): 2122-2129, 2023-Previous research suggests that cooling distal to the working agonist muscles during the interset rest periods of high-intensity resistance exercise may facilitate improved performance by means of improving metabolic conditions of contractile machinery. However, these studies have not directly measured indicators of metabolic conditions. Therefore, the aim of this study was to compare 2 palm-cooling conditions with a thermoneutral condition during high-intensity resistance exercise and subsequent effects on physiological and metabolic responses and exercise performance. Eleven healthy, resistance-trained, young men (20-36 years old) performed 4 sets of bench press exercise to exhaustion at 80% 1 repetition maximum each separated by 3 minutes of passive recovery. Palm cooling (10° C [TEN] or 15° C [FTN]) or thermoneutral (28° C [CON]) condition was applied for 60 seconds during the recovery interval of each set in a randomized, double-blind fashion, with 4 days recovery between the experimental conditions. There were no differences ( p > 0.05) in volume load between the experimental conditions across all sets. Mean repetition velocity and force of the bench press declined significantly following set 1 in all conditions ( p < 0.05), but there were no differences between the conditions. Lactate, heart rate, and rating of perceived exertion systematically increased from sets 1 to 4; however, there were no significant differences ( p > 0.05) between any of the conditions. Palm cooling at either 10 or 15° C had no observable effects on physiological and metabolic responses during exercise, nor has it any effect on bench press performance or volume load compared with a thermoneutral condition. Therefore, cooling cannot be currently recommended as an ergogenic strategy to enhance acute bench press performance or mitigate fatigue during high-intensity resistance training.

No Effect of Interset Palm Cooling on Acute Bench Press Performance, Electromyography Amplitude, or Spectral Frequencies in Resistance-Trained Men.

ABSTRACT: McMahon, G, Kennedy, R, and Burden, A. No effect of interset palm cooling on acute bench press performance, electromyography amplitude or spectral frequencies in resistance-trained men. J Strength Cond Res 37(3): 555-563, 2023-Previous research has suggested that cooling distal to the working agonist muscles during the interset rest periods of high-intensity resistance exercise may facilitate improved performance through increased agonist activation. However, these studies have used inappropriate electromyography (EMG) normalization techniques. Therefore, the aim of this study was to compare 2 palm-cooling conditions with a thermoneutral condition during high-intensity resistance exercise and subsequent effects on exercise performance, EMG amplitude, and spectral frequencies using appropriate normalization methodologies. Eleven healthy, resistance-trained, young men (20-36 years old) performed 4 sets of bench press exercise to exhaustion at 80% 1RM each separated by 3 minutes of passive recovery. Palm-cooling (10° C [TEN] or 15° C [FTN]) or thermoneutral (28° C [CON]) conditions were applied for 60 seconds during the recovery interval of each set in a randomized, double-blind fashion, with 4 days of recovery between experimental conditions. Palm temperature was significantly lower (p < 0.05) in the TEN and FTN conditions compared with CON. Number of repetitions and mean power in the bench press declined significantly after each set in all conditions (p < 0.05). There were no significant differences (p > 0.05) in any bench press performance or EMG-related variables between any of the conditions. Palm cooling at either 10 or 15° C had no effects on bench press performance compared with a thermoneutral condition, with no observable effects on neuromuscular responses during exercise. Therefore, cooling is not currently recommended as an ergogenic strategy to enhance acute bench press performance during high-intensity resistance training.

Running Performance Is Correlated With Creatine Kinase Levels and Muscle Soreness During an Olympic Games in Hockey.

PURPOSE: To compare the global positioning system- and accelerometry-derived running demands, creatine kinase (CK), and self-reported wellness during an Olympic Games in international hockey. METHODS: Data were collected across 5 games during the 2016 Rio Olympic Games. Global positioning system units (10 Hz) were used to assess the running demands, accelerations, and decelerations of outfield players in a men's hockey squad with matches 2 to 5 compared with match 1. CK was used as a marker of muscle damage, and self-reported psychometric questionnaires were used to assess wellness, with each of the 5 matches compared with precompetition assessments. RESULTS: There were significant increases (P < .05) in either, or both, absolute and relative total distance, player load, high-speed running distance, sprint distance, and accelerations and decelerations, compared with baseline. There was a significant decrease (P < .05) in maximal velocity by match 5. CK significantly increased from match 1 to 5 and displayed significant correlations with total distance (r = .55) and player load (r = .41). Muscle soreness correlated with total distance and player load, with other wellness markers unchanged compared with baseline. CONCLUSIONS: International hockey athletes may maintain or increase running activities over the course of an Olympic tournament; however, this may be impacted by situational (match score/outcome) and environmental (ambient temperature) factors. Despite CK and muscle soreness displaying relationships with running variables, further work is needed to establish their individual value in monitoring international hockey athletes.

Improving the Signal-To-Noise Ratio When Monitoring Countermovement Jump Performance.

ABSTRACT: Kennedy, RA and Drake, D. Improving the signal-to-noise ratio when monitoring countermovement jump performance. J Strength Cond Res 35(1): 85-90, 2021-Countermovement jump (CMJ) performance has been routinely used to monitor neuromuscular status. However, the protocol used to establish the criterion score is not well documented. The purpose of this study was to examine how the protocol used would influence of the sensitivity of CMJ variables in rugby union players. Fifteen male (age: 19.7 ± 0.5 years) rugby union players performed 8 CMJs on 2 occasions, separated by 7 days. The between-session coefficient of variation (CV) was calculated using 2 techniques for treating multiple trials, the average, and the trial with the best jump height (JH), and then compared with the smallest worthwhile change (SWC). The signal-to-noise ratio was measured as the group mean change in a variable divided by the CV. Using the average value across multiple trials is superior to the best trial method, based on lower CVs for all variables. Only the average performance across 6 or more trials was classified as ideal (CV < 0.5 × SWC) for peak velocity (PV). In addition, the signal-to-noise ratio for peak concentric power (PCP), PV, and JH were classified as good, irrespective of the treatment method. Although increasing the number of trials can reduce the random error, it may be pragmatic to simply take the average from 2 to 3 trials, facilitating a CV < SWC for PV, PCP, and JH. Due to its simplicity, JH may be considered the principal variable to monitor neuromuscular fatigue.

Changes in Player Activity Profiles After the 2015 FIH Rule Changes in Elite Women's Hockey.

McMahon, GE and Kennedy, RA. Changes in player activity profiles after the 2015 FIH rule changes in elite women's hockey. J Strength Cond Res 33(11): 3114-3122, 2019-The aim of this study was to compare the player activity profiles of elite international women's hockey players before (2014) and after (2015) the 2015 the International Hockey Federation (FIH) match rule changes at team and positional levels. The match activity profiles (n = 400) of 19 female hockey players (age 23 ± 4 years, mass 63.6 ± 5.5 kg, VO2max 57 ± 6 ml·kg·min in 2014, 58 ± 6 ml·kg·min in 2015) were recorded during competitive international matches in 2014 (match n = 12) and 2015 (match n = 13) using 10-Hz global positioning system units. The practical utility of an effect was only classified as substantial when there was a >75% likelihood that the ±90% confidence interval of the effect size (ES) was equal to or greater than the small (ES ± 0.2) reference value. Mean match time decreased by over 2 minutes from 71.72 ± 1.38 to 69.40 ± 4.72 minutes. There were increases at the team level in relative substitutions (SUB), relative distance (RD), high-speed running (HSR: 3.08-5.27 m·s), and surges (S), with a fall in low-speed running (LSR: 0-3.05 m·s) between 2014 and 2015. There were no changes in the between-position differences observed from 2014 to 2015. Within positions, there were relative increases in RD for all positions, HSR and S for midfield, and in SUB and S in forwards. The 2015 FIH rule changes seem to have increased the general intensity of international women's hockey. However, the different facets of physical performance did not change uniformly across team positions. Therefore, specific modifications to conditioning practices for each position may be warranted to more accurately reflect match demands.

Measuring what matters in isometric multi-joint rate of force development.

This study aimed to evaluate responsiveness (ability to detect change) of isometric force-time measures to neuromuscular fatigue in resistance-trained participants using two differing protocols that modified both the instructions provided to participants and the duration of the test. Both protocols were completed at two knee joint angles in the isometric squat test. Ten participants volunteered to take part in this study (age: 27.0 ± 4.5 years, strength training experience: 7.7 ± 2.6 years). Isometric peak force (ISqTpeak) and isometric explosive force (ISqTexp) test protocols were assessed at two joint angles (knee angle 100° and 125°) pre-high intensity strength training, immediately post strength training, 24-h post, 48-h post and analysed for peak and RFD performance. Participants completed eight sets of three repetitions of the back-squat exercise as the high-intensity strength training. Results showed the highest standardised response means (SRM) detected was peak force using the ISqTpeak 100, SRM -1.97 compared to an SRM of -1.31 for RFD 200 ms in the ISqTexp 125. Peak force was the most responsive variable using the ISqTpeak protocol, whereas the ISqTexp protocol was most responsive for RFD measures. Therefore, ISqTpeak and ISqTexp test protocols should not be used interchangeably to evaluate RFD variables.

Multi-joint rate of force development testing protocol affects reliability and the smallest detectible difference.

Isometric tests have been used to assess rate of force development (RFD), however variation in testing methodologies are known to affect performance outcomes. The aim of this study was to assess the RFD in the isometric squat (ISqT) using two test protocols and two testing angles. Eleven participants (age: 26.8 ± 4.5 years, strength training experience: 7.1 ± 3.03 years) completed test and retest sessions one week apart, whereby two test protocols with respect to duration and instructions were compared. Isometric peak force (ISqTpeak) and isometric explosive force (ISqTexp) tests were assessed at two joint angles (knee flexion angle 100° and 125°). Force-time traces were sampled and subsequently analysed for RFD measures. Average and instantaneous RFD variables did not meet reliability minimum criteria in ISqTpeak at 100° or 125°. The ISqTexp test at 100° met reliability criteria in the RFD 0-200 and 0-250ms variables. The ISqTexp test at 125° met reliability criteria in the RFD 0-150, 0-200 and 0-250ms variables. Force-time characteristics were optimized at the higher knee joint angle. Average and instantaneous RFD measures obtained using a traditional peak force test do not meet basic reliability criteria. Researchers assessing multi-joint RFD should employ the explosive RFD test protocol as opposed to the traditional isometric peak force protocol.

Is a Bimodal Force-Time Curve Related to Countermovement Jump Performance?

A countermovement jump (CMJ) represents one of the most frequently used performance tests for monitoring neuromuscular function in athletes. An often-overlooked feature that may provide some useful diagnostic information is the actual shape of the force-time curve. The aim of this study was therefore to consider how the shape of the force-time curve influences jump performance. Thirty-three male rugby union players performed two CMJs on a force plate, with discrete variables and continuous curve analysis used. The subjects were dichotomized based on shape of the force-time curve during the propulsion phase and by jump height. The differences between the unimodal and bimodal groups were unclear for jump height (ES = 0.28, ±0.58) and reactive strength index-modified (ES = −0.30, ±0.59). A substantial difference between high (40.2 ± 2.9 cm) and low (31.2 ± 3.2 cm) jumpers only existed in the late propulsion phase by 79.0% to 97.0% of the normalized force-time curve. A bimodal force-time curve is not representative of an optimal pattern of performance and simply reflects an inefficient stretch-shortening cycle. The inter-individual variability that exists in braking COM displacement renders temporal phase analysis impractical in cross-sectional type studies.

Dissociated Time Course of Recovery Between Strength and Power After Isoinertial Resistance Loading in Rugby Union Players.

Kennedy, RA and Drake, D. Dissociated time course of recovery between strength and power after isoinertial resistance loading in rugby union players. J Strength Cond Res 32(3): 748-755, 2018-There is a substantial amount of research on the responses to isometric and eccentric loading. However, only a paucity of literature exists on the responses to isoinertial loading, especially in trained athletic populations using realistic loading protocols. The purpose of this study was to examine the acute neuromuscular response to a bout of isoinertial resistance loading in elite rugby players. Seventeen male (age: 19.5 ± 2.3 years) rugby union players performed a conventional maximal isoinertial resistance loading protocol. Countermovement jump (CMJ) and maximal voluntary isometric contraction (MVC) squat performance were measured on 3 occasions: at baseline, immediately post, and 48 hour post. The results indicated that the decrease in MVC (9.7%) is greater than or comparable with the CMJ output variables (4.2-10.3%), immediately postexercise. Although isometric strength had demonstrated a full recovery at 48 hour post, many of the key CMJ output variables were still impaired (p ≤ 0.05). Similar findings were observed in the normalized CMJ curves. Complete recovery of the ability to rapidly produced force may require more than 48 hours in many athletes. Individual responses should, therefore, be monitored to help plan acute and chronic training loads. It is recommended that future fatigue studies should incorporate temporal phase analyses to consider the power-, force-, velocity-, and displacement-time curves.

Familiarization, validity and smallest detectable difference of the isometric squat test in evaluating maximal strength.

Isometric multi-joint tests are considered reliable and have strong relationships with 1RM performance. However, limited evidence is available for the isometric squat in terms of effects of familiarization and reliability. This study aimed to assess, the effect of familiarization, stability reliability, determine the smallest detectible difference, and the correlation of the isometric squat test with 1RM squat performance. Thirty-six strength-trained participants volunteered to take part in this study. Following three familiarization sessions, test-retest reliability was evaluated with a 48-hour window between each time point. Isometric squat peak, net and relative force were assessed. Results showed three familiarizations were required, isometric squat had a high level of stability reliability and smallest detectible difference of 11% for peak and relative force. Isometric strength at a knee angle of ninety degrees had a strong significant relationship with 1RM squat performance. In conclusion, the isometric squat is a valid test to assess multi-joint strength and can discriminate between strong and weak 1RM squat performance. Changes greater than 11% in peak and relative isometric squat performance should be considered as meaningful in participants who are familiar with the test.

Reliability of bounce drop jump parameters within elite male rugby players.

BACKGROUND: The aims of the study were to investigate the number of familiarization sessions required to establish reliability of the bounce drop jump (BDJ) and subsequent reliability once familiarization is achieved. METHODS: Seventeen trained male athletes completed 4 BDJs in 4 separate testing sessions. Force-time data from a 20 cm BDJ was obtained using two force plates (ensuring ground contact <250 ms). Subjects were instructed to "jump for maximal height and minimal contact time" while the best and average of four jumps were compared. A series of performance variables were assessed in both eccentric and concentric phases including jump height, contact time, flight time, Reactive Strength Index (RSI), peak power, rate of force development (RFD) and actual dropping height (ADH). Reliability was assessed using the intraclass correlation coefficient (ICC) and coefficient of variation (CV) while familiarization was assessed using a repeated-measures analysis of variance (ANOVA). RESULTS: The majority of DJ parameters exhibited excellent reliability with no systematic bias evident, while the average of 4 trials provided greater reliability. With the exception of vertical stiffness (CV: 12.0%) and RFD (CV: 16.2%), all variables demonstrated low within subject variation (CV range: 3.1-8.9%). Relative reliability was very poor for ADH, with heights ranging from 14.87-29.85 cm. CONCLUSIONS: High levels of reliability can be obtained from the BDJ with the exception of vertical stiffness and RFD, however, extreme caution must be taken when comparing DJ results between individuals and squads due to large discrepancies between actual drop height and platform height.

The Validity and Responsiveness of Isometric Lower Body Multi-Joint Tests of Muscular Strength: a Systematic Review.

BACKGROUND: Researchers and practitioners working in sports medicine and science require valid tests to determine the effectiveness of interventions and enhance understanding of mechanisms underpinning adaptation. Such decision making is influenced by the supportive evidence describing the validity of tests within current research. The objective of this study is to review the validity of lower body isometric multi-joint tests ability to assess muscular strength and determine the current level of supporting evidence. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed in a systematic fashion to search, assess and synthesize existing literature on this topic. Electronic databases such as Web of Science, CINAHL and PubMed were searched up to 18 March 2015. Potential inclusions were screened against eligibility criteria relating to types of test, measurement instrument, properties of validity assessed and population group and were required to be published in English. The Consensus-based Standards for the Selection of health Measurement Instruments (COSMIN) checklist was used to assess methodological quality and measurement property rating of included studies. Studies rated as fair or better in methodological quality were included in the best evidence synthesis. RESULTS: Fifty-nine studies met the eligibility criteria for quality appraisal. The ten studies that rated fair or better in methodological quality were included in the best evidence synthesis. The most frequently investigated lower body isometric multi-joint tests for validity were the isometric mid-thigh pull and isometric squat. The validity of each of these tests was strong in terms of reliability and construct validity. The evidence for responsiveness of tests was found to be moderate for the isometric squat test and unknown for the isometric mid-thigh pull. No tests using the isometric leg press met the criteria for inclusion in the best evidence synthesis. CONCLUSIONS: Researchers and practitioners can use the isometric squat and isometric mid-thigh pull with confidence in terms of reliability and construct validity. Further work to investigate other validity components such as criterion validity, smallest detectable change and responsiveness to resistance exercise interventions may be beneficial to the current level of evidence.

The effect of acute fatigue on countermovement jump performance in rugby union players during preseason.

BACKGROUND: A countermovement jump (CMJ) is routinely used in many sporting settings to provide a functional measure of neuromuscular fatigue. However, the variables that are most sensitive to fatigue remain somewhat unclear. The purpose of this study was to determine the acute changes in neuromuscular fatigue in rugby union players during a period of preseason training. METHODS: Nine male (age: 19.0±1.5 years) academy rugby union players performed five CMJ trials on three occasions, at baseline, 24 hours and 48 hours postbaseline. The fatiguing protocol consisted of multiple high-intensity training sessions commensurate with the period of preparation and the sport. A total of 14 CMJ variables were derived from the force-time curve. Meaningful differences in CMJ performance were examined using the magnitude of change (effect sizes; ES) compared to baseline. RESULTS: Most variables, 9 of the 14, showed substantial decreases at 24 hours postbaseline. Mean concentric power, peak velocity, jump height and force at zero velocity were impaired by the greatest magnitude (ES=-0.98 to -1.57). At 48 hours postbaseline, substantial increases in eccentric duration, concentric duration and total duration were first observed (ES=0.48 to 0.61). Concomitantly, peak power, peak velocity and jump height, recovered to baseline levels. CONCLUSIONS: During the late regeneration phase, neuromuscular fatigue can manifest itself as an altered movement strategy, rather than as a simple reduction in physical output such as jump height. Practitioners are therefore advised to incorporate a wide range of variables when trying to identify subtle changes in the bimodal recovery pattern associated with stretch-shortening cycle induced fatigue.

An approach to controlled drug infusion via tracking of the time-varying dose-response.

Automatic administration of medicinal drugs has the potential of delivering benefits over manual practices in terms of reduced costs and improved patient outcomes. Safe and successful substitution of a human operator with a computer algorithm relies, however, on the robustness of the control methodology, the design of which depends, in turn, on available knowledge about the underlying dose-response model. Real-time estimation of a patient's actual response would ensure that the most suitable control algorithm is adopted, but the potentially time-varying nature of model parameters and the limited number of observation signals may cause the estimation problem to be ill-posed, posing a challenge to adaptive control methods. We propose the use of Bayesian inference through a particle filtering approach as a way to overcome these limitations and improve the robustness of automatic drug administration methods. We report on the results of a simulation study modeling the infusion of vasodepressor drug sodium nitroprusside for the control of mean arterial pressure in acute hypertensive patients. The proposed control architecture was able to meet the required performance objectives under challenging operating conditions.

Insights into head-related transfer function: Spatial dimensionality and continuous representation.

This paper studies head-related transfer function (HRTF) sampling and synthesis in a three-dimensional auditory scene based on a general modal decomposition of the HRTF in all frequency-range-angle domains. The main finding is that the HRTF decomposition with the derived spatial basis function modes can be well approximated by a finite number, which is defined as the spatial dimensionality of the HRTF. The dimensionality determines the minimum number of parameters to represent the HRTF corresponding to all directions and also the required spatial resolution in HRTF measurement. The general model is further developed to a continuous HRTF representation, in which the normalized spatial modes can achieve HRTF near-field and far-field representations in one formulation. The remaining HRTF spectral components are compactly represented using a Fourier spherical Bessel series, where the aim is to generate the HRTF with much higher spectral resolution in fewer parameters from typical measurements, which usually have limited spectral resolution constrained by sampling conditions. A low-computation algorithm is developed to obtain the model coefficients from the existing measurements. The HRTF synthesis using the proposed model is validated by three sets of data: (i) synthetic HRTFs from the spherical head model, (ii) the MIT KEMAR (Knowles Electronics Mannequin for Acoustics Research) data, and (iii) 45-subject CIPIC HRTF measurements.

An especial skill: Support for a learned parameters hypothesis.

We tested the 'learned parameters' hypothesis as an explanation of the 'especial skill effect'. Outcome attainment and movement kinematics were recorded for 10 expert and 10 novice players performing basketball free-throw shots at five distances (11-19 ft) with a regular and heavy weight basketball. As predicted, experts performed better than expected relative to the regression equation at the 15 ft, free-throw line with the regular basketball, supporting the 'especial skill effect'. This effect was not present for the experts when shooting with the heavy ball. Novices did not show an advantage at the free-throw line when performing with either ball. Although the outcome attainment scores support the 'learned parameters' hypotheses, kinematic analysis failed to identify differences in the movement pattern for the especial skill, suggesting that these skills (i.e., shooting at different distances) are not governed by separate motor programs.

Parallel computation of mutual information on the GPU with application to real-time registration of 3D medical images.

Due to processing constraints, automatic image-based registration of medical images has been largely used as a pre-operative tool. We propose a novel method named sort and count for efficient parallelization of mutual information (MI) computation designed for massively multi-processing architectures. Combined with a parallel transformation implementation and an improved optimization algorithm, our method achieves real-time (less than 1s) rigid registration of 3D medical images using a commodity graphics processing unit (GPU). This represents a more than 50-fold improvement over a standard implementation on a CPU. Real-time registration opens new possibilities for development of improved and interactive intraoperative tools that can be used for enhanced visualization and navigation during an intervention.

Orthogonal basis expansion based atrial activity reconstruction for atrial fibrillation electrocardiogram analysis.

We propose a novel algorithm for extracting atrial activity from single lead electrocardiogram (ECG) signal sustained with atrial fibrillation (AF), based on a short-time expansion of an orthogonal basis function set. The method preserves the time variation of spectral content of the underlying AF signal, thus time-frequency analysis of the AF signal can be successfully performed. The new method is compared to the standard average beat subtraction (ABS) method using synthetic AF sustained ECG data. The orthogonal basis expansion method has a higher correlation with the original AF signal compared to the ABS method for a range of signal to noise ratio (SNR) levels, and correlation is improved by 16% at an SNR of 0dB. Time-frequency analysis of the reconstructed AF signal based on Bessel distribution also shows the superiority of the orthogonal basis expansion method over ABS.

Evaluating the effects of a low volume stairclimbing programme on measures of health-related fitness in sedentary office workers.

Despite its obvious advantages, few studies have examined health outcomes of regular stariclimbing. In this study, we investigated the training effects of eight weeks of stairclimbing on recognised measures of health-related fitness in an occupational setting. Forty-five public sector employees (22 male, 23 female) aged 42.3 ± 9.0 years were randomly assigned to control (n = 16) or stairclimbing (n = 29) groups. Stairclimbing training began with 1 bout 5d·wk(-1) in week 1, increasing by one climb per day every two weeks until week 5, where a maintenance level of 3 climbs per day was reached. Participants climbed on staircases located within an 8 storey office block, consisting of 145 steps. The prescribed exercise intensity involved climbing the 8 flights of stairs at a rate of 75 steps·min(-1). All participants agreed not to change their diet or lifestyle over the experimental period. Relative to controls, the stairclimbing group showed a significant increase of 9.4% in predicted VO2max (p < 0. 05). No significant changes in blood pressure, blood lipid concentrations or body composition were noted. These findings provide evidence that stairclimbing can enhance an important component of health-related fitness, namely cardiovascular fitness. Given that such improvement resulted from less than 30 minutes per week of moderate exercise, stairclimbing in the workplace should be promoted as a health-enhancing physical activity. Key pointsLow volumes of stairclimbing significantly increased a key component of cardiorespiratory fitness, namely VO2max.Stairclimbing can therefore be promoted within the typical urban workplace as a health enhancing activity.Indices of morphological or metabolic fitness may require larger volumes of stairclimbing than as prescribed in the current study.