Perforated duodenal ulcer after Roux-en-Y gastric bypass: an unusual complication.

Summary: Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy. Learning points: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis. The pathophysiology of this perforation is not clear, but several mechanisms have been proposed. Helicobacter pylori has been implicated. Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.

Validity and reliability of My Jump 2® app to measure the vertical jump on elite women beach volleyball players.

Purpose: The aim of this study was to assess the reliability and validity of the My Jump 2® app in measuring jump height, flight time, and peak power among elite women beach volleyball players on sand surfaces. Methods: Eleven elite female beach volleyball players (aged 23.6 ± 6.2 years; weight 66.3 ± 5.8 kg; height 174.4 ± 5.8 cm; with 8.4 ± 4.8 years of professional experience) participated in this study. Each player performed six countermovement jumps in a wooden box filled with sand on a force platform while simultaneously recording a video for subsequent analysis using the My Jump 2® app. Results: We found excellent agreement for flight time, jump height and peak power between observers (ICC = 0.92, 0.91 and 0.97, respectively). No significant differences between force platform and My Jump 2® app were detected in the values obtained for the three variables (P > 0.05). For the force platform and the My Jump 2® app, we found a good agreement measuring jump height and flight time (ICC = 0.85 and 0.85, respectively). However, we only found a moderate agreement for peak power (ICC = 0.64). The difference in jump height showed a limit of agreement between -4.10 and 4.74 cm in Bland-Altman, indicating a high level of agreement between the two measurement tools. Conclusion: Based on our findings, the My Jump 2® app reveals a valid tool for measuring jump height and flight time of CMJ on sand surfaces. However, more caution is needed when measuring peak power.

Chest Computed Tomography for Lymphoma Staging: A Wasted Opportunity for Cardiovascular Risk Stratification?

AIM: Patients with a lymphoma diagnosis undergo non-gated chest computed tomography (CT) scans as part of cancer diagnosis or staging. Although coronary artery calcification (CAC) is traditionally evaluated on dedicated cardiac CT, CAC can also be detected on standard chest CT. This exploratory study aimed to determine the prognostic value of CAC detected on non-gated chest CT and to report its use on clinical practice. METHOD: Consecutive patients with a lymphoma diagnosis who performed non-contrasted non-gated chest CT for cancer diagnosis or staging were included and retrospectively evaluated. Coronary artery calcification was evaluated by quantitative (Agatston score) and qualitative (visual) assessment. RESULTS: Fifty-seven patients were included in this study (mean age 61±15 years; 58% male). Coronary artery calcification was identified in 22 patients (39%), most of them with multi-vessel involvement. Coronary artery calcification was qualitatively classified as mild, moderate and severe in 11%, 19% and 9% patients, respectively. This study suggested that moderate or severe CAC was an independent predictor of all-cause mortality (odds ratio 3, 95% confidence interval 2-11; p=0.04) after adjusting for cardiovascular risk factors and lymphoma staging. Regarding quantitative evaluation, a higher CAC score was also associated with higher mortality. While significant CAC was identified in 22 patients, it was only reported in four patients. CONCLUSIONS: The preliminary findings of this hypothesis-generating study support the investigation of CAC identified by chest CT for diagnosis/staging of cancer as a risk modifier in the global risk assessment of patients with lymphoma. The unrecognition and underreporting of this finding may represent a wasted opportunity to detect subclinical coronary atherosclerosis in these patients and may help in guiding preventive cardiology care.

Portuguese research on physical education and sport didactics-a critical discussion.

This article presents a discussion of research in Physical Education and Sport Didactics in Portugal. It starts by situating it from an historical perspective, placing the 1980s as the beginning era, mainly based on the studies provided by the two first Physical Education higher education institutes of the country. The initial research, first based on master and doctoral dissertations, progressed to ongoing projects that have been disseminated in international and national journals and books. This development is also reported from the theoretical, conceptual, and methodological perspectives, showing how it has informed the quality of Physical Education and teacher education as the two main research strands to be described, however, acknowledging that a strand on sports coaching and coach education exists. On teaching Physical Education, the article discusses the elements relative to the teacher and to the student, focusing from the immediate and short-term to the distant and long-term events that lead into young adulthood's active lifestyles. In this analysis, research on curriculum and assessment are also reported. On physical education teacher education, the article shows the prevalence of the post-primary Physical Education to argue for the need for more research on primary-level education, and discusses the diverse foci from initial teacher education to in-service education practises. In line with current trends in research, we suggest a set of four features for the future research agenda: (1) addressing short to long-term outcomes of Physical Education; (2) adopting multifactorial and multi-layered perspectives of analysis; (3) embracing inter- and multidisciplinary designs; and (4) taking comparative perspectives within and between European countries, and between Europe and other continents. We conclude that these features need to focus on four levels of integration and cooperation: (a) integration between the research initiatives and the needs of the professional field; (b) integration between research on teaching and learning, teacher education and the curriculum; (c) cooperation between the different national higher education and professional institutions; and (d) integration in the international research agenda by leading and participating in project partnerships which are needed to fully and effectively implement such agenda.

To Sample or to Specialise? Sport Participation Patterns of Youth Team Sport Male Players.

This study characterised the sport participation patterns of 546 male youth team sport players. A retrospective questionnaire was used to identify the sport starting age (general sports and main sport) and the quantity and type of sports undertaken during the early years of development. A mixed-ANOVA and Chi-square tests were implemented. All participants started involvement in sports at the same age (~5 years) and participated in the same number of sports during their early years (1 to 2 sports). However, football players started participating mainly in team games (football, futsal) and water polo players in CGS sports (swimming). Participants reported different ages for initial participation in: (i) main sport (football players started participating earlier, around 5-6 years), (ii) onset of specialisation (football players specialised earlier, around 7 or 8 years), (iii) types of sports engaged in (football players were involved in more team games and water polo in more CGS sports), and (iv) variations in weekly training hours (water polo reported more hours of training). This study provided empirical evidence for understanding the effects of different sporting pathways on long-term athlete development. Some key incongruities between contemporary knowledge and practice are acknowledged. Further investigations should be developed by examining the trajectories in different sports, countries, genders, and cultural contexts.

Iatrogenic Cushing's Syndrome: The Result of Cobicistat and Glucocorticoid Interaction in an HIV Patient After Bariatric Surgery.

Cobicistat, used as a pharmacokinetic booster in therapeutic combination with human immunodeficiency virus (HIV) protease inhibitors and integrase inhibitors, is a strong inhibitor of cytochrome P450 3A4 (CYP3A4). Since most glucocorticoids are metabolized by the isoenzyme of the cytochrome P450 pathway, their plasma concentrations can be highly increased in the presence of cobicistat-boosted darunavir, with subsequent risk of iatrogenic Cushing's syndrome (ICS) and secondary adrenal insufficiency. We report a case of a 45-year-old man with HIV-hepatitis C virus co-infection treated with raltegravir and darunavir/cobicistat since 2019. In May 2021, he underwent a sleeve gastrectomy due to morbid obesity (BMI: 50.9 kg/m2) with multiple comorbidities. Four months after surgery, he was diagnosed with asthma and was started on inhaled budesonide, which was later changed to fluticasone propionate. At the 12-month postoperative visit, the patient referred proximal muscle weakness and asthenia, and suboptimal weight loss (excess weight loss of 39%) and high blood pressure were documented. Moon facies, buffalo hump, and abdominal large vinous striae were evident on physical examination. Laboratory studies showed impaired glucose metabolism and hypokalemia. Cushing's syndrome was suspected and further investigation confirmed its iatrogenic origin. The diagnosis of ICS and consequent secondary adrenal insufficiency due to an interaction between the darunavir/cobicistat combination and budesonide/fluticasone was established. Darunavir/cobicistat therapy was replaced by dolutegravir/doravirine dual therapy, inhaled corticoid was switched to beclomethasone, and glucocorticoid substitutive therapy was introduced. This is a particular case of overt ICS due to cobicistat-inhaled corticosteroid interaction in a superobese patient, developed after he underwent bariatric surgery. The presence of morbid obesity, combined with the rarity of this pharmacological complication in individuals taking cobicistat, made the correct diagnosis even more challenging. A meticulous review of pharmacologic habits and potential interactions is essential to avoid serious harm to patients.

How Can Learner-Oriented Scaffolding Strategies Be Implemented in Coach Education? A Case Study.

Purpose: Although emerging research has explored the development of coach education curricula, coach learning and how a deep learning approach can be made accessible to aspiring coaches, the study of coach educators' scaffolding of micro-pedagogies in action remains a missing link in the field. Therefore, the purpose of this study was to explore scaffolding strategies adopted by an experienced coach educator to encourage aspiring coaches to adopt an active approach to learning. Method: A case-study was conducted for a full semester of twelve practical lessons in the unit "Sports Methodology I-Volleyball" of a renowned sport sciences coach education program. Multiple data collection sources included participant observation, video and audio recordings, individual interviews with the coach educator and focus group interviews with the aspiring coaches. A thematic analysis was performed, and trustworthiness criteria included data triangulation, crosschecking, and collaborative interpretational analysis. Results: The strategies adopted by the coach educator progressively unfolded throughout three main stages: (i) laying the foundations of a learner-oriented approach; (ii) enhancing personally meaningful learning experiences; and (iii) mediating peer-coaching activities. An intricate interplay was unraveled between the nature and reduction of the support given and the increased responsibility transferred to the aspiring coaches for their active participation in learning experiences. Conclusions: The learner-oriented scaffolding processes employed by the coach educator sought to promote enhanced understanding of game-play problem-solving and the aspiring coaches' development of a deeper sense of what is required to become a coach through engagement in coaching technical activities and peer-coaching interventions.

Treinadores de futsal brasileiros de elite: aspectos influenciadores da escolha da profissão e da construção da competência profissional / Brazilian elite futsal coaches: influencering aspects in the choice of profession and the construction of professional competence / Entrenadores de fútbol sala de élite brasileño: aspectos que influyen en la elección de la profesión y la construcción de la competencia profesional

Resumo A relevância do futsal brasileiro no cenário mundial é reconhecida pela sua prática massiva e conquistas internacionais. Neste contexto, compreender aspectos envoltos de uma função relevante, a de treinador, torna-se fundamental. O objetivo deste estudo foi investigar as percepções de treinadores brasileiros de elite sobre os aspectos influenciadores na escolha da profissão e os conhecimentos fundamentais necessários à competência profissional. Realizaram-se entrevistas em profundidade com 10 treinadores de elite. Os resultados sugerem que a influência familiar, a exposição prolongada à prática, à escola e aos seus treinadores enquanto atletas foram fundamentais nas suas trajetórias. O conhecimento específico do futsal, a leitura de jogo e a tomada de decisão parecem ser relevantes para a competência na função. Por fim, a relação aberta, de troca e cobrança com os atletas demonstram ser essenciais no contexto prático e a busca pelo desenvolvimento dos atletas é realizada de maneira global.

Abstract The growing worldwide significance of Brazilian futsal is recognized due to its extensive practice and international achievements. In this context, it becomes essential to further explore the critical aspects associated with the coaching role. The aim of this study was to investigate elite Brazilian coaches' perceptions regarding the factors influencing their decision to pursue this profession and the fundamental aspects related to coaches' professional competence. In-depth interviews were conducted with 10 elite coaches. The results suggest that family influence, prolonged exposure to practice, the school, and their coaches were fundamental in shaping the coaches' professional trajectories. Specific futsal knowledge, game reading, and decision making seem to be relevant for competence in the role. Finally, an open, reciprocal, and accountable relationship with athletes is considered essential in the practical context, as well as the pursuit of significantly contributing to athlete development as an integral part of the coaching role.

Resumen La importancia del fútbol sala brasileño es mundialmente reconocida por su práctica masiva y logros internacionales. En este contexto, es fundamental profundizar en la comprensión de los aspectos críticos involucrados en el rol del entrenador. El objetivo de este estudio fue investigar las percepciones de entrenadores de élite brasileños sobre los aspectos que influyen en la elección de la profesión y los conocimientos fundamentales necesarios para la competencia profesional. Se realizaron entrevistas en profundidad a 10 entrenadores de élite. Los resultados sugieren que la influencia familiar, la exposición prolongada a la práctica, la escuela y sus entrenadores como atletas fueron fundamentales en sus trayectorias. El conocimiento específico del fútbol sala, la lectura de juegos y la toma de decisiones parecen ser relevantes para la competencia en el rol. Finalmente, la relación abierta, de intercambio y de rendición de cuentas con los atletas resultan esenciales en la práctica y que la búsqueda del desarrollo de los atletas se realice de manera global.

Ongoing Bidirectional Feedback between Planning and Assessment in Educational Contexts: A Narrative Review.

Quality in education is one of the 17 goals in the United Nations' sustainable agenda for 2030, presupposing careful planning and assessment of learning. Traditional planning in sports education (either in training or school settings) largely adopts pre-determined learning sequences and temporal milestones that, in theory, enhance the learning process. However, learning is a context-dependent, non-linear process with considerable intra- and interindividual variability, whereby planning and assessment should also be non-linear. In this narrative review, the main findings suggest that the specific teaching or training contents and their relative (i.e., ordering or sequencing) and absolute timing (i.e., the specific time point where certain learning or adaptations are expected) should vary depending on the learners and the context. In a process-oriented perspective, this requires flexible planning and the establishment of ongoing bidirectional links between planning and assessment. In this framework, assessment should be a flexible, evolving, and daily pedagogical tool instead of a set of formal checkpoints. We further explored how planning and assessment could be linked to provide an ongoing feedback loop that respects the individuality of each learner and its context, and therefore hope this review helps bring about a change in current planning and assessment paradigms in sports education.

A Novice Teacher as Facilitator of Learning During a Hybrid Sport Education/Step-Game Approach Volleyball Season.

This study aimed to examine how a novice Physical Education teacher unfolded her pedagogical practice as a facilitator of learning during a hybrid Sport Education/Step-Game-Approach volleyball season; and to investigate students' perceptions about their lived learning experiences and active involvement in building their own learning process. For this purpose, an insider action-research design was implemented throughout one school term (20 lessons of 45 minutes each in total). Twenty-five students (aged between16 and17 years old), enrolled in the 12th grade at a Portuguese high school took part in this investigation. The novice teacher, who held two years of professional experience, assumed the dual role of teacher-researcher, facilitating an in-depth understanding of the complexity featuring of the teaching-learning process. Qualitative data were collected using multiple data sources (i.e., teacher's lesson plans and field diary, and student's focus-group interviews), and analyzed using a hybrid approach of inductive and deductive thematic analysis. The results revealed that the use of this hybrid season helped the teacher to act as facilitator of learning, namely by: (i) using two student-centered models with unique internal structures and functionalities, (ii) increasing the level of responsibility taken by students for their own learning experiences, (iii) adapting the lesson plans to students' individual needs, and (iv) combining a more supportive intervention with the use of more indirect teaching strategies. Together, these strategies seemed to prompt students' autonomy and sense of active control of the class activities, the development of students' abilities and volleyball-based knowledge, leading them to be more interested and engaged in Physical Education. In conclusion, the alliance between the student-centered environment (Sport Education) and the specificity of the content subject-knowledge (Step-Game Approach for non-invasion games) seems to have allow the novice teacher to adjust her pedagogical intervention as facilitator of learning to students' individual learning needs.

How can team synchronisation tendencies be developed combining Constraint-led and Step-game approaches? An action-research study implemented over a competitive volleyball season.

Combining Constraint-led (ecological) and Step-Game (constructivist) approaches through an Action-Research (AR) design conducted throughout a competitive volleyball season, this study aimed to: (i) analyse the impact of increased tactical complexity on lateral and longitudinal collective Synchronisation Tendencies (ST) during defensive and offensive counterattack-subphases, and (ii) examine how opposition attacking contexts (i.e. playing in full-system or in-system) might influence ST throughout each counterattack-subphase. Performance of a youth team, comprised of 15 players, was studied across three AR-cycles. The team's competitive performance was analysed through three competitive matches (one per cycle). Team ST were evaluated using the cluster-phase method and a 3 (matches) × 2 (counterattack-subphases) × 2 (opposition attacking contexts) × 2 (court directions) repeated-measures ANOVA were used to calculate the differences in cluster-amplitude mean values. Results showed that increments in tactical complexity (second AR-cycle) were followed by decreases in collective ST, which were (re)achieved during the third AR-cycle, possibly due to the ecological-constructivist coaching intervention. Our findings imply that coaches could design representative and specific-didactical learning environments, predicated on a team's tactical needs and strategical ideas from a game-plan, framing player intentionality. Results also support the use of questioning strategies to narrow players' attentional focus, stimulating perceptual attunement to relevant constraints emerging in performance. Finally, the insider AR-design provided valuable contextualised insights on coaching interventions for developing collective coordinative structures.

Flexible Training Planning Coupled with Flexible Assessment: A 12-Week Randomized Feasibility Study in a Youth Female Volleyball Team.

According to the Quality Education and Gender Equality ambitions established at the 2030 Agenda for Sustainable Development Goals, we aimed to test the feasibility of a flexible planning and assessment process, using ongoing, bidirectional feedback between planning and assessment. Eighteen players (11.5 ± 0.5 years of age) from a U13 female volleyball team were randomized into an experimental group (in which the plan could be changed daily) or a contrast group (pre-defined planning, adjusted monthly). The pedagogical intervention lasted three months. Besides ongoing daily assessments from the training practices, the Game Performance Assessment Instrument was adopted as a starting point for the weekly assessments in 4 vs. 4 game-forms (i.e., the instrument was modified monthly based on feedback from the training process). Information from daily and weekly formal assessment was used in the planning of the experimental group, and monthly in the contrast group. Data suggested that pre-established and strict planning (even updated monthly) failed to fit current learner needs. Over 12 weeks, the pre-established planning suffered regular modifications in the experimental group, and the assessment tool changed monthly. In conclusion, both planning and assessment should be open and flexible to exchange information mutually, and support the design of tailor-made learning environments.

Surgical approach to gastric polyposis in Cowen syndrome-case report.

Cowden syndrome is a rare autosomal dominant disorder that is characterized by multiple hamartomatous neoplasms in a variety of tissues and is associated with germline mutations in the PTEN gene. Cowden syndrome does not have increased risk of gastric malignancy; however, complications of benign neoplasm can occur. The authors report a case of a patient with Cowden Syndrome and with gastric polyps that caused severe morbidity and a surgical approach was indicated. An antrectomy with troncular vagotomy was performed with a Billroth I reconstruction. In this case, this was of paramount importance so the duodenum can be revisited.

The Influence of Parents, Coaches, and Peers in the Long-Term Development of Highly Skilled and Less Skilled Volleyball Players.

The purpose of this study was to understand the perceptions of highly skilled and less skilled volleyball players about the influences that parents, coaches, and peers had on their sport development and performance achievement. Highly skilled (n = 30) and less skilled (n = 30) volleyball players participated in semi-structured retrospective interviews to explain how parents, coaches and peers may have influenced their sport participation. Data was analyzed through a process of content analysis. Results indicated that parents, coaches, and peers had an important influence in player's sport development but differing according to players' expertise level. Concerning to parental influences, tangible support during the early years of development was mentioned by all players. However, parents' level of involvement and parenting styles revealed interesting differences between highly skilled and less skilled players. Highly skilled players perceived a moderate parental involvement and an autonomy-supportive parenting style, while less skilled players referred a excessive parental involvement in players' sport participation. Coaches influences showed to have some similarities in the early years with all players mentioning coaches as caring and recognizing their value as an athlete. However, highly skilled players described a different training environment characterized by a demanding coach, individualized instruction, and specific goal setting. Regarding peers' influence, all players recognized that friends were not only one of the main reasons to start playing volleyball, but also an important source of support to remain engaged and staying motivated to do sport. Highly skilled players, however, mentioned the importance of teammates' positive push and critiques during practice for enhancing their motivation, team cohesion and friendship. They also highlighted the importance of friends outside of sport in the later years of their career by acting as an escape from all the pressure that emerged from volleyball training and competition demands. Overall, these findings highlight different social influences according to the players' expertise level suggesting the need to examine more extensively the nature of significant others' support on athlete and talent development.

Towards a More Efficient Training Process in High-Level Female Volleyball From a Match Analysis Intervention Program Based on the Constraint-Led Approach: The Voice of the Players.

The aim of the research was to know the perception of high-level volleyball players of the changes produced (in relation to the previous season) in the efficiency of the training process, after a match analysis intervention program based on the Constraint-led Approach (CLA). The sample consisted of 11 players from a women's volleyball team. The protocol of the intervention program consisted of providing objective, contextualised and systematic information to the coach (adapted to his needs) that would allow understanding the different real game contexts. We used semi-structured interviews to assess players' perceptions. The athletes perceived changes in training, both in their preparation and development, specifically in greater involvement and organisation in preparing the training; in an increase in the specificity and suitability of training tasks according to individual needs; in the representativeness of the restrictions of the game; in a more tactical approach; in the variability of task and in the accountability to achieve the objective proposed. In addition, in the preparation and development for competition, the players detected more game planning; a deeper analysis of the opponents; an objective selection of the most relevant data, an increase in the depth of match analysis and the inclusion of the weekly meeting with the use of video compared to the previous season. These results expose the benefits of coaches incorporate programmes to obtain objective information about the game in their training process.

What Actually Differs between Traditional Teaching and Sport Education in Students' Learning Outcomes? A Critical Systematic Review.

This systematic review aimed to examine the main findings concerning to the investigations focused on compare, within Physical Education context, the influence of Sport Education (SE) and Traditional Teaching (TT) on students' learning outcomes. A literature search was conducted on nine electronic databases (PubMed, Google Scholar, Web of Science, SCOPUS, Academic Search Ultimate, ERIC, Education Source, APA PsycINFO and APA PsycARTICLES). Inclusion criteria were defined before the selection process. Accordingly, were only included articles that (i) were published in peer-reviewed international journals indexed in Journal Citation Reports or Scientific Journal Rankings; (ii) were available in full-text; (iii) were published in English, Portuguese or Spanish; (iv) were performed within Physical Education context; and (v) provided specifically a comparison between the effects of SE and TT on students' learning outcomes. Globally, twenty-eight studies met the inclusion criteria. The manuscripts' methodological quality was assessed through Downs and Black checklist, with all studies displaying moderate quality. Results showed that comparisons among SE and TT tend to analyze team sports activities sampling high-school students via quasi-experimental designs, with more than half of them were published over the past five years. Also, these investigations typically focused on the differences between both models on the development of personal and social skills, as well as its impact on the motor and cognitive domains. In this respect, although the results tend to point out increases in both SE and TT, superior values are achieved when SE is implemented. The analysis of the teaching-learning process using alternative research methods and designs (i.e., experimental studies, qualitative data, longitudinal analysis, action-research and case studies), longer units with appropriate planning, and the report of model's fidelity so that robust findings can endorse the teachers' praxis, must be a concern in future studies.

Developing Players' Tactical Knowledge Using Combined Constraints-Led and Step-Game Approaches-A Longitudinal Action-Research Study.

Purpose: Using an action-research design, this study examined the impact of combining concepts from two contemporary pedagogical approaches, the Constraints-led Approach (CLA) and Step-Game Approach (SGA), on the development of youth volleyballers' tactical knowledge, as expressed in performance, throughout a full competitive season. Method: Fifteen players and one coach participated in this study, which involved three action-research cycles, each including the processes of planning, acting and monitoring, reflecting, and fact-finding. The first author, who had the role of coach-researcher, collected data using a reflexive diary and field notes between September 2017 and June 2018, as well as eight semi-structured focus-group interviews. Data were analyzed using thematic analysis, in which inductive procedures deepened understanding of the development of the participants' tactical knowledge. Results: Findings suggested that combining CLA with SGA improved tactical knowledge in specific ways. Players progressed from a starting point where they were only able to describe game scenarios, and act without tactical criteria or considering contextual game constraints, to a point where their intentions during tactical actions were shaped by their ability to think strategically and guide their attention to recognize and interpret different constraints. Conclusions: Results suggested that the development of players' tactical knowledge benefited from a mutual integration of different, yet complementary, pedagogical approaches. By integrating SGA and CLA it was possible to enhance players' adaptable thinking using learning tasks involving the manipulation of meaningful constraints that afforded variable repetition and the resolution of tactical problems.

Laparoscopic treatment of a gastro-gastric fistula after Roux-en-Y gastric bypass-report of two cases.

The most frequently performed bariatric surgery is the laparoscopic Roux-en-Y gastric bypass (LRYGB). An uncommon complication of LRYGB is gastro-gastric fistula (GGF). Possible causes of GGF include incomplete transection of the stomach during the initial surgery, staple-line leaks in the post-operative period and marginal ulcers. The optimal management of GGF is still under debate, with medical, endoscopic and surgical treatment modalities available. The authors present two cases of a GGF successfully managed with a laparoscopic surgical approach, after failed medical and endoscopic treatment.

Relacionamentos amorosos como experiências de ser e de não ser. Uma leitura psicanalítica da função no self do relacionamento amoroso e da repetição / Loving relationships as experiences of being and not being. A psychoanalytic reading of the function in the self of the loving relationship and repetition

A autora pretende demonstrar como os relacionamentos amorosos podem servir funções de estabilidade, regulação e manutenção de um sentimento de coesão do Self, seja mais no nível da estabilidade e da coesão (linha de introjetiva) como referira Blatt, visando impedir a angústia de aniquilação ou, por outro, lado possibilitar, em estados mais desenvolvidos do Self (linha anaclitica) (BLATT, S. J.; BLASS, R. B.,1992), uma visão mais segura de si (autoestima e sentimento de eficácia) impedindo a angústia de perda do objeto em ambos os casos, possibilitando o sentimento de ser. A estabilidade da relação amorosa e a satisfação com o seu desenvolvimento estarão diretamente ligadas à possibilidade de autonomização em relação aos objetos internos, à transcendência do self e ao seu desenvolvimento na relação, interligadas a uma maior autonomização face aos objetos internos e a uma possibilidade de autorregulação e regulação do meio. Pretende-se demonstrar como em determinadas situações a psicoterapia de casal não pode avançar para o trabalho da relação a dois e para o trabalho da intersubjetividade sem que o sentimento de Self esteja firmado em cada um dos elementos do casal(AU)

The author aims to demonstrate how love relationships can serve stability functions, adjustment and maintenance of the Self cohesion, either at the level of stability and cohesion as referred by Blatt (introjective), to prevent the anguish of annihilation or otherwise allow, in another developed Self states (anaclitic) (BLATT, S. J., e BLASS, R. B.,1992), a safer view of themselves (Self-esteem and sense of efficacy) preventing the loss anxiety, in both cases allowing the sense of being. The stability and satisfaction with a love relationship and his development is directly linked to the possibility of autonomy to internal objects, the transcendence of the Self and his development allong the relationship is linked to the greater autonomy related to the internal objects and the possibility of Self regulations and environment regulation. It is intended to demonstrate how in couple psychotherapy we cannot work in the couple relation, in intersubjectivity without the establishment of a sense of cohesive Self of each other(AU)

Increasing tactical complexity to enhance the synchronisation of collective behaviours: An action-research study throughout a competitive volleyball season.

An Action-Research (AR) design was implemented throughout a competitive season in which Constraint-led and Step-Game approaches were combined. This intervention study investigated the impact of increased performance complexity on emergence of counterattacking synchronisation tendencies in team players (laterally and longitudinally on court) at different set moments. Fifteen youth volleyball team players were studied across three action-research cycles, with performance in one competitive match analysed per cycle. Team synchronisation tendencies were assessed using the cluster phase method, with a 3 (matches) x 2 (set moments) x 2 (court direction) repeated-measures ANOVA statistical procedure to calculate differences in cluster amplitude mean values. Results revealed a reduction in team synchrony levels when tactical complexity of counterattacking play increased (second AR-cycle). Nevertheless, similar levels of team synchrony emerged between the first and third AR-cycles. Results also revealed the final moments of a set as a significant environmental constraint that shaped synchronisation tendencies. Evidence suggested that the (re)achievement of functional synchrony was realised through integration of Constraint-led and Step-Game approaches during practices designed to enhance tactical awareness in players. Finally, an insider action-research design provided relevant contextualised insights on the development of a team's synchronisation tendencies.