How do sleepwear and bedding fibre types affect sleep quality: A systematic review.

Sleepwear and bedding materials can affect sleep quality by influencing the skin and body temperature and thermal comfort. This review systematically evaluates the impact of sleepwear or bedding of different fibre types on sleep quality. A systematic search was conducted in six data bases plus Google Scholar and manual searches. Original articles that compared human sleep quality between at least two fibre types of bedding or sleepwear were included, resulting in nine eligible articles included in the review. The fibre types included cotton, polyester, wool, and blended materials for sleepwear; cotton, duck down, goose down, polyester and wool for duvet; and linen and a combination of cotton and polyester for bedding. The interplay between fibre materials and sleep quality is complex. Blended sleepwear demonstrated potential benefits for specific populations. Wool sleepwear showed benefits for sleep onset in adults (cool conditions) and in older adults (warm conditions). Linen bedsheets improved sleep quality under warm conditions in young adults. Goose down-filled duvets increased slow-wave sleep under cool conditions in young adults. However, a systematic comparison of fibre types is challenging due to the diverse nature of the studies evaluating sleep quality. Further research employing standardised methodologies with standard fibre samples in different populations and in different temperature conditions is imperative to elucidate comprehensively the effects of fibre choices on sleep quality. Despite the limitations and heterogeneity of the included studies, this analysis offers valuable insights for individuals seeking to optimise their sleep experiences and for manufacturers developing sleep-related products.

A Qualitative Exploration Of Experiences And Perceptions In Recent Parents Screening Positive For Perinatal Depression In Karachi, Pakistan.

The narrative review was planned to qualitatively analyse the experiences, factors and context of parents screening positive for perinatal depression in Karachi. Semi structured in-depth interviews were conducted to explore the experiences and perceptions of participants during pregnancy, birth and 10-12 weeks after birth. Seven men and 20 women participated in the in-depth interviews. Factors in the perinatal period that affected new parents included sleep disturbances, emotional stressors linked to preference for a male child, a lack of social support, financial burdens of perinatal care, personal frustrations caused by an inability to comprehend the signs and symptoms of perinatal depression, denial to admit challenging issues concerning mental health and social disapproval with expressing mental health issues. There is an imminent need for appropriate initiatives to raise awareness about perinatal depression, and the provision of adequate perinatal mental health services for Pakistani women and men.

Quantifying demands on the hamstrings during high-speed running: A systematic review and meta-analysis.

INTRODUCTION: Hamstring strain injury (HSI) remains a performance, economic, and player availability burden in sport. High-speed running (HSR) is cited as a common mechanism for HSI. While evidence exists regarding the high physical demands on the hamstring muscles in HSR, meta-analytical synthesis of related activation and kinetic variables is lacking. METHODS: A systematic search of Medline, Embase, Scopus, CINAHL, SportDiscus, and Cochrane library databases was conducted in accordance with the PRISMA 2020 guidelines. Studies reporting hamstring activation (electromyographic [EMG]) or hamstring muscle/related joint kinetics were included where healthy adult participants ran at or beyond 60% of maximum speed (activation studies) or 4 m per second (m/s) (kinetic studies). RESULTS: A total of 96 studies met the inclusion criteria. Run intensities were categorized as "slow," "moderate," or "fast" in both activation and kinetic based studies with appropriate relative, and raw measures, respectively. Meta-analysis revealed pooled mean lateral hamstring muscle activation levels of 108.1% (95% CI: 84.4%-131.7%) of maximal voluntary isometric contraction (MVIC) during "fast" running. Meta-analysis found swing phase peak knee flexion internal moment and power at 2.2 Newton meters/kilogram (Nm/kg) (95% CI: 1.9-2.5) and 40.3 Watts/kilogram (W/kg) (95% CI: 31.4-49.2), respectively. Hip extension peak moment and power was estimated as 4.8 Nm/kg (95% CI: 3.9-5.7) and 33.1 W/kg (95% CI: 17.4-48.9), respectively. CONCLUSIONS: As run intensity/speed increases, so do the activation and kinetic demands on the hamstrings. The presented data will enable clinicians to incorporate more objective measures into the design of injury prevention and return-to-play decision-making strategies.

Comparison of image quality assessments between interventional radiographers and interventional radiologists using digital subtraction angiography.

Purpose: The aim of our study was to compare the image quality assessments of vascular anatomy between interventional radiographers and interventional radiologists using digital subtraction angiography (DSA) runs acquired during an interventional radiology procedure. Approach: Visual grading characteristics (VGC) analysis was used to assess image quality by comparing two groups of images, where one group consisted of procedures in which radiation dose was optimized (group A, n = 10 ) and one group where dose optimization was not performed (group B, n = 10 ). The radiation dose parameters were optimized based on theoretical and empirical evidence to achieve radiation dose reductions during uterine artery embolization procedures. The two observer groups comprised of interventional radiologists ( n = 4 ) and interventional radiographers ( n = 4 ). Each observer rated the image quality of 20 DSA runs using a five-point rating scale. Results: The VGC analysis produced an area under the VGC curve ( AUC VGC ) of 0.55 for interventional radiographers ( P = 0.61 ) and AUCVGC of 0.52 for interventional radiologists ( P = 0.83 ). The optimization of radiation dose parameters demonstrated a reduction in kerma-area product by 35% ( P = 0.026 , d = 0.5 ) and reference air kerma (Ka, r ) by 43% ( P = 0.042 , d = 0.5 ) between group A and group B. Conclusions: VGC analysis indicated that the image quality assessments of interventional radiographers were comparable with interventional radiologists, where a reduction in radiation dose revealed no effect on both observer groups regarding their image quality assessment of vascular anatomy.

The facilitators and barriers to exercise in the Noongar Aboriginal population in Perth, Australia.

Indigenous Standpoint Theory forms the epistemological foundation for this study and methodological choices were made within this theoretical framework to ensure culturally responsive research processes that engaged the Indigenous agenda of self-determination and rights. The objectives of this research were to determine: (i) Indigenous perceptions of the facilitators and barriers to exercise; (ii) The potential feasibility and sustainability of an exercise intervention. In this context, Participatory Action Research methods were used to design the data-gathering instrument for the study-a questionnaire, co-designed with the Noongar Aboriginal community of Perth, Western Australia. This self-administered questionnaire, distributed to participants by email, post and manual delivery, sought to elicit the factors that impact uptake and retention of regular exercise activities. Questionnaire data included individual demographic detail and specific question responses on labelled 5 point Likert Scales. Specific question responses were tabulated by Likert Scale label category and the response distribution for each question was enumerated. Simple descriptive statistics (measures of central tendency and variance) were used to characterize the data set and the Chi squared test was used to evaluate frequency differences between males and females. A total of 133 participants (71 females) completed the questionnaire. The results indicated that people valued exercise. The most common barriers indicated by participants were exercising with an injury (63%), changing diet (58%), finding time to exercise every day (55%) and exercising the next day with pain from exercising the day before (54%). A larger proportion of males (34%) than females (24%) reported greater ease in finding time to exercise every day (p < 0.05). Facilitators mainly related to the potential social and community benefits of exercising with other people, preferably in small groups, and the importance of a culturally secure venue. These findings shed light on what a culturally secure exercise programme might involve for the Noongar community. As this may have implications for other Aboriginal and Torres Strait Islander and international First Nations' Peoples, more focused research is needed on the place of traditional physical activities and the nature of culturally secure exercise programmes and spaces to enable wider application.

Longitudinal changing relationships between growth tempo and vertical stiffness in movement across maturation.

PURPOSE: To determine whether average growth tempo influenced longitudinal relationships between maturity status and coordination capability using a 15-s hopping task (Aim 1). To investigate how differences in absolute growth tempo were associated with change in coordination capability within and across peak growth (Aim 2). METHODS: Participants were N1 = 110 (Aim 1) and N2 = 71 (Aim 2) Australian male competitive swimmers, aged 10-15 years, exposed to repeated-measures tracking (2-years, and 12-months respectively) of maturity status, growth tempo and movement coordination capability. Coordination capability was estimated via vertical stiffness (KV) in a hopping task, reflected by participant mean KV and between-jump coefficient of variation (CV). RESULTS: For Aim 1, log-linear mixed model trends identified maturity status and growth tempo were significantly associated with KV mean and KV CV. For a given maturity status, mean KV was 9% lower in the 'High' average growth tempo group than the 'Low' average tempo group. For Aim 2, mixed repeated-measures analyses of variance identified how time points of increased growth tempo were significantly associated with 7-11% reductions in mean KV, with similar mean KV decrements irrespective of growth tempo group. Meanwhile, KVCV only illustrated progressive longitudinal reductions. CONCLUSIONS: Within maturational progression, short-term accelerations in growth tempo corresponded with short-term decreases in KV mean, suggesting temporary disruptions to movement coordination capability. Measuring growth tempo and applying hopping tasks in specific movement contexts could help consistently identify disturbances in motor coordination.

Limited evidence of altered gait parameters in people with chronic nonspecific low back pain.

BACKGROUND: Differences in gait parameters have been shown between people with and without low back pain (LBP). However, previous studies did not well control factors such as sex, age, height and walking speed known to influence gait parameters. RESEARCH QUESTION: Is gait altered in people with LBP when sex, age, height and walking speed are controlled? METHODS: A series of gait parameters were measured in 16 participants with LBP and 16 age, sex and height matched healthy controls while walking on an instrumented treadmill. LBP group walked at a comfortable speed whilst control group walked at their own comfortable speed and at the comfortable speed of their matched participants with LBP. Pain and disability were measured for the LBP group. The between-group differences in mean, standard deviation (SD) and coefficient of variation (CV) of gait parameters were tested using paired samples t-test, Wilcoxon signed-rank test or two-factor repeated measures analyses of variance. RESULTS: The median (interquartile range) of pain intensity was 2 (1, 3.5). From 102 tests of between-group difference in mean, SD and CV of 17 gait parameters at both comfortable speed and matched speed walking, only the mean of stride length (p = 0.037) during matched speed walking and SD of single support phase (p = 0.040) during comfortable speed walking showed significant between-group differences. There was no significant between-group difference in the rest means (comfortable walking: p ≥ 0.116; matched speed walking: p ≥ 0.069), SDs (comfortable walking: p ≥ 0.066; matched speed walking: p ≥ 0.098) and CVs of gait parameters (comfortable walking: p ≥ 0.110; matched speed walking: p ≥ 0.121). SIGNIFICANCE: The lack of significant between-group difference in gait parameters may suggest that the gait of people with low level of LBP were not altered when sex, age and height were controlled.

Phase I trial of the MuSic to CONnect (MuSiCON) protocol: feasibility and effect of choir participation for individuals with cognitive impairment.

BACKGROUND: Individuals living in residential aged care facilities with cognitive decline are at risk of social isolation and decreased wellbeing. These risks may be exacerbated by decline in communication skills. There is growing awareness that group singing may improve sense of wellbeing for individuals with dementia. However, to date few studies have examined broader rehabilitative effects on skills such as communication of individuals with dementia. AIMS: To determine the feasibility and acceptability of the MuSic to Connect (MuSiCON) choir and language/communication assessment protocol in people with cognitive impairment living in non-high-care wards of a residential facility. METHODS: Six individuals with mild-moderate cognitive impairment participated (age range 55-91 years, five female, one male). A mixed method approach was used. Quantitative outcomes included attendance rates, quality of life and communication measures. The qualitative measure was a brief survey of experience completed by participants and carers post-intervention. RESULTS: Overall, MuSiCON was perceived as positive and beneficial, with high attendance, perception of improved daily functioning and high therapeutic benefit without harmful effects. While there was no reliable change in communication skills over the course of the six-week intervention, most participants successfully engaged in the conversational task, suggesting it is a suitable and ecologically valid method for data collection. CONCLUSIONS: The MuSiCON protocol demonstrated feasibility and was well received by participants and staff at the residential facility. A co-design approach is recommended to improve upon feasibility, acceptability and validity of the assessment protocol prior to Phase II testing.

Maturation-based Corrective Adjustment Procedures (Mat-CAPs) in youth swimming: Evidence for restricted age-group application in females.

Inter-individual differences in maturation-associated development can lead to variations in physical performance, resulting in performance (dis)advantages and maturation selection bias within youth sport systems. To address such bias and account for maturational differences, Maturation-based Corrective Adjustment Procedures (Mat-CAPs) could be beneficial. The present study aimed to: (1) determine maturity timing distributions in youth female swimming; (2) quantify the relationship between maturation status and 100-m front-crawl (FC) performance; (3) implement Mat-CAPs to remove maturational influences upon swimming performance. For Aim 1 and 2, participants were 663 female (10-15 years) swimmers who participated in 100-m FC events at Australian regional, state, and national-level competitions between 2016-2020 and underwent anthropometric assessment (mass, height and sitting height) to estimate maturity timing and offset. For Aim 3, participants aged 10-13 years were categorised into maturity timing categories. Maturity timing distributions for Raw ('All', 'Top 50%' and 'Top 25%') and Correctively Adjusted swim times were examined. Chi-square, Cramer's V and Odds Ratios determined the presence of maturation biases, while Mat-CAPs identified whether such biases were removed in targeted age and selection-groups. Results identified that between 10-13 years, a significantly higher frequency of 'early' maturers was apparent, although tapered toward higher frequencies of 'Late-normative' maturers by 14-15 years. A curvilinear relationship between maturity-offset and swim performance was identified (R2 = 0.51, p<0.001) and utilised for Mat-CAPs. Following Mat-CAPs application, maturity timing biases evident in affected age-groups (10-13 years), and which were magnified at higher selection levels ('Top 50%' & '25%' of swim performances) were predominantly removed. Findings highlight how maturation advantages in females occurred until approximately 13 years old, warranting restricted Mat-CAPs application. Mat-CAPS has the potential to improve female swimmer participation experiences and evaluation.

Effect of Set-Structure on Upper-Body Muscular Hypertrophy and Performance in Recreationally-Trained Male and Female.

ABSTRACT: Davies, TB, Halaki, M, Orr, R, Mitchell, L, Helms, ER, Clarke, J, and Hackett, DA. Effect of set structure on upper-body muscular hypertrophy and performance in recreationally trained men and women. J Strength Cond Res 36(8): 2176-2185, 2022-This study explored the effect of volume-equated traditional-set and cluster-set structures on muscular hypertrophy and performance after high-load resistance training manipulating the bench press exercise. Twenty-one recreationally trained subjects (12 men and 9 women) performed a 3-week familiarization phase and were then randomized into one of two 8-week upper-body and lower-body split programs occurring over 3 and then progressing to 4 sessions per week. Subjects performed 4 sets of 5 repetitions at 85% one repetition maximum (1RM) using a traditional-set structure (TRAD, n = 10), which involved 5 minutes of interset rest only, or a cluster-set structure, which included 30-second inter-repetition rest and 3 minutes of interset rest (CLUS, n = 11). A 1RM bench press, repetitions to failure at 70% 1RM, regional muscle thickness, and dual-energy x-ray absorptiometry were used to estimate changes in muscular strength, local muscular endurance, regional muscular hypertrophy, and body composition, respectively. Velocity loss was assessed using a linear position transducer at the intervention midpoint. TRAD demonstrated a significantly greater velocity loss magnitude (g = 1.50) and muscle thickness of the proximal pectoralis major (g = -0.34) compared with CLUS. There were no significant differences between groups for the remaining outcomes, although a small effect size favoring TRAD was observed for the middle region of the pectoralis major (g = -0.25). It seems that the greater velocity losses during sets observed in traditional-set compared with cluster-set structures may promote superior muscular hypertrophy within specific regions of the pectoralis major in recreationally trained subjects.

Risk factors of paternal postnatal depression in Pakistan: Findings from an urban sample.

Paternal postnatal depression is an emerging public health concern, with negative outcomes for men, their partners, and the newborn. There is a dearth of data on paternal postnatal depression in lower-middle-income countries like Pakistan. This study aimed to identify risk factors of postnatal depression in Pakistani men. Men who consented to this cross-sectional study completed a questionnaire that included sociodemographic information and Urdu translated versions of the Edinburgh Postnatal Depression Scale (EPDS) and the Pittsburgh Sleep Quality Index, 10-12 weeks postpartum. Descriptive analyses for the sociodemographic variables were calculated. Univariate analyses were conducted to calculate the relative risk and 95% confidence interval of the independent variables with an EPDS score of >10. Multivariate binary logistic regression models were performed for risk factors of paternal postnatal depression. Fifty-one questionnaires were analyzed and 23.5% of the participants scored more than 10 on the EPDS. Spouse's EPDS score > 12, and own sleep disturbance were risk factors of paternal postnatal depression in Pakistani men. There is an imminent need to incorporate fathers in the existing and future perinatal mental health programs in Pakistan.

Effect of high-volume cluster sets versus lower-volume traditional sets on muscular performance.

BACKGROUND: Similar muscle performance adaptations have been shown following volume-equated resistance training using cluster (CLUS) versus traditional (TRAD) set structures. This study aimed to examine the effects of higher-volume CLUS compared to lower-volume TRAD set structures on muscle performance. METHODS: Twenty resistance-trained males (age 20.9±4.3 years) were randomized into one of two bench press training routines performed for 6 weeks. Subjects in CLUS (N.=10), performed six sets of five repetitions at 85% one-repetition maximum (1RM) with 30 seconds inter-repetition rest and three minutes of inter-set rest. In contrast, subjects in TRAD (N.=10) performed three sets of five repetitions at 85% 1RM with five minutes of inter-set rest. Muscular strength (1RM), concentric velocity, power, local muscular endurance and maintenance of muscle performance (in training sessions) were assessed. RESULTS: For 1RM there was a significant time effect (P<0.001) with moderate effect sizes (ES) within each group (CLUS: ES=0.48; TRAD: ES=0.67). A trend towards significant time effect was found for concentric velocity (P=0.05; CLUS: ES=-0.36; TRAD ES=-0.96). There were no other significant time or group effects nor group × time interactions. Greater maintenance of concentric velocity and power (sets 1-3) was found for CLUS compared to TRAD at week one (P<0.05) but not at week 6. CONCLUSIONS: High load resistance training in the bench press exercise, utilizing intra-set rest periods to increase the training volume, does not yield any muscular performance benefits compared to traditional set structures.

Predictors of radiation dose for uterine artery embolisation are angiography system-dependent.

This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura,n= 95) and Group II (Azurion,n= 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm2vs 52.9 Gy cm2;P< 0.001,d= 0.8) and 67% (0.6 Gy vs 0.2 Gy;P< 0.001,d= 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm2and the limits of agreement were +28.49 and -27.71 Gy cm2, and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.

Analysis of phase detects altered timing of muscle activation in subjects with chronic shoulder pain.

Optimal exercise therapy for shoulder pain is unknown due to limited information regarding specific changes in muscle function associated with pain. Timing of muscle activity with respect to movement (phase) can provide information about muscle activation patterns without requiring electromyography data normalization which is problematic in the presence of pain. The aim of this study was to determine if a phase measure is able to detect differences in the timing of shoulder muscle activation in subjects with chronic shoulder pain. Fourteen subjects with pain and 14 without pain were recruited. Electromyography from eight shoulder muscles was recorded. Approximately 20 cycles of small amplitude (∼30°) rapid shoulder flexion/extension was performed. A cross-correlation and spectrographic analysis provided a measure of phase. Welch's t-tests were used to compare mean phase angles between groups. Subjects with chronic shoulder pain had greater variability in the relative timing of muscle activation with significant differences found in the phase angles for pectoralis major, infraspinatus, supraspinatus, upper and lower trapezius and serratus anterior. This preliminary study indicates that the examination of the timing of muscle activation using a phase measure can identify significant differences in muscle function between normal subjects and those with chronic shoulder pain.

Conversational speech of school-age children after syllable-timed speech treatment for stuttering.

Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners.Method: Participants were four children, ages 8-11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings.Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study.Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted.

A standard enteral formula versus an iso-caloric lower carbohydrate/high fat enteral formula in the hospital management of adolescent and young adults admitted with anorexia nervosa: a randomised controlled trial.

BACKGROUND: The nutritional rehabilitation of malnourished patients hospitalised with anorexia nervosa is essential. The provision of adequate nutrition must occur, while simultaneously, minimising the risk of refeeding complications, such as electrolyte, metabolic, and organ dysfunction. The aim of this study was to compare the efficacy and safety of an iso-caloric lower carbohydrate/high fat enteral formula (28% carbohydrate, 56% fat) against a standard enteral formula (54% carbohydrate, 29% fat). METHODS: Patients (aged 15-25 years) hospitalised with anorexia nervosa were recruited into this double blinded randomised controlled trial. An interim analysis was completed at midpoint, when 24 participants, mean age 17.5 years (± 1.1), had been randomly allocated to lower carbohydrate/high fat (n = 14) or standard (n = 10) feeds. RESULTS: At baseline, there was no significant difference in degree of malnutrition, medical instability, history of purging or serum phosphate levels between the two treatment arms. A significantly lower rate of hypophosphatemia developed in patients who received the lower carbohydrate/high fat formula compared to standard formula (5/14 vs 9/10, p = 0.013). The serum phosphate level decreased in both feeds, however it decreased to a larger extent in the standard feed compared to the lower carbohydrate/high fat feed (standard feed 1.11 ± 0.13 mmol/L at baseline vs 0.88 ± 0.12 mmol/L at week 1; lower carbohydrate/high fat feed 1.18 ± 0.19 mmol/L at baseline vs 1.06 ± 0.15 mmol/L at week 1). Overall, serum phosphate levels were significantly higher in the lower carbohydrate/high fat feed compared with standard feed treatment arm at Week 1 (1.06 ± 0.15 mmol/L vs 0.88 ± 0.12 mmol/L, p < 0.001). There was no significant difference in weight gain, number of days to reach medical stability, incidence of hypoglycaemia, or hospital length of stay. CONCLUSIONS: The results of this study indicate that enteral nutrition provided to hospitalised malnourished young people with anorexia nervosa using a lower carbohydrate/high fat formula (28% carbohydrate, 56% fat) seems to provide protection from hypophosphatemia in the first week compared to when using a standard enteral formula. Further research may be required to confirm this finding in other malnourished populations. TRIAL REGISTRATION: ANZCTR, ACTRN12617000342314. Registered 3 March 2017, http://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617000342314.

Patients hospitalised with anorexia nervosa require nutrition support as part of their treatment, whilst refeeding complications are prevented. Of particular concern, is the reintroduction of carbohydrate to malnourished patients, which has been proposed to cause a surge in insulin levels and disturbance in electrolytes, particularly a decrease in blood phosphate levels. This double-blinded randomised controlled trial measured the occurrence of low phosphate blood levels and other refeeding complications, in adolescent and young adult patients hospitalised with anorexia nervosa. These patients were provided either a lower carbohydrate/high fat feed (28% carbohydrate, 56% fat) or a standard enteral feed (54% carbohydrate, 29% fat). Fewer patients in the lower carbohydrate/high fat feed group (5/14) than standard feed group (9/10) developed a low phosphate level. There was no significant difference in weight gain, number of days to reach medical stability, occurrence of hypoglycaemia, or hospital length of stay.

UTERINE ARTERY EMBOLISATION: CONTINUOUS QUALITY IMPROVEMENT REDUCES RADIATION DOSE WHILE MAINTAINING IMAGE QUALITY.

The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a 'CQI intervention' group (n = 50) and 'Control' group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the 'Control' group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.

The effectiveness of EMG-driven neuromusculoskeletal model calibration is task dependent.

Calibration of neuromusculoskeletal models using functional tasks is performed to calculate subject-specific musculotendon parameters, as well as coefficients describing the shape of muscle excitation and activation functions. The objective of the present study was to employ a neuromusculoskeletal model of the shoulder driven entirely from muscle electromyography (EMG) to quantify the influence of different model calibration strategies on muscle and joint force predictions. Three healthy adults performed dynamic shoulder abduction and flexion, followed by calibration tasks that included reaching, head touching as well as active and passive abduction, flexion and axial rotation, and submaximal isometric abduction, flexion and axial rotation contractions. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using subject-specific EMG-driven neuromusculoskeletal models that were uncalibrated and calibrated using (i) all calibration tasks (ii) sagittal plane calibration tasks, and (iii) scapular plane calibration tasks. Joint forces were compared to published instrumented implant data. Calibrating models across all tasks resulted in glenohumeral joint force magnitudes that were more similar to instrumented implant data than those derived from any other model calibration strategy. Muscles that generated greater torque were more sensitive to calibration than those that contributed less. This study demonstrates that extensive model calibration over a broad range of contrasting tasks produces the most accurate and physiologically relevant musculotendon and EMG-to-activation parameters. This study will assist in development and deployment of subject-specific neuromusculoskeletal models.

Is there an association between high-speed running biomechanics and hamstring strain injury? A systematic review.

Despite increased awareness of the multifactorial nature of Hamstring Strain Injury (HSI), the role of running biomechanics remains unclear. The aim of this systematic review was to investigate whether an association exists between running biomechanics and HSI. Five databases were searched from inception to January 2021. Eligibility criteria included epidemiological studies that provide data on running biomechanics in athletes who have sustained a HSI (retrospectively or prospectively) and compared to control data. Searches yielded 4,798 articles. Twelve met the selection criteria. Biomechanical analysis differed considerably across studies, thus meta-analyses was not possible. Studies largely found either no differences or contradicting findings between running biomechanics of athletes who have sustained a HSI (retrospectively or prospectively) and controls, with the exception of lateral trunk kinematics and horizontal propulsive forces. It is important to note some concern regarding the quality of included studies, particularly sample size, increasing the risk of bias associated with results. Further research utilising validated methods of biomechanical analysis, is needed to determine if an association exists between running biomechanics and HSI. Until then, definitive conclusions cannot be drawn as to whether specific biomechanical interventions should be included in injury prevention and/or rehabilitation programmes.

Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review.

OBJECTIVES: Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing. METHODS: A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator. RESULTS: Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated. CONCLUSIONS: Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.