Intra- and Inter-Day Reliability of Inertial Loads with Cluster Sets When Performed during a Quarter Squat on a Flywheel Device.

The aims of this study were to (i) estimate the intra- and inter-day reliability of mean concentric (CON) and eccentric (ECC) power at different inertial loads during a flywheel quarter-squat using a cluster set approach and (ii) to determine the acute effect of internal and external attentional focus on mean power when performing the flywheel quarter squat. Twelve collegiate field sport male athletes (age 22.4 ± 3.2 years, weight 81.4 ± 10.3 kg, height 1.81 ± 0.06 m) attended four cluster set testing sessions separated by 7 days. Sessions consisted of 4 sets of 15 repetitions using 4 inertial loads (0.025, 0.050, 0.075, and 0.100 kg·m2). A cluster block consisted of 5 repetitions, including "momentum repetitions" (4 × 5 + 5 + 5). Mean power (MP), CON power, ECC power, and ECC overload were recorded for both internal and external attentional focus groups. The external instructional group attained familiarization after two flywheel sessions (ES = 0.03-0.15) with little volatility between performance measures (CV% = 3.39-9.22). The internal instructional group showed large differences in MP output from session 2 to session 3 for all loads (ES = 0.59-1.25). In conclusion, the flywheel cluster set approach is a reliable training modality for maintaining MP output during all repetitions.

Flywheel Romanian Deadlift: Intra- and Inter-Day Kinetic and Kinematic Reliability of Four Inertial Loads Using Cluster Sets.

The primary aim of this study was to investigate the intra- and inter-day reliability of flywheel cluster set training in concentric power (CON), eccentric power (ECC), and ECC overload during the Romanian deadlift exercise (RDL). A secondary aim was to assess the acute effect of internal and external attentional focus instructions on mean power when performing the flywheel RDL. Fourteen collegiate male field sport athletes (age, 23.3 ± 3.7 years; mass, 80.8 ± 9.9 kg; height, 1.79 ± 0.06 m) were randomized into internal (n = 7) or external (n = 7) attentional focus groups and attended four testing sessions, with a between-session separation of 7 days. Sessions consisted of four cluster sets of fifteen repetitions "excluding momentum repetitions" (4 × (5 + 5 + 5)) using a specific inertial load (0.025, 0.050, 0.075, and 0.100 kg·m-2) for a given set in a randomized ascending or descending order. Cluster sets were separated by a 45 s intra-set rest period. Both instructional focus groups attained familiarization, although the time taken to achieve familiarization (outcome stability) differed between groups. The external instructional group attained familiarization post-session 2 (Cohen's d (ES), ES = 0.11-0.65) with little volatility between performance measures (CV% = 4.61-9.59). Additionally, the internal group reported inconsistencies among all inertial loads, reporting large differences in MP in the 0.100 kg·m-2 inertial load from day 2 to day 3 (ES = 1.22) and both 0.050 kg·m2 (p = 0.010) and 0.075 kg·m-2 (p = 0.016) between day 3 and day 4. The flywheel RDL cluster set approach is a reliable training modality for maintaining mean power output during cluster set repetitions.

A global survey of companion animal veterinary practitioners on animal welfare teaching - Focus on undergraduate and continuing education, and clients' sources of information.

As part of a wider research on animal welfare, a global survey was developed to gain insight into the opinion of companion animal veterinarians about animal welfare education, namely to investigate i) their exposure to animal welfare teaching during their undergraduate education, ii) their access to continuing professional education on animal welfare, and iii) their opinions on clients' sources of information on animal welfare. The survey was distributed to companion animal veterinarians around the world. The results were highly influenced by the large numbers of respondents who trained in the Russian Federation, Australia, Israel, the Netherlands, the United Kingdom of Great Britain and Northern Ireland, or the United States of America. Worldwide, 58.4% of the respondents thought that animal welfare was poorly covered or not taught at all when they were students. The best coverage of animal welfare was in the Netherlands and the United Kingdom of Great Britain and Northern Ireland. Most companion animal veterinarians (65.3%) had access to continuing education on animal welfare, but there were small differences between the six above-mentioned countries. Companion animal veterinarians get information on animal welfare mainly from the internet and veterinary conferences/meetings, and thought that their clients obtained animal welfare information from various sources. The findings show that there is a need to improve education on animal welfare in veterinary curricula and the provision of relevant continuing education, so that companion animal practitioners can keep abreast of developments and societal expectations.

Utilizing Whole Slide Images for the Primary Evaluation and Peer Review of a GLP-Compliant Rodent Toxicology Study.

The approach undertaken to deliver a Good Laboratory Practice (GLP) validation of whole slide images (WSIs) and the associated workflow for the digital primary evaluation and peer review of a GLP-compliant rodent inhalation toxicity study is described. The contract research organization (CRO) undertook validation of the slide scanner, scanner software, and associated database software. This provided a GLP validated environment within the database software for the primary histopathologic evaluation using WSI and viewed with the database software web viewer. The CRO also validated a cloud-based digital pathology platform that supported the upload and transfer of WSI and metadata to a cache within the sponsor's local area network. The sponsor undertook a separate GLP validation of the same cloud-based digital pathology platform to cover the download and review of the WSI. The establishment of a fit-for-purpose GLP-compliant workflow for WSI and successful deployment for the digital primary evaluation and peer review of a large GLP toxicology study enabled flexibility in accelerated global working and potential future reuse of digitized data for advanced artificial intelligence and machine learning image analysis.

Sodium Glucose Co-Transporter 2 Inhibition Does Not Favorably Modify the Physiological Responses to Dietary Counselling in Diabetes-Free, Sedentary Overweight and Obese Adult Humans.

Sedentary obesity is associated with increased risk of many cardio-metabolic diseases, including type 2 diabetes. Weight loss is therefore a desirable goal for sedentary adults with obesity. Weight loss is also a well-documented side effect of sodium glucose co-transporter 2 (SGLT2) inhibition, a pharmaceutical strategy for diabetes treatment. We hypothesized that, compared with placebo, SGLT2 inhibition as an adjunct to out-patient dietary counselling for weight loss would lead to more favorable modification of body mass and composition, and greater improvement in glucose regulation and lipid profile. Using a randomized, double-blind, repeated measures parallel design, 50 sedentary men and women (body mass index: 33.4 ± 4.7 kg/m2; mean ± SD) were assigned to 12 weeks of dietary counselling, supplemented with daily ingestion of either a placebo or SGLT2 inhibitor (dapagliflozin: up to 10 mg/day). Dietary counselling favorably modified body mass, body fat, glucose regulation, and fasting concentrations of triglyceride and very low-density lipoprotein cholesterol (main effects of counselling: p < 0.05); SGLT2 inhibition did not influence any of these adaptations (counselling × medication interactions: p > 0.05). However, SGLT2 inhibition when combined with dietary counselling led to greater loss of fat-free mass (counselling × medication interaction: p = 0.047) and attenuated the rise in high-density lipoprotein cholesterol (counselling × medication interaction: p = 0.028). In light of these data and the health implications of decreased fat-free mass, we recommend careful consideration before implementing SGLT2 inhibition as an adjunct to dietary counselling for weight loss in sedentary adults with obesity.

Cerebellum and cognition in multiple sclerosis.

Kalron et al. (Kalron A, Allali G, Achiron A. J Neurol 265: 809-816, 2018.) report that people with multiple sclerosis (PwMS) who fall show a decreased cerebellar volume along with decreased overall cognition compared with nonfallers. While their paper focuses on cerebellar and cognitive alterations in PwMS, these findings may also be explained by additional factors such as aging and have the potential for broader impact in additional clinical populations who simultaneously experience cognitive and mobility dysfunction.

Cerebellum and cognition in multiple sclerosis.

Kalron et al. (Kalron A, Allali G, Achiron A. J Neurol 265: 809-816, 2018.) report that people with multiple sclerosis (PwMS) who fall show a decreased cerebellar volume along with decreased overall cognition compared with nonfallers. While their paper focuses on cerebellar and cognitive alterations in PwMS, these findings may also be explained by additional factors such as aging and have the potential for broader impact in additional clinical populations who simultaneously experience cognitive and mobility dysfunction.

The Trajectory of Postoperative Pain Following Mastectomy with and without Paravertebral Block.

Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered analgesics as a combination of acetaminophen and a strong opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some pain in the context of receiving weak and strong opioids for GA patients and more frequent use of nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of analgesic administration in addition to reports of postoperative pain to determine the most effective means of avoiding postoperative pain in patients who require mastectomy.

Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system.

OBJECTIVES: To compare patterns of care and peri-operative outcomes of robot-assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case-mix funding system. PATIENTS AND METHODS: We retrospectively reviewed all radical prostatectomies (RPs) performed for localized prostate cancer in Victoria, Australia, from the Victorian Admitted Episode Dataset, a large administrative database that records all hospital inpatient episodes in Victoria. The first database, covering the period from July 2010 to April 2013 (n = 5 130), was used to compare length of hospital stay (LOS) and blood transfusion rates between surgical approaches. This was subsequently integrated into an economic model. A second database (n = 5 581) was extracted to cover the period between July 2010 and June 2013, three full financial years, to depict patterns of care and make future predictions for the 2014-2015 financial year, and to perform a hospital volume analysis. We then created an economic model to evaluate the incremental cost of RARP vs open RP (ORP) and laparoscopic RP (LRP), incorporating the cost-offset from differences in LOS and blood transfusion rate. The economic model constructs estimates of the diagnosis-related group (DRG) costs of ORP and LRP, adds the gross cost of the surgical robot (capital, consumables, maintenance and repairs), and manipulates these DRG costs to obtain a DRG cost per day, which can be used to estimate the cost-offset associated with RARP in comparison with ORP and LRP. Economic modelling was performed around a base-case scenario, assuming a 7-year robot lifespan and 124 RARPs performed per financial year. One- and two-way sensitivity analyses were performed for the four-arm da Vinci SHD, Si and Si dual surgical systems (Intuitive Surgical Ltd, Sunnyvale, CA, USA). RESULTS: We identified 5 581 patients who underwent RP in 20 hospitals in Victoria with an open, laparoscopic or robot-assisted surgical approach in the public and private sector. The majority of RPs (4 233, 75.8%), in Victoria were performed in the private sector, with an overall 11.5% decrease in the total number of RPs performed over the 3-year study period. In the most recent financial year, 820 (47%), 765 (44%) and 173 patients (10%) underwent RARP, ORP and LRP, respectively. In the same timeframe, RARP accounted for 26 and 53% of all RPs in the public and private sector, respectively. Public hospitals in Victoria perform a median number of 14 RPs per year and 40% of hospitals perform <10 RPs per year. In the public system, RARP was associated with a mean (±sd) LOS of 1.4 (±1.3) days compared with 3.6 (±2.7) days for LRP and 4.8 (±3.5) days for ORP (P < 0.001). The mean blood transfusion rates were 0, 6 and 15% for RARP, LRP and ORP, respectively (P < 0.001). The incremental cost per RARP case compared with ORP and LRP was A$442 and A$2 092, respectively, for the da Vinci S model, A$1 933 and A$3 583, respectively, for the da Vinci Si model and A$3 548 and A$5 198, respectively for the da Vinci Si dual. RARP can become cost-equivalent with ORP where ~140 cases per year are performed in the base-case scenario. CONCLUSIONS: Over the period studied, RARP has become the dominant approach to RP, with significantly shorter LOS and lower blood transfusion rate. This translates to a significant cost-offset, which is further enhanced by increasing the case volume, extending the lifespan of the robot and reductions in the cost of consumables and capital.

Hypopharyngeal cancer.

Hypopharyngeal cancers are usually squamous cell carcinomas (SCCs) that has the worst prognosis among the head and neck cancers. Overall, 5-year survival rate remains poor despite recent improvements in diagnostic imaging, radiation and chemotherapy, and improved surgical techniques. Hypopharyngeal cancers tend to present with advanced primary disease, and nodal metastasis is highly likely. The most important features determining prognosis are the size and extent of local spread of the primary carcinoma and the extent of involvement of regional lymph nodes. Distant metastasis at presentation is more common in hypopharyngeal cancers than in other head and neck cancers. Poor survival rate is partly due to emergence of second primary cancers but also to development of distant metastasis. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) remain the mainstay of initial radiological evaluation of hypopharyngeal cancer. Imaging usually results in upstaging of the tumor at presentation. Meticulous evaluation of the extent of the primary tumor with attention to spread to the subsites of the hypopharynx, larynx, and cartilage invasion are necessary for accurate staging. After surgery and radiation therapy, it is difficult with CT and MR to differentiate residual and recurrent tumor from edema and scarring. Fluorine 18-fluoro-deoxy-glucose -positron emission tomography (FDG-PET) has high sensitivity in detection of occult, residual, and recurrent tumors but has low specificity. Combined PET and CT increase specificity and are increasingly being used to image posttreatment cases. Other newer imaging modalities such as diffusion-weighted imaging (DWI), MR spectroscopy, and MRI with superparamagnetic iron oxide (SPIO) contrast agent are reported to be useful and should be used more widely in difficult cases.

Biotransformation of aliphatic and aromatic ketones, including several monoterpenoid ketones and their derivatives by five species of marine microalgae.

The biotransformation of a series of aliphatic and aromatic ketones by five cultures of photosynthetic microalgae is reported. The test substrates include the monoterpenoid ketones carvone and menthone and a series of aromatic ketones related to and including acetophenone. All of the test organisms show some degree of specificity and stereoselectivity in the biotransformation of substrates.