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Globally physical inactivity is a leading, independent, and significant risk factor for disease and mortality. Exercise scientists and clinical exercise physiologists have a key role in supporting client participation in physical activity. However, with the rates of physical activity continuing to be low, we argue for a paradigm shift in the way practitioners engage with clients. Attachment theory, a theory which focuses on social relationships and bonds, has received increased attention within physical activity and broader health literature. Awareness of attachment theory provides insight into individual health-related responses and physical activity motivation and guides key professional practices and processes relevant to both exercise scientists and clinical exercise physiologists. However, there remains no research specific to the application of attachment theory by these 2 professions. This narrative review provides an overview of the literature on attachment theory applicable to exercise science and exercise physiology and highlights the potential for attachment theory to inform future practice, education, and research, concluding with 3 recommendations for future research priorities.

Background Depression is associated with physical inactivity, low cardiorespiratory fitness (CRF), and poor physical health compared with the general population. Various protocols are employed to determine CRF studies of people experiencing depression, but standardized methods are absent from the literature. Thus, the aim of the present review is to systematically examine the protocols reported to determine CRF in patients with major depressive disorder (MDD). Methods Replicating a previously published search strategy, the present review sourced relevant studies from PubMed, PsycInfo, Embase, CINAHL, MEDLINE, Psychology and Behavioural Sciences Collection, and SPORTDiscus from August 2015 to February 2021. Details of CRF testing protocols were extracted into a preprepared form for analysis. Results Twenty-three studies met the inclusion criteria, including those from a previous review of CRF in people with MDD. Twelve included studies employed maximal testing protocols, while 11 studies reported using submaximal testing protocols. Cycle ergometry was the most used protocol, followed by treadmill and walk tests. Notably, complete descriptions of the test protocols to facilitate test replication were frequently absent. Conclusions Cycle ergometry is commonly used to assess CRF in people with MDD, but protocol details are lacking, making replication difficult. Efforts to standardize protocol descriptions are warranted.

Fox, JL, Conte, D, Stanton, R, McLean, B, and Scanlan, AT. The application of accelerometer-derived moving averages to quantify peak demands in basketball: A comparison of sample duration, playing role, and session type. J Strength Cond Res 35(12S): S58-S63, 2021-The purpose of this was to study compare peak external workload intensities in basketball using accelerometer-derived moving averages between different sample durations (0.5-5 minutes), session types (training vs. game-play), and playing roles (starting vs. bench players). Five starting and 3 bench players were monitored over a 15-week competitive season using accelerometers. For all training sessions and games, peak external workload intensities were determined using accelerometer-derived moving averages for PlayerLoad per minute (PL·min-1) across sample durations of 0.5, 1, 2, 3, 4, and 5 minutes. Linear mixed-models and effect sizes (ESs) were used to compare peak PL·min-1 between sample durations, session type, and playing role. Peak PL·min-1 was significantly different between all sample durations (p0.05; ES = 0.88-5.45), with higher intensities evident across shorter sample durations. In starting players, peak intensities were significantly higher during games compared with training for all sample durations (p0.05; ES = 0.69-0.93). Peak game intensities were higher in starting players using all sample durations (p0.05; ES = 0.69-1.43) compared with bench players. Shorter sample durations produced higher peak PL·min-1. Peak intensities were higher during games than training in starting players, indicating training may not adequately prepare players for the most demanding passages of game-play.

Objective To systematically identify, appraise, and examine evidence regarding the effects of therapeutic tape on pain and function in individuals with lateral epicondylalgia (LE). Methods Five electronic databases were systematically searched up to March 2018. Full-text, peer-reviewed, English-language studies were included if they had an LE population, a standalone tape condition, and an outcome related to pain or function. Results Eight out of 2022 screened studies were included. Three studies demonstrated immediate (i.e. within 1 h) improvements in pain and pain-free grip strength following diamond deloading rigid tape. One study reported immediate improvements in proprioception following transverse rigid tape. The immediate effects of longitudinal kinesiotape were inconsistent. One study reported improvements in pain and pain-free grip strength, while another study reported no effect on pain, strength, or muscle activity. Two studies examined short-term (i.e. within six weeks) kinesiotape application. One study reported two weeks of longitudinal kinesiotape improved pain and maximum grip strength. The other study reported one week of diamond kinesiotape improved patient-reported pain and function, but not maximum grip strength. Conclusions In individuals with LE, diamond deloading rigid tape may immediately improve pain and strength. There is conflicting evidence regarding kinesiotape effects in both immediate and short-term timeframes.

Match activity demands of basketball players have been well reported but little exists in terms of quantifying the demands encountered by referees during match-play. Potential differences between referees and players may identify different fitness capacities and subsequent need for different training regimes.

BACKGROUND: Exercise is nowadays considered as an evidence-based treatment modality in people with mental illness. Nurses and occupational therapists working in low-resourced mental health settings are well-placed to provide exercise advice for people with mental illness. OBJECTIVES: We examined the current exercise prescription practices employed by Ugandan health care professionals when working with people with mental illness, and identified perceived barriers to exercise prescription and exercise participation for people with mental illness. METHODS: In this study, 31 Ugandan health care professionals 20 men; 31.2 ± 7.1 years completed the Exercise in Mental Illness Questionnaire- Health Professionals Version EMIQ-HP. RESULTS: The vast majority of the respondents 29/31, 94% reported they prescribed exercise at least "occasionally" to people with mental illness. Exercise-prescription parameters used were consistent with those recommended for people with mental illness. Regarding barriers to exercise participation, coping with side effects of psychotropic medication at the individual level and reducing stigma at community level should be prioritized. CONCLUSION: A health care reform to enable collaboration with exercise professionals, such as exercise physiologists or physiotherapists, might increase exercise uptake for people with mental illness, thereby improving health outcomes for this vulnerable population. ispartof: AFRICAN HEALTH SCIENCES vol:19 issue:2 pages:2172-2182 ispartof: location:Uganda status: published

The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy—a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis—remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery.

Fox, JL, Scanlan, AT, Stanton, R, and Sargent, C. The effect of game-related contextual factors on sleep in basketball players. J Strength Cond Res 36(10): 2942-2945, 2022-The purpose of this study was to determine whether contextual factors including game location, game outcome, and score-line margin influence subsequent nightly sleep duration and quality in basketball players. Seven semiprofessional, male basketball players were monitored across one competitive season using self-reported sleep diaries and activity monitors. Linear mixed models and effect sizes (ESs) were used to compare sleep duration and quality following games based on game location (played at home or away venues), game outcome (win or loss), and score-line margin (balanced [≤ 8-point margin] or unbalanced [≥ 9-point margin]). Sleep onset was later following away games (ES = 0.79 ± 0.86 [ moderate ], p = 0.12), losses (ES = 0.63 ± 0.79 [ moderate ], p = 0.18), and unbalanced games (ES = 1.36 ± 0.90 [ large ], p = 0.01). Wake time was later following losses (ES = 1.14 ± 0.85 [ moderate ], p = 0.02). Sleep fragmentation was higher following wins (ES = 0.65 ± 0.74 [ moderate ], p = 0.17). Sleep efficiency was higher following losses (ES = 0.70 ± 0.80 [ moderate ], p = 0.14). All other differences in sleep variables yielded trivial - small ESs ( p0.05). Because of the later sleep onset times of players, basketball practitioners should consider avoiding early morning travel or training sessions following away games, losses, and unbalanced games, to maintain similar nightly sleep durations in light of the contextual factors encountered. Basketball practitioners may also need to ensure player sleep is optimized following wins compared with losses given the lower quality observed.

People with mental illness are twice as likely to develop cardiovascular, respiratory, infectious and metabolic diseases compared with the general population.1This disparity in health occurs from the earliest presentation of mental ill health and affects people across the life span,1 reducing life expectancy by 15–30 years compared with the general population.2 This poor physical health, as well as the associated widening mortality gap,3 has been described as a ‘human rights scandal’.2 This problem led to a Lancet Psychiatry Commission1 on protecting the physical health of people living with mental illness, with a focus on prevention and early intervention across all levels of treatment. The Lancet Psychiatry Commission outlines advances in our understanding of the link between physical and mental health, summarising findings from over 100 systematic reviews and meta-analyses, providing a practical blueprint towards protecting the physical health of this vulnerable population.1 Importantly, the blueprint recommends that all people living with mental illness have access to exercise and dietary interventions as part of routine mental healthcare. For people living with mental illness, higher rates of smoking, sleep disturbance, physical inactivity and …

Bromilow, L, Stanton, R, and Humphries, B. A structured e-investigation into the prevalence and acceptance of smartphone applications by exercise professionals. J Strength Cond Res 34(5): 1330-1339, 2020-The primary purpose of this study was to examine the prevalence and acceptance of smartphone applications by exercise professionals when interacting with clients and patients. A 29-item anonymous online survey was designed, containing separate sections on demographics, smartphone proficiency, benefits and barriers to using smartphones, and use of smartphones in a professional setting. Accredited members of the Australian Strength and Conditioning Association, and Exercise and Sports Science Australia received an information sheet through organizational communication channels, inviting them to participate. Two hundred forty-nine exercise professionals completed the survey, with men (71%; n = 176) accounting for most of the respondents. Proficiency using smartphone applications is predominantly-advanced (37%; n = 92), intermediate (33%; n = 82), or expert (14%; n = 35). Identified strategies to find smartphone applications included personal searches (67%; n = 167) and colleague recommendations (55%; n = 137). Reported benefits include fast access to information (67%; n = 167), saves time for record keeping (56%; n = 141), and allows performance tracking (55%; n = 138). Almost all respondents (92%; n = 229) identified barriers, such as inexperience with using particular applications (42%; n = 105). Almost all respondents (96%; n = 239) reported they would recommend smartphone applications to clients and patients, primarily for self-tracking (53%; n = 132). Smartphone use among exercise professionals is prevalent; however, application and sensor technology are reluctantly underused. Increasing acceptance requires embedding within educational curricula, recognition from professional organizations, and collaboration with, to maximize the potential capabilities of smartphone technology within working environments.

Background: Physical activity (PA) significantly improves physical health and clinical symptoms across mental disorders. Accredited Exercise Physiologists (AEPs) are trained to lead PA interventions for people with mental illness, but referrals to AEPs are low. Aims: To determine the knowledge and attitudes of delegates attending the 2017 Royal Australian and New Zealand College of Psychiatrists (RANZCP) conference toward physical health monitoring and exercise interventions for people with mental illness. Methods: A cross-sectional survey of RANZCP delegates investigated knowledge and attitudes toward PA for people with mental illness, self-reported PA, and their understanding of AEP’s role within mental health settings. A subgroup of delegates underwent fitness assessments. Results: Seventy-three delegates completed surveys and 24 underwent fitness assessments. Delegates demonstrated good knowledge regarding associations between PA and cardiovascular disease risk. Delegates were less knowledgeable of AEP’s role within mental health settings. Forty-six participants (63%) did not meet the Australian recommended guidelines for PA. No association between referrals to AEPs and self-reported PA or fitness measures were evident. Conclusions: Promoting PA participation for mental health professionals, coupled with education on the important role AEPs play in the multidisciplinary treatment of mental health consumers is vital to improve health outcomes for this vulnerable group.

Background Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. Objectives To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. Design/Methods In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the ‘Access’, ‘Acceptability’ and ‘Shared Decision Making’ dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. Results Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. Conclusions The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.

The purpose of this study was to quantify and compare training and competition demands in basketball.Fifteen semiprofessional male basketball players wore microsensors during physical conditioning training (PCT), games-based training (GBT), and competition to measure absolute and relative (·minPlayerLoad (arbitrary units [AU]) and EED (m) were statistically significantly (p .05) higher during PCT (632 ± 139 AU, d = 1.36; 5,964 ± 1,312 m, d = 1.36; 6.50 ± 0.81 AU·minTraining demands exceeded competition demands.

People diagnosed with mental illness (hereinafter "consumers") have higher rates of chronic disease and significantly shorter lives than the wider population. Peer workers have become increasingly involved in facilitating access to physical health care, yet the consumer perspective regarding peer involvement is unknown. This absent voice is needed to inform strategic planning and generate solutions to address the current inequity in health status.To articulate the views of consumers in regards to the potential use of peer workers to further the physical health of people with mental illness.A qualitative exploratory study was conducted involving four focus groups with 31 consumer participants. Focus group responses were analysed thematically.Three themes pertaining to enhancing physical health care emerged: (1) the potential of peer workers in mitigating existing barriers, (2) consumer advocacy organisations expanding their agenda and (3) benefits of segregated activities as a segue to mainstream options.The envisaged forms of peer contribution have far greater scope and depth than is currently considered in policy, the research literature and health practice. Innovative solutions are required for this neglected population. Individual and systemic advocacy led by peer workers can enhance access to physical health care and have the potential to reduce physical health inequalities.

Fox, JL, Scanlan, AT, and Stanton, R. A review of player monitoring approaches in basketball: current trends and future directions. J Strength Cond Res 31(7): 2021-2029, 2017-Effective monitoring of players in team sports such as basketball requires an understanding of the external demands and internal responses, as they relate to training phases and competition. Monitoring of external demands and internal responses allows coaching staff to determine the dose-response associated with the imposed training load (TL), and subsequently, if players are adequately prepared for competition. This review discusses measures reported in the literature for monitoring the external demands and internal responses of basketball players during training and competition. The external demands of training and competition were primarily monitored using time-motion analysis, with limited use of microtechnology being reported. Internal responses during training were typically measured using hematological markers, heart rate, various TL models, and perceptual responses such as rating of perceived exertion (RPE). Heart rate was the most commonly reported indicator of internal responses during competition with limited reporting of hematological markers or RPE. These findings show a large discrepancy between the reporting of external and internal measures and training and competition demands. Microsensors, however, may be a practical and convenient method of player monitoring in basketball to overcome the limitations associated with current approaches while allowing for external demands and internal responses to be recorded simultaneously. The triaxial accelerometers of microsensors seem well suited for basketball and warrant validation to definitively determine their place in the monitoring of basketball players. Coaching staff should make use of this technology by tracking individual player responses across the annual plan and using real-time monitoring to minimize factors such as fatigue and injury risk.

Accredited Exercise Physiologists (AEPs) are trained to deliver exercise and physical activity interventions for people with chronic and complex health conditions including those with mental illness. However, their views on exercise for mental illness, their exercise prescription practices, and need for further training are unknown.To examine the way in which Australian AEPs prescribe exercise for people with mental illness.Eighty-one AEPs (33.3 ± 10.4 years) completed an online version of the Exercise in Mental Illness Questionnaire. Findings are reported using descriptive statistics.AEPs report a high level of knowledge and confidence in prescribing exercise for people with mental illness. AEPs rate exercise to be at least of equal value to many established treatments for mental illness, and frequently prescribe exercise based on current best-practice principles. A need for additional training was identified. The response rate was low (2.4%) making generalisations from the findings difficult.Exercise prescription practices utilised by AEPs are consistent with current best-practice guidelines and there is frequent consultation with consumers to individualise exercise based on their preferences and available resources. Further training is deemed important.

Diabetic nephropathy (DN) is a major cause of end-stage renal disease, and therapeutic options for preventing its progression are limited. To identify novel therapeutic strategies, we studied protective factors for DN using proteomics on glomeruli from individuals with extreme duration of diabetes (ł50 years) without DN and those with histologic signs of DN. Enzymes in the glycolytic, sorbitol, methylglyoxal and mitochondrial pathways were elevated in individuals without DN. In particular, pyruvate kinase M2 (PKM2) expression and activity were upregulated. Mechanistically, we showed that hyperglycemia and diabetes decreased PKM2 tetramer formation and activity by sulfenylation in mouse glomeruli and cultured podocytes. Pkm-knockdown immortalized mouse podocytes had higher levels of toxic glucose metabolites, mitochondrial dysfunction and apoptosis. Podocyte-specific Pkm2-knockout (KO) mice with diabetes developed worse albuminuria and glomerular pathology. Conversely, we found that pharmacological activation of PKM2 by a small-molecule PKM2 activator, TEPP-46, reversed hyperglycemia-induced elevation in toxic glucose metabolites and mitochondrial dysfunction, partially by increasing glycolytic flux and PGC-1α mRNA in cultured podocytes. In intervention studies using DBA2/J and Nos3 (eNos) KO mouse models of diabetes, TEPP-46 treatment reversed metabolic abnormalities, mitochondrial dysfunction and kidney pathology. Thus, PKM2 activation may protect against DN by increasing glucose metabolic flux, inhibiting the production of toxic glucose metabolites and inducing mitochondrial biogenesis to restore mitochondrial function.

Aims and Objectives: To elicit the perspectives of carers of people with mental illness regarding access to, and experience with, physical healthcare services for mental health consumers. Background: People diagnosed with mental illness have increased risks of physical illness and earlier death, problems able to be addressed through better physical health services. Carers of people with mental illness play a significant role in the mental healthcare system yet research examining their views is lacking. Design: Qualitative exploratory. Methods: In-depth interviews were conducted with 13 mental health carers. They were asked to describe their views and experiences pertaining to the physical health and availability of physical health care for the people they care for. Data were analysed using the framework of Braun and Clarke. Results: Analysis of carer responses identified two important themes: responsiveness and access, and a shortage of care coordination. Carers felt alienated from physical healthcare providers and were compelled to fill gaps in available care through persistence in ensuring access to physical healthcare services. Conclusions: The findings identify carers as key stakeholders in the physical health care for the people they care for. Their involvement in accessing and coordinating care provides vital perspective on health service capacity, which requires further consideration in the practice and research domains. Relevance to clinical practice: Carers of people diagnosed with mental illness are crucial to the effective delivery of mental health services. Their perspectives must be central to their research agenda and contribute to the development of initiatives to improve clinical practice and promote improved physical health care.

Fibrous Dysplasia / McCune Albright syndrome (FD/MAS) represents a wide spectrum of diseases due to somatic gain-of-function mutations of the GNAS gene. The mutation leads to overactivity in the target tissues and to a wide phenotype of clinical features that vary in severity and age of onset. The rarity of the disease and its variable presentation to multiple specialities often leads to misdiagnosis and inappropriate variability in investigations and treatments. To address this, our international consortium of clinicians, researchers, and patients' advocates has developed pragmatic clinical guidelines for best clinical practice for the definition, diagnosis, staging, treatment and monitoring for FD/MAS to empower patients and support clinical teams in both general and specialised healthcare settings. With the lack of strong evidence to inform care, the guidelines were developed based on review of published literature, long-standing extensive experience of authors, input from other healthcare professionals involved in the care of FD/MAS patients and feedback from patients and patient groups across the globe. This has led to the formulation of a set of statements to inform healthcare professionals, patients, their families, carers and patient groups of the best practice of care. It is anticipated the implementation of these recommendations will lead to improvement in the care of patients with FD/MAS internationally.

Fibrous Dysplasia / McCune Albright syndrome (FD/MAS) represents a wide spectrum of diseases due to somatic gain-of-function mutations of the GNAS gene. The mutation leads to overactivity in the target tissues and to a wide phenotype of clinical features that vary in severity and age of onset. The rarity of the disease and its variable presentation to multiple specialities often leads to misdiagnosis and inappropriate variability in investigations and treatments. To address this, our international consortium of clinicians, researchers, and patients’ advocates has developed pragmatic clinical guidelines for best clinical practice for the definition, diagnosis, staging, treatment and monitoring for FD/MAS to empower patients and support clinical teams in both general and specialised healthcare settings. With the lack of strong evidence to inform care, the guidelines were developed based on review of published literature, long-standing extensive experience of authors, input from other healthcare professionals involved in the care of FD/MAS patients and feedback from patients and patient groups across the globe. This has led to the formulation of a set of statements to inform healthcare professionals, patients, their families, carers and patient groups of the best practice of care. It is anticipated the implementation of these recommendations will lead to improvement in the care of patients with FD/MAS internationally. Electronic supplementary material The online version of this article (10.1186/s13023-019-1102-9) contains supplementary material, which is available to authorized users.

Scanlan, AT, Fox, JL, Milanovic, Z, Stojanovic, E, Stanton, R, and Dalbo, VJ. Individualized and fixed thresholds to demarcate PlayerLoad intensity zones produce different outcomes. J Strength Cond Res 35(7): 2046-2052, 2021-Individualized approaches to derive intensity zones are yet to be examined using microsensor metrics in basketball. The purpose of this study was to quantify and compare the time spent in different PlayerLoad intensity zones using individualized and fixed approaches during basketball training. Thirteen semiprofessional, male basketball players were monitored across the preparatory training phase. Microsensors recorded the time spent in 6 PlayerLoad intensity zones using individualized and fixed approaches. Individualized zones were calculated relative to the peak instantaneous PlayerLoad response observed in each player across training. Fixed zones were determined following predefined cut-points set in proprietary software. The majority of training time was spent in zones 1-2 (98-99%), with a low proportion of time detected in zones 3-6 (1-2%) across approaches. The fixed approach produced greater training time in zones 2 (11.9 ± 1.2 vs. 9.3 ± 2.4 minutes; very likely large) and 3 (1.7 ± 0.8 vs. 0.8 ± 0.9 minutes; very likely moderate), was an unclear small increase in time spent in zone 1 were apparent using individualized thresholds (76.5 ± 11.2 vs. 72.9 ± 9.6 minutes). Almost certain similar time was spent in zones 4-6 across approaches. Individual analyses showed deviations across players; however, fixed PlayerLoad thresholds produced higher training time in zones 2 (moderate to very large), 3 (moderate to very large), 4 (moderate to large), and 5 (moderate) than the individualized approach in most players. Variations in outcomes between individualized and fixed approaches must be considered when quantifying the time spent working in PlayerLoad intensity zones.

Del Vecchio, L, Stanton, R, Reaburn, P, Macgregor, C, Meerkin, J, Villegas, J, and Korhonen, MT. Effects of combined strength and sprint training on lean mass, strength, power, and sprint performance in masters road cyclists. J Strength Cond Res 33(1): 66-79, 2019-Strength and sprint-training exercises are integral part of training in many younger endurance cyclists to improve cycling efficiency and sprinting ability. This study was undertaken to examine whether muscle and performance characteristics could be improved in endurance-trained masters cyclist by adding strength and sprint-training stimuli into their training regimen. Twenty-five masters road cyclists were assigned to a combined strength and sprint-training group (CT; n = 9, 53.5 ± 9.3 years), a sprint-training group (ST, n = 7, 49.4 ± 4.8 years) or a control group (CG, n = 9, 56.9 ± 8.6 years). Before and after the 12 weeks intervention, whole body lean mass, total lower limb lean mass (LLLM), countermovement jump height, peak isometric torque of quadriceps and hamstring muscles were examined. For evaluation of sport-specific performance, 10-second sprint cycling peak power (PP10), total 30 seconds work (TW), PP output and flying 200-m time trial (TT) performance were assessed. No pretraining differences were observed between CT, ST, and CG groups for any of the dependant variables. After training, a significant (p < 0.05) between group difference was observed in TW between CT and CG groups. A significant effect of time (p < 0.05) was observed for LLLM in CT and ST groups, and for TT in the CT group. These results suggest including strength and sprint exercises in training can increase LLLM and sprint performance in endurance-trained masters road cyclists. Further research is warranted to find out an ideal pattern of training to maintain aerobic capabilities along with sprint performance in aging road cyclists.

Berkelmans, DM, Dalbo, VJ, Fox, JL, Stanton, R, Kean, CO, Giamarelos, KE, Teramoto, M, and Scanlan, AT. Influence of different methods to determine maximum heart rate on training load outcomes in basketball players. J Strength Cond Res 32(11): 3177-3185, 2018-The summated-heart-rate-zones (SHRZ) approach uses heart rate (HR) responses relative to maximum HR (HRmax) to calculate the internal training load (TL). Age-predicted, test-derived, and session-based approaches have all been used to determine HRmax in team sports. The purpose of this study was to determine the effects of using age-predicted, test-derived, and session-based HRmax responses on SHRZ TL in basketball players. Semiprofessional, male basketball players (N = 6) were analyzed during the preparatory training phase. Six age-based approaches were used to predict HRmax including Fox (220 - age); Hossack (206 - [0.567 × age]); Tanaka (208 - [0.7 × age]); Nikolaidis (223 - [1.44 × age]); Nes (211 - [0.64 × age]); and Faff (209.9 - [0.73 × age]). Test-derived HRmax was taken as the highest HR during the Yo-Yo intermittent recovery test (Yo-Yo IRT), whereas session-based HRmax was taken as the higher HR seen during the Yo-Yo IRT or training sessions. Comparisons in SHRZ TL were made at group and individual levels. No significant group differences were evident between SHRZ approaches. Effect size analyses revealed moderate (d = 0.60-0.79) differences between age-predicted, test-derived, and session-based methods across the group and individually in 2 players. The moderate differences between approaches suggest age-predicted, test-derived, and session-based methods to determine HRmax are not interchangeable when calculating SHRZ. Basketball practitioners are encouraged to use individualized HRmax directly measured during field-based tests supplemented with higher HR responses evident during training sessions and games when calculating the SHRZ TL to ensure greatest accuracy.

Aim: Nursing students experience high levels of stress, anxiety and depression. This study examined associations between health behaviors and stress, anxiety and depression in Australian nursing students. Design: this was a cross-sectional study. Methods: Participants completed an online survey providing demographic information and responses to the 21-item Depression Anxiety Stress Scale, Fagerstrom Test for Nicotine Dependence, short Food Frequency Questionnaire, Alcohol Use Disorders Identification Test, International Physical Activity Questionnaire and Workforce Sitting Questionnaire. Associations were evaluated using multivariate linear regression. Results: Mild to extremely severe stress (46.6%), anxiety (52.8%) and depression (42.2%) were prevalent. Intake of snack-foods was associated with higher depression (β = 8.66, p < 0.05) and stress (β = 3.92, p = 0.055) scores. More time spent sitting was associated with higher depression (β = 0.48, p < 0.001) and stress (β = 0.28, p < 0.05) scores. Skipping meals correlated with higher stress, anxiety and depression scores. Conclusion: More support must be provided to nursing students to manage psychological distress and mental health during university study.

Interprofessional care and consumer-oriented services are embodied in modern healthcare policy and practice. The views, needs, and values of consumers are essential to ensuring translation of policy to practice. This is particularly pertinent for people diagnosed with mental illness who experience a higher risk of physical health problems and premature death. A qualitative, exploratory research project was conducted, involving focus groups with members of a mental health consumer group in the Australian Capital Territory. Participants were asked about their experiences and opinions in relation to physical health and care and treatment provided. Focus group transcripts were thematically analysed. Three themes arose via analysis: (1) Meeting diverse physical healthcare needs, where mental health consumers connect with many types of healthcare providers, conventional and non-conventional, (2) centre of the interprofessional team for holistic care, where there is preference for a consumer-centred group effort in addressing health issues as the model of care, and (3) more gateways, less gatekeeping, where points of access were affected by cost, place and gatekeepers could be enabling. People with mental illness seek enhanced collaboration between a broader range of health professionals, with potential to contribute to their overall health and well-being.

Background Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions. Methods Following the 2010 earthquake in Haiti, an emergency physician was trained using the Emergency Physician's General Anesthesia Syllabus (EP GAS) to perform duties similar to those of certified registered nurse anesthetists. The emergency physician then provided anesthesia during surgical mission trips with an orthopaedic team from February 2011 to March 2017, in Milot, Haiti. This is a descriptive overview of this training program and prospectively collected data on the cohort of patients whom the surgical mission teams treated in Haiti during that time frame. Results A single emergency physician anesthetist provided anesthesia for 71 of the 172 orthopaedic surgical cases, nearly doubling the number of cases that could be performed. This also allowed the anesthesiologists to focus on pediatric and more difficult cases. Both immediately after the surgical procedure and at 1 year, there were no serious adverse events for cases in which the emergency physician provided anesthesia. Conclusions Given emergency physicians' baseline training in airway management and sedation, well-supervised and focused extra training under the vigilant supervision of a board-certified anesthesiologist may allow emergency physicians to be able to safely administer anesthesia. Using emergency physicians as anesthetists in this closely supervised setting could increase the number of surgical cases that can be performed in a disaster setting.

Achieving blood pressure (BP) goals is an essential goal for both primary and secondary prevention of diabetic kidney disease (DKD). Even though there is universal agreement about the importance of controlling BP, there are many issues about many aspects of hypertension management for DKD patients. These issues include: what is the optimal BP for the prevention or slowing of progression of DKD patients; what is the best method for diagnosing hypertension and monitoring BP, and what are the best medicines to use to treat hypertension in DKD patients. In this review, these issues as well as others will be discussed.

Purpose: This study examines attendance at, and satisfaction with, a group exercise program in an inpatient mental health setting. Design and Method: Thirty-two inpatients completed discharge surveys to evaluate group activities. Data were analyzed for participation and satisfaction. Findings: More inpatients (n = 16, 50%) rated exercise as "excellent" compared with all other activities. Nonattendance rates were lowest for cognitive behavioral therapy (n = 2, 6.3%), highest for the relaxation group (n = 6, 18.8%), and 12.5% (n = 4) for the group exercise program. Practice Implications: Group exercise programs delivered by highly trained personnel are well attended and achieve high satisfaction ratings by inpatient mental health consumers.

PURPOSE This paper examines the findings from an exit interview with a cardiometabolic health nurse (CHN) following a 26-week trial. DESIGN AND METHODS The CHN participated in a semi-structured exit interview following completion of the 26-week trial. Applied thematic analysis was used to identify themes contained in the resultant transcript. FINDINGS Contrary to the literature, the CHN did not consider additional training necessary to undertake the role. The CHN felt additional information regarding the research implications of the trial and greater organizational support would contribute to better consumer and health service outcomes. PRACTICE IMPLICATIONS While personally rewarding, more can be done to help the CHN role reach its potential.

Purpose To investigate the views of general practitioners (GPs) regarding exercise and the treatment of depression. Design and Methods Twenty GPs completed a 25-item survey investigating their knowledge, beliefs, perceived benefits and barriers, and recommendations to patients regarding exercise for the treatment of depression. The exercise habits of the GPs were also recorded. Findings GPs are positive toward exercise in the treatment of depression despite low levels of confidence in prescribing exercise or limited measurable benefits. Exercise patterns of GPs were not associated with GP exercise prescription habits. Practice Implications Education, use of support materials and referral schemes, and increasing exercise behavior among GPs may increase the use of exercise as treatment for people with depression.

PURPOSE A cardiometabolic specialist nursing role could potentially improve physical health of people with serious mental illness. DESIGN AND METHODS A national survey of Australian nurses working in mental health settings investigated predictors of support for the role. FINDINGS Predictors included belief in physical healthcare neglect, interest in training; higher perceived value of improving physical health care. PRACTICE IMPLICATIONS The findings suggest that nurses see the cardiometabolic health nurse role as a promising initiative for closing gaps in cardiometabolic health care and skilling other nurses in mental health. However, as the majority of variance in cardiometabolic health nurse support was unexplained, more research is urgently needed on factors that explain differences in cardiometabolic health nurse endorsement.

PURPOSE To determine the changes in attitudes toward the inclusion of a cardiometabolic health nurse for the physical healthcare management of people with serious mental illness following a 6-month trial. DESIGN AND METHODS Repeated survey of nurses working in a regional mental health facility. FINDINGS Nurses working in mental health were initially supportive of the role. A 6-month trial of a cardiometabolic health nurse in the workplace reduced ambivalence and increased positivity toward the role. PRACTICE IMPLICATIONS Reduced ambivalence and improved positivity toward the role may facilitate less organization resistance to the implementation of a cardiometabolic health nurse in the mental healthcare setting. Specialized training and role recognition may be needed to further support this role.

Purpose: This article reports baseline data from a randomized controlled trial investigating the impact of a specialist cardiometabolic healthcare nurse on physical health care. Design and Methods: Survey of community-based mental health consumers randomized to a cardiometabolic health nurse intervention. Findings: Findings show a high prevalence of respiratory conditions, hypercholesterolemia, hypertension, and low quality of life. Participants reported regular blood pressure but infrequent cholesterol and blood glucose testing. Few received advice about smoking cessation, diet, or physical activity. Participants were mostly satisfied with physical healthcare provision; however, positive health behaviors are lacking. Practice Implications: An individualized intervention based on knowledge and attitudes may be necessary.

Aims and objectives To ascertain the views and experiences of mental health consumers regarding the availability and quality of care and treatment received for their physical health needs. Background People diagnosed with mental illness have higher occurrence of physical health problems. Responsive health care services are crucial for prevention and management of physical health problems, and for reducing disparities in health between people diagnosed with mental illness and those who are not. There is limited research giving voice to consumer perspectives on their experiences with health care providers. Design Exploratory qualitative. Methods Focus group interviews with mental health consumers accessed via a consumer network group in a region of Australia (n = 31). All interview audio recordings were transcribed professionally. Interviews were thematically analysed. Results The main themes were: symptomising; failure to act and alertness to prejudice. The first two themes were consumer perceptions of the actions and behaviours of health professionals, and the third describes consumer responses to these behaviours and actions. Consumers described increased risks of illness and death because of undiagnosed physical illness despite their physical health advice-seeking as the reason for the health consultation. Conclusion Health care providers’ non-recognition of physical health problems presents a clear example of a significant and potentially life threatening health inequity. The service provider responses described by participants suggest that mental health consumers’ physical health needs may not be taken seriously. Relevance to clinical practice Clinicians need to take seriously the physical health needs and concerns of people with mental illness. Nurses can play a crucial role in the prevention of diagnostic overshadowing as part of a broader direction of balancing biomedical perspectives with other approaches to health care.

Shortened life expectancy of people with mental illness is now widely known and the focus of research and policy activity. To date, research has primarily reflected perspectives of health professionals with limited attention to the views and opinions of those most closely affected. The voice of carers is particularly minimal, despite policy stipulating carer participation is required for mental health services.To present views and opinions of carers regarding physical health of the people they care for.Qualitative exploratory. Two focus groups and one individual interview were conducted with 13 people identifying as carers of a person with mental illness. Research was conducted in the Australian Capital Territory. Data analysis was based on the thematic framework of Braun and Clarke.Two main themes were interaction between physical and mental health; and, carers' own physical and mental health. Participants described the impact of mental illness and its treatments on physical health, including their own.Carers are acknowledged as crucial for the delivery of high quality mental health services. Therefore they have an important role to play in addressing the poor physical health of people with mental illness. Hearing their views and opinions is essential.

My Jump Health and Fitness iOS 7.0 or later; Optimised for iPhone 5, iPhone 6 and iPhone 6 Plus. Compatible with iPhone, iPad and iPod touch. $A7.49 Current version is V.2.1 which has iPhone 6 and iPhone 6 Plus support, and iOS8 support. No trial version is available. Vertical jump is a widely used measure of functional performance in athletic and non-athletic populations.1 My Jump is a low-cost, easy-to-use application which integrates with the video camera to assess vertical jump performance (figure 1). The in-app settings allow slow-motion playback for easy identification of the video frame in which jump take-off and landing occurs. The app determines the number of …

BACKGROUND Oxidative stress is critical to the teratogenic effects of diabetic pregnancy, yet the specific biochemical pathways responsible for oxidative stress have not been fully elucidated. The hexosamine pathway is activated in many tissues during diabetes and could contribute to oxidative stress by inhibiting the pentose shunt pathway, thereby diminishing production of the cellular antioxidant, reduced glutathione (GSH). METHODS To test the hypothesis that activation of the hexosamine pathway might contribute to the teratogenic effects of diabetic pregnancy, pregnant mice were injected with glucose, to induce hyperglycemia, or glucosamine, to directly activate the hexosamine pathway. Embryo tissue fragments were also cultured in physiological glucose, high glucose, or physiological glucose plus glucosamine, to test effects on oxidative stress and embryo gene expression. RESULTS Glucosamine increased hexosamine synthesis and inhibited pentose shunt activity. There was a trend for transient hyperglycemia to have the same effects, but they did not reach statistical significance. However, both glucose and glucosamine significantly decreased GSH, and increased oxidative stress, as indicated by 2′,7′-dichloro-dihydrofluorescein fluorescence. Glucose and glucosamine inhibited expression of Pax-3, a gene required for neural tube closure both in vivo and in vitro, and increased neural tube defects (NTDs) in vivo; these effects were prevented by GSH ethyl ester. High glucose and glucosamine inhibited Pax-3 expression by embryo culture, but culture in glutamine-free media to block the hexosamine pathway prevented the inhibition of Pax-3 expression by high glucose. CONCLUSIONS Activation of the hexosamine pathway causes oxidative stress through depletion of GSH and consequent disruption of embryo gene expression. Activation of this pathway may contribute to diabetic teratogenesis. Birth Defects Research (Part A), 2004. © 2004 Wiley-Liss, Inc.

Stanton, R., P. Reaburn, and B. Humphries. The ef- fect of short-term Swiss ball training on core stability and run- ning economy. J. Strength Cond. Res. 18(3):522-528. 2004.—The purpose of this study was to investigate the effect of a short- term Swiss ball training on core stability and running economy. Eighteen young male athletes (15.5 6 1.4 years; 62.5 6 4.7 kg; S9 skinfolds 78.9 6 28.2 mm; VO2max 55.3 6 5.7 ml·kg 21 ·min 21 ) were divided into a control (n 5 10) and experimental (n 5 8) groups. Athletes were assessed before and after the training pro- gram for stature, body mass, core stability, electromyographic activity of the abdominal and back muscles, treadmill VO2max, running economy, and running posture. The experimental group performed 2 Swiss ball training sessions per week for 6 weeks. Data analysis revealed a significant effect of Swiss ball training on core stability in the experimental group (p , 0.05). No sig- nificant differences were observed for myoelectric activity of the abdominal and back muscles, treadmill VO2max, running econo- my, or running posture in either group. It appears Swiss ball training may positively affect core stability without concomitant improvements in physical performance in young athletes. Spec- ificity of exercise selection should be considered.

Parkinson’s disease (PD) is a multifactorial disorder with a complex etiology including genetic risk factors, environmental exposures, and aging. While energy failure and oxidative stress have largely been associated with the loss of dopaminergic cells in PD and the toxicity induced by mitochondrial/environmental toxins, very little is known regarding the alterations in energy metabolism associated with mitochondrial dysfunction and their causative role in cell death progression. In this study, we investigated the alterations in the energy/redox-metabolome in dopaminergic cells exposed to environmental/mitochondrial toxins (paraquat, rotenone, 1-methyl-4-phenylpyridinium [MPP+], and 6-hydroxydopamine [6-OHDA]) in order to identify common and/or different mechanisms of toxicity. A combined metabolomics approach using nuclear magnetic resonance (NMR) and direct-infusion electrospray ionization mass spectrometry (DI-ESI-MS) was used to identify unique metabolic profile changes in response to these neurotoxins. Paraquat exposure induced the most profound alterations in the pentose phosphate pathway (PPP) metabolome. 13C-glucose flux analysis corroborated that PPP metabolites such as glucose-6-phosphate, fructose-6-phosphate, glucono-1,5-lactone, and erythrose-4-phosphate were increased by paraquat treatment, which was paralleled by inhibition of glycolysis and the TCA cycle. Proteomic analysis also found an increase in the expression of glucose-6-phosphate dehydrogenase (G6PD), which supplies reducing equivalents by regenerating nicotinamide adenine dinucleotide phosphate (NADPH) levels. Overexpression of G6PD selectively increased paraquat toxicity, while its inhibition with 6-aminonicotinamide inhibited paraquat-induced oxidative stress and cell death. These results suggest that paraquat “hijacks” the PPP to increase NADPH reducing equivalents and stimulate paraquat redox cycling, oxidative stress, and cell death. Our study clearly demonstrates that alterations in energy metabolism, which are specific for distinct mitochondiral/environmental toxins, are not bystanders to energy failure but also contribute significant to cell death progression.

A new method of treatment planning for the I-125 and Pd-103 permanent interstitial prostate implant is developed, which does not use the traditional nomograms but automatically generates optimized source configurations. An iterative algorithm is used that places one seed at a step. The volume dose of target is calculated at each step to determine the coldest spot where the next source is to be placed, so that the dose uniformity of target is best improved as source placement proceeds. At each step, the total activity required for the seed configuration as so established is calculated by normalizing the minimal dose to the prescribed dose. An optimized configuration is the one that takes the minimized total activity. Around its minimum the total activity has a very small variation with the number of seeds. Consequently multiple clinically acceptable seed configurations with similar total activity but different individual activities are generated simultaneously. In our computer generated treatment plans most of the seeds are distributed in the periphery of the target, similar to the Paterson-Parker pattern of a volume implant.

Historically, patients with type 1 diabetes and macroalbuminuria had high competing risks: cardiovascular death or renal failure. Here, we assessed these risks in patients receiving therapies implemented during the last 30 years. Between 1991 and 2004, we enrolled 423 white patients with type 1 diabetes who developed macroalbuminuria (albumin excretion rate, ≥300 μg/min). With follow-up for 98% through 2008, ESRD developed in 172 patients (incidence rate, 5.8/100 person-years), and 29 died without ESRD (mortality rate, 1/100 person-years). The majority of these outcomes occurred between ages 36 and 52 years with durations of diabetes of 21 to 37 years. The 15-year cumulative risks were 52% for ESRD and 11% for pre-ESRD death. During the 15 years of follow-up, the use of renoprotective treatment increased from 56 to 82%, and BP and lipid levels improved significantly; however, the risks for both ESRD and pre-ESRD death did not change over the years analyzed. There were 70 post-ESRD deaths, and the mortality rate was very similar during the 1990s and the 2000s (11/100 person-years versus 12/100 person-years, respectively). Mortality was low in patients who received a pre-emptive kidney transplant (1/100 person-years), although these patients did not differ from dialyzed patients with regard to predialysis eGFR, sex, age at onset of ESRD, or duration of diabetes. In conclusion, despite the widespread adoption of renoprotective treatment, patients with type 1 diabetes and macroalbuminuria remain at high risk for ESRD, suggesting that more effective therapies are desperately needed.

An excellent physician must be aware of the countless issues that affect each patient's health. Many medical education programs expose students to a broad spectrum of disparate knowledge and hope they will integrate all the pieces into a coherent whole. The authors describe an explicit approach to integration used at Harvard Medical School since 2003 that aims to enhance students' learning in medical school and throughout their medical careers: the Mentored Clinical Casebook Project (MCCP). The MCCP is constructed on the premise that such integration does not occur suddenly but, rather, is an unending process. A first-year student is assigned to one clinician and follows one patient for one year. The student is expected to spend as much time with the patient as possible, in both clinical and nonclinical settings, seek help from the clinician, and consult other experts and sources to develop a complete picture of the patient's life. The student must produce a casebook that includes, but is not limited to, the patient's history; basic science, clinical, socioeconomic, and cultural issues; and self-reflection. The MCCP is intended to allow students to develop a deeper and more diverse understanding of what comprises a patient's health care life, to discern the patient as a person and the person as a patient. This educational project has been popular with students since its inception, providing them with a personal framework from which to address the needs of future patients and introducing them to how much they will continue to learn from their patients.

Hyperaldosteronism is associated with impaired vascular reactivity; however, the mechanisms by which aldosterone promotes endothelial dysfunction remain unknown. Glucose-6-phosphate dehydrogenase (G6PD) modulates vascular function by limiting oxidant stress to preserve bioavailable nitric oxide (NO(*)). Here we show that aldosterone (10(-9)-;10(-7) mol/l) decreased endothelial G6PD expression and activity in vitro, resulting in increased oxidant stress and decreased NO(*) levels-similar to what is observed in G6PD-deficient endothelial cells. Aldosterone decreased G6PD expression by increasing expression of the cyclic AMP-response element modulator (CREM) to inhibit cyclic AMP-response element binding protein (CREB)-mediated G6PD transcription. In vivo, infusion of aldosterone decreased vascular G6PD expression and impaired vascular reactivity. These effects were abrogated by spironolactone or vascular gene transfer of G6pd. These findings demonstrate that aldosterone induces a G6PD-deficient phenotype to impair endothelial function; aldosterone antagonism or gene transfer of G6pd improves vascular reactivity by restoring G6PD activity.

Corrigendum: Aldosterone impairs vascular reactivity by decreasing glucose-6-phosphate dehydrogenase activity