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Purpose: To compare the habitual sleep of female basketball and soccer athletes to age- and sex-matched controls and to characterize the sleep of basketball and soccer athletes at different competition locations and on the days surrounding competition. Methods: Using an observational case–control design, 41 female participants were recruited to participate, consisting of 11 basketball athletes (mean [SD]: age = 24.1 [4.9] y), 10 soccer athletes (24.8 [6.4] y), and 20 nonathletic controls (24.2 [2.8] y). Sleep was monitored using actigraphy for four 7-day periods throughout the preseason and subsequent competition season. Generalized linear models were used to analyze the effect of group and competition situation (eg, Home or Away) on sleep. Results: During habitual conditions, basketball athletes had longer sleep durations (7.4 [1.5] h) than soccer athletes (7.0 [1.2] h, P P = .002). During competition, basketball and soccer athletes had longer sleep durations following home (7.7 [1.7] and 7.2 ± 1.3 h) compared with away games (6.8 [1.8] and 7.0 [1.3] h). In addition, basketballers went to bed earlier (23:49 [01:25]) and woke earlier (07:22 [01:59]) following away games compared with soccer athletes (00:10 [01:45] and 08:13 [01:45]). Conclusions: Basketballers had longer habitual sleep durations compared with soccer athletes and nonathletic controls. During competition, basketballers had earlier bed and wake times compared with soccer athletes following away games, highlighting the need for individualized sleep strategies.

Persistent androgen receptor (AR) signalling is the main driver of prostate cancer (PCa). Truncated isoforms of the AR called androgen receptor variants (AR-Vs) lacking the ligand binding domain often emerge during treatment resistance against AR pathway inhibitors such as Enzalutamide. This review discusses how AR-Vs drive a more aggressive form of PCa through the regulation of some of their target genes involved in oncogenic pathways, enabling disease progression. There is a pressing need for the development of a new generation of AR inhibitors which can repress the activity of both the full-length AR and AR-Vs, for which the knowledge of differentially expressed target genes will allow evaluation of inhibition efficacy. This review provides a detailed account of the most common variant, AR-V7, the AR-V7 regulated genes which have been experimentally validated, endeavours to understand their relevance in aggressive AR-V driven PCa and discusses the utility of the downstream protein products as potential drug targets for PCa treatment.

PURPOSE This study aimed to determine the efficacy of α-lactalbumin (A-LAC) supplementation for improving sleep and performance recovery after simulated evening competition in female athletes. METHODS Sixteen trained women (mean ± SD: age, 27 ± 7 yr; mass, 62 ± 10 kg; stature, 167 ± 8 cm) participated in this randomized double-blind three-arm crossover study. Participants completed a simulated evening competition before consuming either an A-LAC whey protein, whey protein placebo (PLA), or water control (CON) beverage. Sleep was monitored via polysomnography, and participants completed a series of physical, cognitive, and perceptual assessments before, and 14 and 24 h after simulated competition. RESULTS Non-rapid eye movement stage 2 sleep increased after competition in A-LAC (pre, 199 ± 44 min; post, 212 ± 37 min) but decreased in CON (pre, 228 ± 43 min; post, 195 ± 40 min) and PLA (pre, 224 ± 25 min; post, 211 ± 35 min; P = 0.012). In addition, Yo-Yo Intermittent Recovery Test Level 1 distance improved over time in A-LAC (baseline, 664 ± 332 m; 14 h post, 667 ± 326 m; 24 h post, 781 ± 427 m) compared with CON (baseline, 741 ± 366 m; 14 h post, 648 ± 351 m; 24 h post, 720 ± 407 m) and PLA (baseline, 763 ± 394 m; 14 h post, 636 ± 366 m; 24 h post, 720 ± 396 m; P < 0.001). CONCLUSIONS The findings indicate that A-LAC supplementation may be useful for retaining some sleep characteristics after evening competition, leading to improved physical performance in female athletes.

Background/Aims Advice lines in Rheumatology services are well established and supported by NICE to provide specialist support and advice to rheumatology patients. During COVID-19 the demand on this service greatly increased due to disruption in appointments, confusion regarding national advice, concerns and fears regarding condition and medication. Although patients were encouraged to refer to national guidance, many found it difficult to interpret therefore continued to access the advice line. Our advice line service largely follows the RCN 2006 guidance regarding service provision. Despite this during COVID-19 the volume of calls increased to up to 100 calls per day during the first lockdown. Support was required to effectively manage these calls with reduced clinical staff. Methods A retrospective review of calls to the advice line compared to the previous year was undertaken from the call log database. A further review of the nature of calls was undertaken for April 2020 and January 2021 where the numbers of calls were at their peak. Data is recorded including time of call, nature of call, advice given and time call returned. Results There was a 130% increase in calls during the first lockdown. This reduced by the early 2021 lockdown to 72%. The majority of calls in April 2020 were related to shielding and risk status (53%). A further 19% of calls were related to medication, these included queries regarding homecare deliveries and delays. 6% were appointment enquiries and they were passed to the administrative team. In January 2021 the majority of calls were related to medication (30%). 19% of calls were regarding the COVID-19 vaccine. There were still 8% of calls regarding shielding. 9% of calls were related to appointments. Pressure on the nursing team was increased due to staff redeployment. Conclusion The analysis of calls during the COVID-19 pandemic highlighted that although there was extensive national guidance produced, many patients still required the support and guidance of their specialist teams to interpret these according to their condition. We believe there is a duty of care for the specialist teams to maintain this level of service during any future events and this should be factored into any decisions regarding redeployment of staff. Appointments and homecare delivery enquiries continued despite directions to alternate numbers, therefore impacted on workload for the clinical nursing team. In order to streamline the service we introduced ‘options’ to select: option 1 for appointments, option 2 for homecare and option 3 for advice line queries. Option 1 and 2 then directed to the relevant team. Future developments include audit to assess the impact of introducing telephone options; reviewing the funding and scope of the service, which has extended beyond medication and flare advice; and further exploration of text and email platforms. Disclosure L. Knight: None. J. Miller: None. S. Dahiya: None.

This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients.

Objectives The primary aims of the present study were to assess the sleep hygiene knowledge of high performance team sport coaches and sports science support staff; the sleep practices these individuals implement with athletes; and the barriers to the more frequent use of these practices. Design Cross-sectional observational study. Methods A sample of 86 Australian coaches and sports science support staff working within high performance team sport volunteered to complete a four-part questionnaire, including the Sleep Beliefs Survey used to assess sleep hygiene knowledge. Results Overall sleep hygiene knowledge was adequate (15.3 ± 2.9, score range 0–20; mean ± SD), however knowledge of sleep–wake cycle behaviours (score 4.9 ± 1.6 out of 7) and thoughts and attitudes about sleep (3.6 ± 1.0 out of 5) were inadequate. Over half (56%) of coaches and support staff had monitored athlete sleep, while 43% had promoted sleep hygiene. Lack of resources (response range 44–60%) and knowledge (16–41%) were the two main barriers to the implementation of sleep monitoring and sleep hygiene practices. Conclusions Team sport coaches and sports science support staff have adequate overall sleep hygiene knowledge, yet some specific areas (e.g. sleep–wake cycle behaviours) warrant improvement. There appear to be limited sleep practices implemented with athletes, particularly regarding the promotion of sleep hygiene. The development of educational sleep resources for coaches and support staff to implement with athletes may help address the identified barriers and improve sleep knowledge.

Despite increasing representation in medicine, women continue to be a minority in academic practice and leadership, especially in male-dominated fields like anesthesiology. Differences in compensation and participation in leadership may represent barriers to career advancement for women in anesthesiology. Key factors for promotion in academic anesthesiology are research, funding, and publication. As such, designation as a first or senior author on a publication in a professional journal may act as currency for promotion. Here, we examine the prevalence of female first and senior authorship of original research articles published in Anesthesiology and Anesthesia & Analgesia during the years 2002, 2007, 2012, and 2017. Other manuscript characteristics assessed in relation to author gender included study type, subspecialty topic, and total number of authors. Of 2600 manuscripts studied, analysis of authorship by year demonstrated an increase in female first authorship, senior authorship, and editorial board membership by 10%, 9%, and 6%, respectively. Women made up a higher percentage of first authors on manuscripts with female senior authors. More nonexperimental studies had female senior authors than experimental studies. Female first authors had greater representation in the subspecialties of neuroanesthesia, obstetrical anesthesia, pain management, and pediatric anesthesia. Median number of authors was unrelated to senior author gender. This study shows increasing female first and senior authorship, as well as editorial board composition in 2 popular, high-impact anesthesiology journals. Recognizing gender-based trends in publications is important to develop strategies for the recruitment, retention, and advancement of women in anesthesiology.

Introduction. Opioids may influence tumor recurrence and cancer-free survival in hepatocellular carcinoma (HCC). The relationship between intrathecal morphine administration, tumor recurrence, and patient survival after hepatectomy for HCC is unknown. Patients and Methods. This single-center, retrospective study included 1837 liver resections between July 2002 and December 2012; 410 cases were incorporated in the final univariate and multivariate analysis. Confirmatory propensity matching yielded 65 matched pairs (intrathecal morphine vs none). Primary outcomes were recurrence of HCC and survival. Secondary outcomes included characterization of factors associated with recurrence and survival. Results. Groups were similar except for increased coronary artery disease in the no intrathecal morphine group. All patients received volatile anesthesia. Compared with no intrathecal morphine (N = 307), intrathecal morphine (N = 103) was associated with decreased intraoperative intravenous morphine administration (median difference = 12.5 mg; 95% confidence interval [CI] = 5-20 mg). There was no difference in blood loss, transfusion, 3- or 5-year survival, or recurrence in the univariate analysis. Multivariate analysis identified covariates that significantly correlated with 5-year survival: intrathecal morphine (hazard ratio [HR] = 0.527, 95% CI = 0.296-0.939), lesion diameter (HR = 1.099, 95% CI = 1.060-1.141), vascular invasion (HR = 1.658, 95% CI = 1.178-2.334), and satellite lesions (HR = 2.238, 95% CI = 1.447-3.463). Survival analysis on the propensity-matched pairs did not demonstrate a difference in 5-year recurrence or survival. Discussion and Conclusion. Multivariate analysis revealed a significant association between intrathecal morphine and 5-year survival. This association did not persist after propensity matching. The association between intrathecal morphine and HCC recurrence and survival remains unclear and prospective work is necessary to determine whether an association exists.

Mesenchymal stromal cells (MSC) hold significant potential for tissue engineering applications. Modular tissue engineering involves the use of cellularized “building blocks” that can be assembled via a bottom-up approach into larger tissue-like constructs. This approach emulates more closely the complexity associated hierarchical tissues compared with conventional top-down tissue engineering strategies. The current study describes the combination of biodegradable porous poly(DL-lactide-co-glycolide) (PLGA) TIPS microcarriers with canine adipose-derived MSC (cAdMSC) for use as implantable conformable building blocks in modular tissue engineering applications. Optimal conditions were identified for the attachment and proliferation of cAdMSC on the surface of the microcarriers. Culture of the cellularized microcarriers for 21 days in transwell insert plates under conditions used to induce either chondrogenic or osteogenic differentiation resulted in self-assembly of solid 3D tissue constructs. The tissue constructs exhibited phenotypic characteristics indicative of successful osteogenic or chondrogenic differentiation, as well as viscoelastic mechanical properties. This strategy paves the way to create in situ tissue engineered constructs via modular tissue engineering for therapeutic applications.

The implications of impact-induced muscle damage (IIMD) that results from participation in contact-sport are not well understood. The purpose of the present study was to implement a novel method of generating IIMD and characterise the implications of this on perceptual, biochemical and exercise performance parameters. Eighteen male recreational contact-sport athletes completed a single-group time series with measures assessed at baseline (PRE) and immediately following (POST) an IIMD protocol, with repeat testing 24, 48, and 72 h following the IIMD protocol. Biochemical indices of muscle damage (myoglobin [Mb]) and inflammation (high-sensitivity C-reactive protein [hs-CRP]), 15 m sprint performance, squat jump peak power (SJ-PP), and perceived soreness were compared to PRE using a one-way (time) repeated measures ANOVA with post-hoc t tests. Speed over 5 and 15 m were impaired for 48 h (7.5 ± 4%, p < 0.01) and SJ-PP was impaired for 48 h following the IIMD protocol (9.5 ±3 %, p < 0.01). Subjective soreness was elevated from baseline for 72 h (P < 0.01) following the IIMD protocol. No change in [CRP] or [Mb] was observed (p > 0.01). IIMD resulted in impaired ability to produce power and speed, whilst negatively influencing perceived soreness. These changes were most pronounced in the 48 h following the IIMD protocol. No change in muscle damage or inflammation indices were observed, primarily due to the highly variable response. Thus, the experimental protocol used in the present study may be used as a model to further investigate other aspects of IIMD.

Purpose: To explore the influence of body composition on thermal responses to cold-water immersion (CWI) and the recovery of exercise performance. Methods: Male subjects were stratified into 2 groups: low fat (LF; n = 10) or high fat (HF; n = 10). Subjects completed a high-intensity interval test (HIIT) on a cycle ergometer followed by a 15-min recovery intervention (control [CON] or CWI). Core temperature (Tc), skin temperature, and heart rate were recorded continuously. Performance was assessed at baseline, immediately post-HIIT, and 40 min postrecovery using a 4-min cycling time trial (TT), countermovement jump (CMJ), and isometric midthigh pull (IMTP). Perceptual measures (thermal sensation [TS], total quality of recovery [TQR], soreness, and fatigue) were also assessed. Results: Tc and TS were significantly lower in LF than in HF from 10 min (Tc, LF 36.5°C ± 0.5°C, HF 37.2°C ± 0.6°C; TS, LF 2.3 ± 0.5 arbitrary units [a.u.], HF 3.0 ± 0.7 a.u.) to 40 min (Tc, LF 36.1°C ± 0.6°C, HF 36.8°C ±0.7°C; TS, LF 2.3 ± 0.6 a.u., HF 3.2 ± 0.7 a.u.) after CWI (P P = .01); however, no differences were observed between HF (6.9% ±5.7%) and LF (5.4% ± 5.2%) with CON. No significant differences were observed between groups for CMJ, IMTP, TQR, soreness, or fatigue in either condition. Conclusion: Body composition influences the magnitude of Tc change during and after CWI. In addition, CWI enhanced performance recovery in the HF group only. Therefore, body composition should be considered when planning CWI protocols to avoid overcooling and maximize performance recovery.

Businesses in the hospitality sector play an important role in the New Zealand economy. As most businesses in this sector are of small size and subject to external disruptions, being resilient is crucial for their coping and survival during a time of crisis. This research aims to measure the resilience of hospitality businesses in the largest city Auckland. A triangulation approach was adopted, including a questionnaire survey and face-to-face interviews. It was found that the key resilience attributes for the studied businesses include: leadership and management, core competence of staff, market sensitivity, situational awareness and having preparedness plans. Resilience was viewed by these businesses as being able to stay viable and withstand the expected fluctuations such as low-demand seasons and unexpected financial issues. However, amongst the surveyed businesses, there is a lack of planning for unexpected events such as large scale disasters, an issue which needs to be brought forward along with the formulation of disaster risk reduction plans.

Purpose: To assess the efficacy of a combined light exposure and sleep hygiene intervention to improve team-sport performance following eastward long-haul transmeridian travel. Methods: Twenty physically trained males underwent testing at 09:00 and 17:00 hours local time on 4 consecutive days at home (baseline) and the first 4 days following 21 hours of air travel east across 8 time zones. In a randomized, matched-pairs design, participants traveled with (INT; n = 10) or without (CON; n = 10) a light exposure and sleep hygiene intervention. Performance was assessed via countermovement jump, 20-m sprint, T test, and Yo-Yo Intermittent Recovery Level 1 tests, together with perceptual measures of jet lag, fatigue, mood, and motivation. Sleep was measured using wrist activity monitors in conjunction with self-report diaries. Results: Magnitude-based inference and standardized effect-size analysis indicated there was a very likely improvement in the mean change in countermovement jump peak power (effect size 1.10, ±0.55), and likely improvement in 5-m (0.54, ±0.67) and 20-m (0.74, ±0.71) sprint time in INT compared with CON across the 4 days posttravel. Sleep duration was most likely greater in INT both during travel (1.61, ±0.82) and across the 4 nights following travel (1.28, ±0.58) compared with CON. Finally, perceived mood and motivation were likely worse (0.73, ±0.88 and 0.63, ±0.87) across the 4 days posttravel in CON compared with INT. Conclusions: Combined light exposure and sleep hygiene improved speed and power but not intermittent-sprint performance up to 96 hours following long-haul transmeridian travel. The reduction of sleep disruption during and following travel is a likely contributor to improved performance.

This study aimed to establish the true influence of spinal cord injury (SCI) level on core temperature and sweating during exercise in the heat independently of biophysical factors.A total of 31 trained males (8 with tetraplegia [TP; C5-C8], 7 with high paraplegia [HP; T1-T5], 8 with low paraplegia [LP; T6-L1], and 8 able bodied [AB]) performed 3 × 10 min of arm ergometry with 3-min rest at a metabolic heat production of (a) 4.0 W·kg (AB vs TP) or (b) 6.0 W·kg (AB vs HP vs LP), in 35°C, 50% relative humidity. Esophageal (Tes) and local skin temperatures and local sweat rate (LSR) on the forehead and upper back were measured throughout.Change in Tes was greatest in TP (1.86°C ± 0.32°C vs 0.29°C ± 0.07°C, P0.001) and greater in HP compared with LP and AB, reaching 1.20°C ± 0.50°C, 0.66°C ± 0.23°C, and 0.53°C ± 0.12°C, respectively (P0.001). Approximately half of the variability in end-trial ΔTes was described by SCI level in paraplegics (adjusted R = 0.490, P = 0.005). Esophageal temperature onset thresholds of sweating at the forehead and upper back were similar among HP, LP, and AB, whereas no sweating was observed in TP. Thermosensitivity (ΔTes vs ΔLSR) was also similar, except for LP demonstrating lower thermosensitivity than AB at the upper back (0.78 ± 0.26 vs 1.59 ± 0.89 mg·cm·min, P = 0.039). Change in skin temperature was greatest in denervated regions, most notably at the calf in all SCI groups (TP, 2.07°C ± 0.93°C; HP, 2.73°C ± 0.68°C; LP, 2.92°C ± 1.48°C).This study is the first to show the relationship between ΔTes and SCI level in athletes with paraplegia after removing variability arising from differences in metabolic heat production and mass. Individual variability in ΔTes is further reduced among athletes with TP because of minimal evaporative heat loss secondary to an absence of sweating.

Jones, MJ, Dawson, B, Eastwood, PR, Halson, SL, Miller, J, Murray, K, Dunican, IC, Landers, GJ, and Peeling, P. Influence of electronic devices on sleep and cognitive performance during athlete training camps. J Strength Cond Res 35(6): 1620-1627, 2021-This study investigated the effects of removing athletes' electronic devices in the evening on sleep and performance during training camps. Water polo athletes (n = 26) attending a 7-night training camp (study 1) and triathletes (n = 23) attending a 4-night training camp (study 2) were randomly allocated to a no-device group (no electronic devices could be used after dinner or overnight; ND) or control group (unrestricted electronic device use; CON). Sleep was monitored through wrist actigraphy. The ND group completed a questionnaire measuring anxiety related to being unable to use electronic devices ("nomophobia"). Triathletes also completed a psychomotor vigilance test (PVT) at the start and end of camp. Water polo ND athletes went to bed earlier and spent longer time in bed than CON on the first night, but not on other nights. In triathletes, sleep quantity was not different between groups on any night. No statistically significant differences were observed for changes in nomophobia from the first to the last night of camp. No differences in PVT performance were observed between ND and CON triathletes. In conclusion, removal of evening electronic devices does not improve sleep quantity or cognitive performance in athletes during short-duration (4-7 nights) training camps.

Purpose:To examine the effect of postexercise cold-water immersion (CWI) protocols, compared with control (CON), on the magnitude and time course of core temperature (Tc) responses.Methods:Pooled-data analyses were used to examine theTcresponses of 157 subjects from previous postexercise CWI trials in the authors’ laboratories. CWI protocols varied with different combinations of temperature, duration, immersion depth, and mode (continuous vs intermittent).Tcwas examined as a double difference (ΔΔTc), calculated as the change inTcin CWI condition minus the corresponding change in CON. The effect of CWI on ΔΔTcwas assessed using separate linear mixed models across 2 time components (component 1, immersion; component 2, postintervention).Results:Intermittent CWI resulted in a mean decrease in ΔΔTcthat was 0.25°C (0.10°C) (estimate [SE]) greater than continuous CWI during the immersion component (P = .02). There was a significant effect of CWI temperature during the immersion component (P = .05), where reductions in water temperature of 1°C resulted in decreases in ΔΔTcof 0.03°C (0.01°C). Similarly, the effect of CWI duration was significant during the immersion component (P = .01), where every 1 min of immersion resulted in a decrease in ΔΔTcof 0.02°C (0.01°C). The peak difference inTcbetween the CWI and CON interventions during the postimmersion component occurred at 60 min postintervention.Conclusions:Variations in CWI mode, duration, and temperature may have a significant effect on the extent of change inTc. Careful consideration should be given to determine the optimal amount of core cooling before deciding which combination of protocol factors to prescribe.

The 10-min Psychomotor Vigilance Test (PVT-10) is regarded as the gold-standard for assessing vigilant attention following sleep loss; however, other studies have investigated whether shorter versions of the test elicit similar results to the PVT-10. The present study compared the PVT-10 with 3-min (PVT-3) and 5-min (PVT-5) versions of the test in elite female basketball players. Athletes performed all three tests in the morning and evening for seven consecutive days. Response speed (mean reciprocal reaction time; mean 1/RT), number of errors and number of lapses were determined for each test and time point. The PVT-3 elicited significantly faster response speeds than the other two tests (p < 0.01), while the PVT-5 and PVT-10 were not different. The PVT-10 resulted in more lapses than the PVT-5, followed by the PVT-3, with all tests being significantly different to each other (p < 0.01). In conclusion, while the PVT-5 and PVT-10 were generally similar for response speed, the PVT-3 did not produce results comparable with the PVT-10 for response speed, lapses or errors, and should therefore not be used interchangeably. Further research is required to determine whether the shorter tests are a suitable replacement for the PVT-10 in professional basketball players.

The aim of the present study was to investigate the influence of different types of tasks performed with or without an electronic device (tablet) on pre-sleep alertness, subsequent sleep quality and next-day athletic performance. Eight highly trained netball players attended a sleep laboratory for pre-sleep testing, polysomnographic sleep monitoring and next-day physical performance testing on 5 separate occasions (1 familiarisation and 4 experimental sessions). For 2 h prior to bedtime, athletes completed cognitively stimulating tasks (puzzles) or passive tasks (reading) with or without a tablet. Sleepiness tended to be greater after reading compared to completing puzzles without a tablet (d = 0.80), but not with a tablet. Melatonin concentration increased more so after reading compared to completing puzzles on a tablet (P = 0.02). There were no significant differences in sleep quality or quantity or next-day athletic performance between any of the conditions. These data suggest that using a tablet for 2 h prior to sleep does not negatively affect subsequent sleep or next-day performance in athletes.

Athletes involved in contact sports are habitually exposed to skeletal-muscle damage in their training and performance environments. This often leads to exercise-induced muscle damage (EIMD) resulting from repeated eccentric and/or high-intensity exercise and to impact-induced muscle damage (IIMD) resulting from collisions with opponents and the playing surface. While EIMD has been an area of extensive investigation, IIMD has received comparatively little research, with the magnitude and time frame of alterations following IIMD not presently well understood. It is currently thought that EIMD results from an overload of mechanical stress that causes ultrastructural damage to the cellular membrane constituents. Damage leads to compromised ability to produce force, which manifests immediately and persists for up to 14 d following exercise exposure. IIMD has been implicated in attenuated neuromuscular performance and recovery and in inflammatory processes, although the underlying course over time remains unclear. Exposure to EIMD leads to an adaptation to subsequent exposures, a phenomenon known as the repeated-bout effect. An analogous adaptation has been suggested to occur following IIMD; however, to date, this contention remains equivocal. While a considerable body of research has explored the efficacy of recovery strategies following EIMD, strategies promoting recovery from IIMD are limited to investigations using animal contusion models. Strategies such as cryotherapy and antioxidant supplementation that focus on attenuating the secondary inflammatory response may provide additional benefit in IIMD and are explored herein. Further research is required to first establish a model of generating IIMD and then explore broader areas around IIMD in athletic populations.

Currently, very little is known about the impact of short- or long-haul air travel on the sleep and wellbeing of wheelchair basketball athletes. Eleven national wheelchair basketball athletes wore actigraphy monitors prior, during, and after air travel to the United Kingdom. Upon arrival, participants rated their subjective jet-lag, fatigue, and vigor. Individuals traveled to the United Kingdom from different locations in Australia, the United States, and Europe and were categorised according to travel length [LONG (up to 30.2 h) or SHORT (up to 6.5 h)]. Linear mixed models determined effects of travel length on sleep and subjective ratings of jet-lag, fatigue, and vigor. During competition, subjective fatigue and jet-lag were substantially higher (ES = 0.73; ±0.77) and (ES = 0.57; ±0.60), subjective vigor was lower (ES = 1.94; ±0.72), and get-up time was earlier (ES = 0.57; ±0.60) for LONG when compared to SHORT. Travelling greater distances by airplane had a larger effect on subjective ratings of jet-lag, fatigue and vigor, rather than sleep. Irrespective of travel group, sleep and subjective responses were compromised, reflecting the travel requirements, competition-mediated influences, and/or due to a change in environment.

Purpose: This study aimed to determine the recovery timeline of sleep, subjective jet lag and fatigue, and team sport physical performance after east and west long-haul travel. Methods: Ten physically trained men underwent testing at 0900 h and 1700 h local time on four consecutive days 2 wk before outbound travel (BASE), and the first 4 d after 21 h of outbound (WEST) and return (EAST) air travel across eight time zones between Australia and Qatar. Data collection included performance (countermovement jump, 20-m sprint, and Yo-Yo intermittent recovery level 1 [YYIR1] test) and perceptual (jet lag, motivation, perceived exertion, and physical feeling) measures. In addition, sleep was measured via wrist activity monitors and self-report diaries throughout the aforementioned data collection periods. Results: Compared with the corresponding day at BASE, the reduction in YYIR1 distance after EAST was significantly different from the increase in WEST on day 1 after travel (P < 0.001). On day 2, significantly slower 20-m sprint times were detected in EAST compared with WEST (P = 0.03), with large effect sizes (ES) also indicating a greater reduction in YYIR1 distance in EAST compared with WEST (d = 1.06). Mean sleep onset and offset were significantly later and mean time in bed and sleep duration were significantly reduced across the 4 d in EAST compared with BASE and WEST (P < 0.05). Lastly, mean jet lag, fatigue, and motivation ratings across the 4 d were significantly worse in EAST compared with BASE and WEST (P < 0.05) and WEST compared with BASE (P < 0.05). Conclusions: Long-haul transmeridian travel can impede team sport physical performance. Specifically, east travel has a greater detrimental effect on sleep, subjective jet lag, fatigue, and motivation. Consequently, maximal and intermittent sprint performance is also reduced after east travel, particularly within 72 h after arrival.

This study examined the influence of body composition on temperature and blood flow responses to post-exercise cold water immersion (CWI), hot water immersion (HWI) and control (CON). Twenty-seven male participants were stratified into three groups: 1) low mass and low fat (LM-LF); 2) high mass and low fat (HM-LF); or 3) high mass and high fat (HM-HF). Experimental trials involved a standardised bout of cycling, maintained until core temperature reached 38.5°C. Participants subsequently completed one of three 15-min recovery interventions (CWI, HWI, or CON). Core, skin and muscle temperatures, and limb blood flow were recorded at baseline, post-exercise, and every 30 min following recovery for 240 min. During CON and HWI there were no differences in core or muscle temperature between body composition groups. The rate of fall in core temperature following CWI was greater in the LM-LF (0.03 ± 0.01°C/min) group compared to the HM-HF (0.01 ± 0.001°C/min) group (P = 0.002). Muscle temperature decreased to a greater extent during CWI in the LM-LF and HM-LF groups (8.6 ± 3.0°C) compared with HM-HF (5.1 ± 2.0°C, P < 0.05). Blood flow responses did not differ between groups. Differences in body composition alter the thermal response to post-exercise CWI, which may explain some of the variance in the responses to CWI recovery.

The use of cold-water immersion (CWI) for postexercise recovery has become increasingly prevalent in recent years, but there is a dearth of strong scientific evidence to support the optimization of protocols for performance benefits. While the increase in practice and popularity of CWI has led to multiple studies and reviews in the area of water immersion, the research has predominantly focused on performance outcomes associated with postexercise CWI. Studies to date have generally shown positive results with enhanced recovery of performance. However, there are a small number of studies that have shown CWI to have either no effect or a detrimental effect on the recovery of performance. The rationale for such contradictory responses has received little attention but may be related to nuances associated with individuals that may need to be accounted for in optimizing prescription of protocols. To recommend optimal protocols to enhance athletic recovery, research must provide a greater understanding of the physiology underpinning performance change and the factors that may contribute to the varied responses currently observed. This review focuses specifically on why some of the current literature may show variability and disparity in the effectiveness of CWI for recovery of athletic performance by examining the body temperature and cardiovascular responses underpinning CWI and how they are related to performance benefits. This review also examines how individual characteristics (such as physique traits), differences in water-immersion protocol (depth, duration, temperature), and exercise type (endurance vs maximal) interact with these mechanisms.

Objective: To investigate the physiological and perceptual effects of three precooling strategies during pre-exercise rest in athletes with a spinal cord injury (SCI).Design: Randomized, counterbalanced. Participants were precooled, then rested for 60 minutes (22.7 ± 0.2°C, 64.2 ± 2.6%RH).Setting: National Wheelchair Basketball Training Centre, Australia.Participants: Sixteen wheelchair basketball athletes with a SCI.Interventions: Participants were precooled through; 1) 10 minutes of 15.8°C cold water immersion (CWI), 2) ingestion of 6.8 g/kg−1 of slushie (S) from sports drink; 3) ingestion of 6.8 g/kg−1 of slushie with application of iced towels to the legs, torso and back/arms (ST); or 4) ingestion of 6.8 g/kg−1 of room temperature (22.3°C) sports drink (CON).Outcome measures: Core temperature (Tgi), skin temperature (Tsk), heart rate (HR), and thermal and gastrointestinal comfort.Results: Following CWI, a significant reduction in Tgi was observed compared to CON, with a greatest reduction of 1.58°C oc...

ObjectiveUncertainty exists among surgeons as to whether minimally invasive esophagectomy (MIE) is a comparable operation to open esophagectomy (OE). The surgical technique and oncologic dissection should not be degraded when using a minimally invasive approach.MethodsWe reviewed a single hospital’s experience with both OE and MIE. From 2000 to 2010, 257 patients underwent esophagectomy by 1 of 3 surgical techniques: transhiatal, Ivor Lewis, or 3-hole.ResultsOf the 257 patients (median age, 67 years; range, 58–74), 92 underwent MIE. Both groups were comparable in terms of gender, age, comorbidities, surgical technique, and induction chemotherapy and radiotherapy. The overall median follow-up was 29.5 months (range, 9.9–61.5). The MIE group had a significantly shorter operative time (MIE vs OE, 330 vs 365 minutes, P = .04), length of stay (MIE vs OE, 9 vs 12 days, P

BACKGROUND: Two plateletpheresis cell separator systems were compared in a paired crossover study with respect to the product quality, the number of platelet (PLT) units per donation, and the donor comfort. STUDY DESIGN AND METHODS: Forty-four female and 47 male donors were distributed to three body weight groups. Double PLT units with 6 × 1011 PLTs were collected from three Fenwal Amicus Crescendo (AC) and three CaridianBCT Trima Accel (TA) machines. Each donor made one donation on each randomly assigned system and answered a questionnaire on the subjective donor comfort. The answers were scored from 5 (best) to 1 (worst). RESULTS: Based on 182 donations, with 91 donations on AC and TA separators each, 179 runs resulted in double PLT units and three (2×AC, 1×TA) in single units. The white blood cell counts were below 1 × 106 in all but eight therapeutic units (8×TA; mean, 1.98 × 106). The mean PLT yield (AC 6.00 × 1011, TA 5.98 × 1011), the collection rate, and the PLT extraction coefficient did not significantly differ between the two devices. Differences of the donor comfort over all groups were only observed for the loudness of the instrument (4.63 AC vs. 4.24 TA, p