The effect of Ashtanga-Vinyasa Yoga method on air force pilots' operational performance

Introduction

In today's military landscape, optimizing performance and bolstering physical health and mental resilience are critical objectives. Introducing a 12-week Ashtanga Vinyasa Yoga Supta Method (AVYSM) to the training protocol of military trained Airforce pilots, we aim to assesses the feasibility and impact of the method.

Materials and equipment

Borg Scale assesses the intensity level of physical activity during the intervention. Flight simulator data gauges operational performance responses. Postural control responses are measured using a force platform, stress responses are monitored via heart monitor, and handgrip dynamometry will measure strength. Respiratory capacity is assessed using a spirometer, body composition is evaluated using impedance balance, and aviation-related questionnaires are administered before and after the intervention period.

Methods

In a randomized controlled trial, the totality of pilots from the "Masters in Military Aeronautics: aviator pilot specialist" course at the Portuguese Air Force Academy (PAA) were randomly assigned to the yoga intervention or the waiting list control groups, with participants providing written informed consent. The control group followed protocolized course classes for 12 weeks, while the intervention group integrated two weekly one-hour yoga sessions into their course.

Results

The PAA has approved the implementation of this intervention protocol at Airbase 11 in Beja, highlighting its significance for the organization's policy makers. We hypothesize that this method will enhance operational performance and, subsequently, elevate flight safety.

Discussion

This research's potential extends beyond the PAA, as it can be adapted for use in Airforce departments of other nations and various military contexts.

Clinical trial registration

Évora University research ethics committee-approval number 21050. Study registered on ClinicalTrials.gov under identifier NCT05821270, registered on April 19, 2023.

Liquid metals for boosting stability of zeolite catalysts in the conversion of methanol to hydrocarbons

Methanol-to-hydrocarbons (MTH) process has been considered one of the most practical approaches for producing value-added products from methanol. However, the commonly used zeolite catalysts suffer from rapid deactivation due to coke deposition and require regular regeneration treatments. We demonstrate that low-melting-point metals, such as Ga, can effectively promote more stable methanol conversion in the MTH process by slowing coke deposition and facilitating the desorption of carbonaceous species from the zeolite. The ZSM-5 zeolite physically mixed with liquid gallium exhibited an enhanced lifetime in the MTH reaction, which increased by a factor of up to ~14 as compared to the parent ZSM-5. These results suggest an alternative route to the design and preparation of deactivation-resistant zeolite catalysts.

Assessing the trophic ecology and migration on the exposure of cape petrels and Wilson's storm petrels from Antarctica to perfluoroalkylated substances, trace and major elements

Chemical pollution is a global concern as contaminants are transported and reach even the remote regions of Antarctica. Seabirds serve as important sentinels of pollution due to their high trophic position and wide distribution. This study examines the influence of migration and trophic ecology on the exposure of two Antarctic seabirds, Wilson's storm petrel (Oceanites oceanicus - Ooc), and Cape petrel (Daption capense - Dca), to chemical elements and perfluoroalkyl substances (PFAS). Our methodology involved assessing the concentration of these pollutants in feather samples obtained from carcasses, offering a practical means for monitoring contamination. Trace and major element concentrations were comparable in both species, suggesting that migratory patterns have a minimal impact on exposure levels. However, Ooc had higher concentration of PFAS compared to Dca (mean, ng g-1dry weight, PFOA: Ooc:0.710, Dca:0.170; PFTrDA: Ooc:0.550, Dca:0.360, and PFTeDA: Ooc:1.01, Dca:0.190), indicating that migration to the more polluted Northern Hemisphere significantly affects PFAS exposure. Furthermore, while no strong associations were found between either trace elements or PFAS and the three stable isotopes (δ13C, δ15N, and δ34S), a negative association was observed between PFUnDA and δ15N, hinting at potential biodilution. The research concludes that the migratory patterns of these seabird species affect their PFAS exposure, underscoring the critical need for further exploration and understanding of these relationships to better inform conservation strategies.

Impact of annual TB screening on stone quarry workers in high-incidence Portuguese municipalities

SETTING

The Portuguese municipalities of Penafiel and Marco de Canaveses are high TB incidence areas, where stone quarry workers represent a vulnerable population.

OBJECTIVE

To assess the annual rate of TB infection (ARI) in stone quarry workers and to compare it with the TB notification rate in the general community.

DESIGN

An annual TB infection screening strategy using interferon-gamma release assay (IGRA) was implemented in 2018 for workers from high-risk stone quarries. A prospective cohort was enrolled and workers screened in periods of 2 years were included. IGRA-positive workers were referred for preventive treatment. ARI was calculated as the proportion of workers with IGRA conversion.

RESULTS

Of the 232 IGRA-negative workers in 2018, 20 tested positive in 2019 (8.6% ARI). Of 171 IGRA-negative workers in 2019, eight tested positive in 2021 (4.7% in 2 years). Two of the 150 IGRA-negative workers in 2021 tested positive in 2022 (1.3% ARI). ARI decreased by 84.9% between 2019 and 2022. In the two municipalities, the TB notification rate declined 23.9% between 2018 and 2021.

CONCLUSION

A more pronounced reduction in ARI was observed among stone quarry workers regularly screened for TB infection compared to the notification rate among the general population in high-incidence municipalities. A screening strategy for high-risk populations, together with enforced community measures, could foster risk reduction in the community..

Special Issue "Sports Science in Children"

In recent times, research and technological advancements have opened an unprecedented window of opportunity for sports science to play a pivotal role in the holistic well-being of children [...].

Olmesartan-Induced Enteropathy: When the Treatment of One Disease Causes Another

Olmesartan is an angiotensin II receptor antagonist used for the management of hypertension. This drug can lead to an enteropathy that clinically and histologically resembles coeliac disease. Symptoms may appear months or years after the introduction of the drug and usually resolve after discontinuation. The authors present a case of an 86-year-old woman with hypertension who was treated with olmesartan for 10 years. She presented to the emergency department with diarrhoea after three months of development and weight loss. The aetiological study that was conducted excluded infectious, inflammatory, endocrinological, and neoplastic causes. The pathological anatomy of the duodenal biopsy was suggestive of coeliac disease, but the serology was not compatible. The patient presented complete remission of the condition with the suspension of the drug and subsequent recrudescence when, by self-initiation, she resumed olmesartan. This case study aims to alert readers of a rare cause of enteropathy with a clinical manifestation that mimics coeliac disease. Olmesartan-induced enteropathy seems to be a diagnosis of exclusion and should be considered in patients chronically medicated with olmesartan.

Obstructive Sleep Apnea: a risk for uncontrolled and more severe asthma in adults that we should keep an eye on

Summary

Background. Asthma control can be influenced by several factors, including obstructive sleep apnea (OSA). The literature reports variable prevalence and magnitude of OSA impact on asthma outcomes. The aim of our study is to analyze the frequency of high-risk for OSA in asthma patients and its impact on disease severity and control. Methods. We conducted a cross-sectional study at an Allergy Department with adult asthma patients recruited while undergoing routine lung function tests. Data on sex, age, body mass index, allergen sensitization, smoking habits, risk of OSA (using the Berlin questionnaire), rhinitis control (through CARAT), asthma severity (based on GINA 2023), asthma control (using the ACT), adherence to asthma treatment (through Treatment Adherence Measure) and pulmonary function test results were collected. Results. We included 216 patients, predominantly women (70.4%), with a median (P25-P75) age of 29.0 (21.0-45.0) years, of whom 28.2% were on GINA treatment levels 4-5. In 75.5% of cases asthma was controlled. High-risk for OSA was identified in 21.8% of patients. Asthma patients with high-risk for OSA were more likely to have uncontrolled [(47.8%; n = 22) vs (15.8%; n = 26); p less than 0.001] and more severe disease [(44.7%; n = 21) vs (23.7%; n = 40), p = 0.006]. In multivariable analysis, high-risk for OSA (OR 2.81 [95%CI 1.1.28-6.17], p = 0.010), sex (women) (OR 5.21 [95% CI 1.70-15.96], p = 0.004), uncontrolled rhinitis (OR 3.65 [95%CI 1.38-9.64], p = 0.009) and GINA asthma treatment steps 4-5 (OR 2.46 [95%CI 1.15-5.26], p = 0.020) were associated with uncontrolled asthma. Conclusions. It is crucial to actively investigate OSA, especially in patients with uncontrolled and more severe forms of asthma.

Chronic Lithium Intoxication: A Challenging Diagnosis

Lithium has been used in clinical practice since the 1970s. This medication is commonly used to treat and prevent bipolar disorder, but it has a narrow therapeutic index, making toxicity a frequent occurrence. Chronic lithium intoxication can arise due to progressive accumulation, particularly in contexts of dehydration. The effects of chronic lithium intoxication on the nervous, renal, and cardiac systems, as well as on the thyroid and parathyroid glands, are well documented in the literature. The authors present the case of a 66-year-old woman with schizoaffective psychosis and chronic kidney disease, admitted due to altered mental status and dysarthria. Notwithstanding an earlier clinical recommendation to cease lithium administration more than a year ago, the patient continued its usage, culminating in neurological, cardiac, renal, and endocrine manifestations. Although the diagnosis was delayed, her clinical progression was favorable, obviating the need for renal replacement therapy. This case highlights the importance of a detailed medical history and the diagnostic challenges in clinical practice. The use of this drug without proper monitoring can lead to multisystem dysfunction.

From Suspected COVID-19 to Anti-synthetase Syndrome: A Diagnostic Challenge in the Pandemic Era

Anti-synthetase syndrome (ASS), a rare immunomediated disease, is characterized by multiple signs and symptoms. Not all patients develop the entire clinical spectrum of the syndrome, as it often varies depending on the involved antibodies. In this case report, a 53-year-old non-smoking woman had complaints of fatigue and dyspnea on exertion for five weeks. The outpatient study revealed creatine kinase (CK) 351U/L, ANAs+, anti-SSa+, normal echocardiogram, and a chest X-ray suggesting imaging suspicion of SARS-CoV-2 pneumonia. Referred to the emergency department, she was hospitalized for bilateral interstitial pneumonia without respiratory failure. Three SARS-CoV-2 polymerase chain reaction tests were negative. She underwent a five-day course of dexamethasone 6mg due to suspected coronavirus disease 2019 (COVID-19) sequelae with favorable progress. About a month later, she experienced fatigue, exertional intolerance, morning cough, and Raynaud's phenomenon episodes. Anti-SARS-CoV-2 antibodies were negative, and a follow-up chest CT showed bilateral organizing pneumonia. Bronchofibroscopy and bronchoalveolar lavage with cytology suggestive of inflammatory appearance, predominantly CD8+ lymphocytes, were performed. Subsequently, positive results for anti-OJ antibodies were obtained. A diagnosis of ASS was established, and prednisolone was initiated at 60mg/day with a tapering regimen, resulting in clinical and radiological improvement. Additional therapy with azathioprine was proposed. This case is presented due to highly suggestive COVID-19 imaging changes, emphasizing the importance of a high suspicion of ASS, despite nearly exclusive pulmonary involvement, with only one isolated elevated CK value and no musculoskeletal complaints. It is also noteworthy for the association with anti-OJ antibodies, rarely identified, often presenting interstitial lung disease as an isolated manifestation.

Dipyrone (Metamizole)-Induced Stevens-Johnson Syndrome

Stevens-Johnson Syndrome (SJS), a severe mucocutaneous hypersensitivity reaction primarily triggered by drugs, poses a low-incidence, high-mortality challenge. This report explores its clinical nuances and emphasizes supportive care as the mainstay of treatment. A 74-year-old female, burdened with a complex medical history, presented with a non-pruritic macular rash escalating to skin and oral mucosal involvement. A recent introduction of dipyrone (metamizole) implicated drug-induced SJS. Histopathological confirmation guided treatment involving supportive care, corticosteroids, and wound care, resulting in clinical improvement. The case underscores the significance of histopathological confirmation and thorough medication history in navigating SJS complexities, especially in patients with comorbidities like connective tissue disease. A successful multidisciplinary approach and the decision for post-discharge monitoring highlight the intricate management challenges. This case illuminates the intricate interplay of medication-induced hypersensitivity, comorbidities, and management challenges in SJS. Optimal outcomes require prompt diagnosis, trigger identification, and a multidisciplinary treatment approach, emphasizing ongoing research and clinical vigilance.

Assessment of spatiotemporal characteristics of gait, trough the Phyphox® app: a case series

BACKGROUND

Spatiotemporal characteristics from human locomotion can provide effective clinical metrics to assess motor control and brain function. This case report aims to assess the temporal structure of variability in stride-to-stride time and calculated the intrinsic fractal frame that is hidden below the repetitive structure of physiological gait through the "Phyphox" app. This is an innovative study from the perspective of analyzing gait variables through a mobile app.

CASE PRESENTATION

Five older adults Caucasian (3 women; age = 73 ± 10,5 years; body mass = 62,2 ± 15,1 kg; height = 1,56 ± 0,1 m; 2 men; age = 75,5 ± 7,8 years; body mass = 86,3 ± 18,0 kg; height = 1,77 ± 0,1 m) participated in this study. Five participants were asked to walk with a natural cadence, two of the participants presented a value greater than 80 step's/minute (81.14 ± 0.01; 86.67 ± 0.02); and the others had values between 55 and 65 step's/minute (55.20 ± 0.02; 55.78 ± 0.05; 61.02 ± 0.05). Regarding the coefficient of variation, only one participant presented 10.08%. For the total number of steps, three of the participants had values greater than 1000 steps. The variability of these stride-to-stride time has been quantified through detrended fluctuation analysis; one participant presented a value above 1.

CONCLUSIONS

This study provides evidence that a smartphone might provide a valid measure to assess the spatiotemporal characteristics of gait.

Longitudinal Assessment of Curaçao Criteria in Children with Hereditary Hemorrhagic Telangiectasia

OBJECTIVE

To assess the utility of the Curaçao criteria by age over time in children with hereditary hemorrhagic telangiectasia (HHT).

STUDY DESIGN

This was a single-center, retrospective analysis of patients attending the HHT clinic at the Hospital for Sick Children (Toronto, Canada) between 2000 and 2019. The evaluation of the Curaçao criteria was completed during initial and follow-up visits. Screening for pulmonary and brain arteriovenous malformations was completed at 5 yearly intervals.

RESULTS

A total of 116 patients with genetic confirmation of HHT were included in the analysis. At initial screening at a median (IQR) age of 8.4 (2.8, 12.9) years, 41% met criteria for a definite clinical diagnosis (≥3 criteria). In children <6 years at presentation, only 23% fulfilled at least 3 criteria initially. In longitudinal follow-up, 63% reached a definite clinical diagnosis, with a median (IQR) follow-up duration of 5.2 (3.2, 7.9) years (P = .005). Specifically, more patients met the epistaxis and telangiectasia criteria at last visit compared with initial (79% vs 60%; P = .006; 47% vs 30%; P = .02) but not for the arteriovenous malformation criterion (59% vs 57%; P = .65).

CONCLUSIONS

In the pediatric population, most patients do not meet definite clinical criteria of HHT at initial presentation. Although the number of diagnostic criteria met increased over time, mainly due to new onset of epistaxis and telangiectasia, accuracy remained low during follow-up visits. Relying solely on clinical criteria may lead to underdiagnosis of HHT in children.

Anthropogenic debris ingestion in a tropical seabird community: Insights from taxonomy and foraging distribution

Oceans have been considered as an unlimited supply of goods and services, but resource extraction and waste disposal became ubiquitous and have been damaging the health of marine ecosystems. Finding suitable sentinel species of the human impacts on the oceans is thus imperative, since they may work as early warnings of disruptive situations. In this study, we investigated how taxonomy and foraging distribution influenced the occurrence of anthropogenic debris among five seabird species inhabiting the tropical Atlantic region. Occurrence of anthropogenic debris was assessed using faeces of breeding individuals as a proxy of ingestion. A total of 268 particles were extracted from all samples. The categories "fragments" and "fibres", as well as the colour "blue", were the most prevalent characteristics across species. There was a high diversity of polymers from cellulosic particles to synthetic plastics (Anthropogenic Cellulosic 26.9 %; Polyester 7.7 %; Varnish 5.8 %; Polypropylene 1.9 %). Species with a more coastal foraging strategy exhibited higher occurrence and number of anthropogenic debris when compared to species foraging comparably more in pelagic areas. This suggests that anthropogenic debris are more prevalent in coastal foraging areas, where human activities occur in higher number and frequency (e.g., fisheries) and sources of freshwater input from inland are at close distance. These results provide more evidence to the growing perception on the ubiquity and diversity of anthropogenic debris in the marine environment, and further support the usefulness of using seabirds as bio-indicators of anthropogenic pollution in both neritic and oceanic regions.

Effectiveness of wearable technology to optimize youth soccer players' off-training behaviour and training responses: a parallel group randomized trial

BACKGROUND

Although youth soccer players meet and exceed the weekly physical activity (PA) guidelines also exhibit high off-training sedentary behaviour (SB) levels. Recent evidence indicated that low PA preceding training leads to decreased PA intensity in soccer practice and that SB impairs sports performance and recovery. Thus, a parallel group randomized trial examined the effect of activity wristbands on young players' off-training PA and SB profiles; assessed the added value of wearable wristbands with PA warnings; and investigated whether manipulating off-training PA can affect the players' training responses.

METHODS

Thirty-two adolescent soccer players (16.1 ± 0.9 years old) were monitored during weekdays for two weeks (interspersed with one week). Players were randomly assigned to a reminder to move (REM) and a non-reminder to move group (nREM). The REM wore an activity wristband (Fitbit Charge 2) with PA warnings in the last week of research, while the nREM wore identical monitors without PA feedback. Throughout the study, off-training PA was assessed using tri-axial accelerometers, and training responses were analysed using wearable inertial monitoring units. Gardner-Altman estimation plots and a Fisher's Exact Test of Independence estimated each group's off-training PA changes between the monitored weeks. Complementary, an analysis of covariance (ANCOVA) quantified the effect of Fitbit wristband configurations (with a reminder to move or without a reminder to move) on the off-training PA and soccer training external load variables. The independent variable group had two levels (REM and nREM). The off-training PA and training load values collected in the first week were introduced in the model as a covariate, the groups were designated fixed factors and the off-training PA and training load from the third week were the dependent variables. The team was also included as a covariate and the between-group differences post-intervention were adjusted for baseline and team.

RESULTS

Interestingly, results showed that different wearable wristbands did not influence the players' off-training PA profiles (p > 0.05). Concomitantly, no differences were observed in training responses (p > 0.05).

CONCLUSION

Findings emphasize the importance of health and youth sports organizations in developing newer approaches for promoting healthier lifestyles, beyond training practices, with potentially favourable implications for sports performance.

Mercury exposure in Antarctic seabirds: Assessing the influence of trophic position and migration patterns

Although naturally present in the environment, mercury (Hg) input is significantly amplified by anthropogenic activities on a global scale, leading to a growing concern about the recent increase in Hg levels observed in Antarctica. This study investigated total mercury (THg) concentrations in feathers and eggs of resident and migratory Antarctic seabirds. Stable isotope data (δ15N, δ13C, and δ34S) were employed to ascertain the key factors influencing the exposure of these species to Hg. We gathered feathers and eggs from three resident species - Adélie, Gentoo, and Chinstrap penguins, as well as five migratory species - Snowy Sheathbill, Antarctic Tern, Southern Giant Petrel, Kelp Gull, and South Polar Skua. These samples were collected from Admiralty Bay, King George Island, in the Antarctica Peninsula. For all species, THg concentrations were higher in feathers (mean ± SD: 2267 ± 2480 ng g-1 dw) than in eggs (906 ± 1461 ng g-1 dw). Species occupying higher trophic positions, such as the Southern Giant Petrel (5667 ± 1500 ng g-1 dw) and South Polar Skua (4216 ± 1101 ng. g-1 dw), exhibited higher THg levels in their feathers than those at lower positions, like Antarctic Tern (1254 ± 400 ng g-1 dw) and Chinstrap Penguin (910 ± 364 ng g-1 dw). The δ15N values, which serve as a proxy for the trophic position, significantly correlated with THg concentrations. These findings reveal that trophic position influences THg concentrations in Antarctic seabirds. Migration did not appear to significantly affect the exposure of seabirds to THg, contrary to initial expectations. This research highlights the importance of evaluating the impacts of THg contamination on the Antarctic ecosystem by considering a variety of species. This multi-species approach offers critical insights into the factors that may potentially influence the exposure of these species to contaminants.

The effects of individual and collective variability on youth players' movement behaviours during football small-sided games

This study aimed to identify the effects of playing with additional individual (IND), collective (COL) or individual-collective (MIX) variability on youth football players' performance during small-sided games. Twelve youth football players (U17, age = 16.1 ± 0.9 years) played a goalkeeper (Gk) + 6 outfield players a-side (Gk+6vs6+Gk) under four conditions: (i) playing in the 1:2:3:1 formation without any other rule (control condition, CTR); (ii) 1:2:3:1 formation with additional body restrictions changing each minute (individual condition, IND); (iii) using different tactical formations modified each minute (collective condition, COL; (iv) using different tactical formations and body restrictions varied each minute (individual-collective condition, MIX). Generally, there were similar behaviours across conditions, especially for the CTR and the MIX. Nevertheless, the CTR condition presented moderate higher values in the lateral direction (p ≤ .05), while also higher longitudinal synchronization compared to the IND (p ≤ .05). The COL condition presented higher spatial exploration (p ≤ .05), which may justify the higher values for distance covered while running and sprinting (p ≤ .05). Overall, coaches may use the IND condition to refine players' technical actions, while the COL condition to develop players' ability to perform in different playing positions and team structures.

HbA1c as a shared treatment goal in type 2 diabetes? A secondary analysis of the DEBATE trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a major health problem in the western world. Despite a widespread implementation of integrated care programs there are still patients with poorly controlled T2DM. Shared goal setting within the process of Shared Decision Making (SDM) may increase patient's compliance and adherence to treatment regimen. In our secondary analysis of the cluster-randomized controlled DEBATE trial, we investigated if patients with shared vs. non-shared HbA1c treatment goal, achieve their glycemic goals.

METHODS

In a German primary care setting, we collected data before intervention at baseline, 6, 12 and 24 months. Patients with T2DM with an HbA1c ≥ 8.0% (64 mmol/mol) at the time of recruitment and complete data at baseline and after 24 months were eligible for the presented analyses. Using a generalized estimating equation analysis, we analysed the association between the achievement of HbA1c goals at 24 months based on their shared vs. non-shared status, age, sex, education, partner status, controlled for baseline HbA1c and insulin therapy.

RESULTS

From N = 833 recruited patients at baseline, n = 547 (65.7%) from 105 General Practitioners (GPs) were analysed. 53.4% patients were male, 33.1% without a partner, 64.4% had a low educational level, mean age was 64.6 (SD 10.6), 60.7% took insulin at baseline, mean baseline HbA1c was 9.1 (SD 1.0). For 287 patients (52.5%), the GPs reported to use HbA1c as a shared goal, for 260 patients (47.5%) as a non-shared goal. 235 patients (43.0%) reached the HbA1c goal after two years, 312 patients (57.0%) missed it. Multivariable analysis shows that shared vs. non-shared HbA1c goal setting, age, sex, and education are not associated with the achievement of the HbA1c goal. However, patients living without a partner show a higher risk of missing the goal (p = .003; OR 1.89; 95% CI 1.25-2.86).

CONCLUSIONS

Shared goal setting with T2DM patients targeting on HbA1c-levels had no significant impact on goal achievement. It may be assumed, that shared goal setting on patient-related clinical outcomes within the process of SDM has not been fully captured yet.

TRIAL REGISTRATION

The trial was registered at ISRCTN registry under the reference ISRCTN70713571.

Fine scale genetics reveals the subtle negative effects of roads on an endangered bat

The effective management of species with small and fragmented populations requires an in-depth understanding of how the effects of human-induced habitat disturbance shape the structure and gene flow at fine spatial scales. Identification of putative environmental barriers that affect individual exchange among subpopulations is imperative to prevent extinction risks. Here, we investigated how landscape affects the gene flow and relatedness structure of a population of the endangered lesser horseshoe bat (Rhinolophus hipposideros). We also assessed the effects of sexbiased dispersal on genetic relatedness. We genotyped 287 bat samples collected across southern Portugal and developed resistance surfaces for landscape variables hypothesized to affect gene flow. Then, we used spatially explicit models to fit relatedness distance through the resistance surfaces. We found genetic evidence of sex-biased dispersal and identified a significant fine scale structuring in the relatedness regarding females, the philopatric sex. Males displayed uniform levels of relatedness throughout the landscape. The results indicated less relatedness between the female´ from roosts located on proximity of roads than in roosts away from roads. Also, when analysing the sexes together the relatedness on roosts separated by highway were subtly less related in comparison to those occurring on the same side. Roads seem to be major shapers of the contemporary population structure of females, regardless of being relatively recent structures in the landscape. Furthermore, the relatedness patterns detected suggested that high tree density among roosts and continuity of forest patches in broader surrounding areas, promotes the relatedness among individuals. Landscape heterogeneity among roosts slightly decreases genetic relatedness. Nevertheless, those relationships are still weak, suggesting that population structuring driven by those factors is slowly ongoing. Thus, effective management measures should focus on issues for promoting safe road passages and suitable habitat corridors, allowing for the exchange of individuals and gene flow among lesser horseshoe bat roosts.

Fipronil affects cockroach behavior and olfactory memory

Fipronil (FPL), an insecticide belonging to the class of phenylpyrazoles, is associated with the widespread mortality of pollinator insects worldwide. Based on studies carried out on residual concentrations of FPL commonly found in the environment, in this work, we evaluated the sublethal effects of FPL on behavior and other neurophysiological parameters using the cockroach Nauphoeta cinerea as a biological model. Sublethal doses of FPL (0.1-0.001 µg/g) increased the time spent grooming and caused dose-dependent inhibition of exploratory activity, partial neuromuscular blockade in vivo, and irreversible negative cardiac chronotropism. FPL also disrupted learning and olfactory memory formation at all doses tested. These results provide the first evidence that short-term exposure to sublethal concentrations of FPL can significantly disrupt insect behavior and physiology, including olfactory memory. These findings have implications for current pesticide risk assessment and could be potentially useful in establishing a correlation with pesticide effects in other insects, such as honey bees.

Family Conferences to Facilitate Deprescribing in Older Outpatients With Frailty and With Polypharmacy: The COFRAIL Cluster Randomized Trial

Importance

For older adults with frailty syndrome, reducing polypharmacy may have utility as a safety-promoting treatment option.

Objective

To investigate the effects of family conferences on medication and clinical outcomes in community-dwelling older adults with frailty receiving polypharmacy.

Design, Setting, and Participants

This cluster randomized clinical trial was conducted from April 30, 2019, to June 30, 221, at 110 primary care practices in Germany. The study included community-dwelling adults aged 70 years or older with frailty syndrome, daily use of at least 5 different medications, a life expectancy of at least 6 months, and no moderate or severe dementia.

Interventions

General practitioners (GPs) in the intervention group received 3 training sessions on family conferences, a deprescribing guideline, and a toolkit with relevant nonpharmacologic interventions. Three GP-led family conferences for shared decision-making involving the participants and family caregivers and/or nursing services were subsequently held per patient at home over a period of 9 months. Patients in the control group received care as usual.

Main Outcomes and Measures

The primary outcome was the number of hospitalizations within 12 months, as assessed by nurses during home visits or telephone interviews. Secondary outcomes included the number of medications, the number of European Union list of the number of potentially inappropriate medication (EU[7]-PIM) for older people, and geriatric assessment parameters. Both per-protocol and intention-to-treat analyses were conducted.

Results

The baseline assessment included 521 individuals (356 women [68.3%]; mean [SD] age, 83.5 [6.17] years). The intention-to-treat analysis with 510 patients showed no significant difference in the adjusted mean (SD) number of hospitalizations between the intervention group (0.98 [1.72]) and the control group (0.99 [1.53]). In the per-protocol analysis including 385 individuals, the mean (SD) number of medications decreased from 8.98 (3.56) to 8.11 (3.21) at 6 months and to 8.49 (3.63) at 12 months in the intervention group and from 9.24 (3.44) to 9.32 (3.59) at 6 months and to 9.16 (3.42) at 12 months in the control group, with a statistically significant difference at 6 months in the mixed-effect Poisson regression model (P = .001). After 6 months, the mean (SD) number of EU(7)-PIMs was significantly lower in the intervention group (1.30 [1.05]) than in the control group (1.71 [1.25]; P = .04). There was no significant difference in the mean number of EU(7)-PIMs after 12 months.

Conclusions and Relevance

In this cluster randomized clinical trial with older adults taking 5 or more medications, the intervention consisting of GP-led family conferences did not achieve sustainable effects in reducing the number of hospitalizations or the number of medications and EU(7)-PIMs after 12 months.

Trial Registration

German Clinical Trials Register: DRKS00015055.

Exploring the Effects of Tasks with Different Decision-Making Levels on Ball Control, Passing Performance, and External Load in Youth Football

This study aimed to understand how the design of decision-making tasks affects youth football players' ball control, passing performance, and external load. A total of 16 male youth football players (age: 12.94 ± 0.25 years) competed in various tasks based on the following levels of decision-making: (i) low decision-making (Low DM), which consisted of a predefined ball control and passing sequence; (ii) moderate decision-making (Mod DM), which consisted of maintaining possession in a square with four players and two balls while maintaining the same position; and (iii) high decision-making (High DM), which consisted of a 3 vs. 3 + 2 neutral players ball possession game. The study design consisted of a pre-post design (a 6 min pre-test game, a 6 min intervention, and a 6 min post-test game). The players' ball control and passing performance were measured using the game performance evaluation tool and notational analysis, while GPS data were used to determine their physical performance. The pre-post test analysis revealed decrements in players' ability to identify more offensive players after the Mod DM task (W = 9.50, p = 0.016), while there was an increase in their ability to receive the ball towards the space following the High DM task (t = -2.40, p = 0.016). Analysis between groups showed lower values in most ball control variables for the Low DM task compared to the Mod DM task (ball control execution, p = 0.030; appropriateness, p = 0.031; motor space, p = 0.025), while there were also lower values in the distance covered while sprinting (p = 0.042). Overall, prescriptive tasks (Low DM) that are repetitive in nature may affect players' perceptual attunement, whereas static tasks (e.g., Mod DM) may limit their ability to locate players in more offensive positions. Moreover, game-based situations (High DM) seem to acutely enhance players' performance, possibly due to contextual dependency. Overall, coaches should carefully consider the type of practice structure when designing tasks that aim to improve players' technical skills in youth football.

Potential Role of Insulin-Like Growth Factors in Myofascial Pain Syndrome: A Narrative Review

ABSTRACT

Insulin-like growth factors have diverse functions in skeletal muscles by acting through multiple signaling pathways, including growth regulation and differentiation, anti-inflammation, and antioxidation. Insulin-like growth factors have anti-inflammatory effects and also play roles in nociceptive pathways, determining pain sensitivity, in addition to their protective role against ischemic injury in both the nervous system and skeletal muscle. In skeletal muscle, insulin-like growth factors maintain homeostasis, playing key roles in maintenance, accelerating muscle regeneration, and repair processes. As part of their maintenance role, increased levels of insulin-like growth factors may be required for the repair mechanisms after exercise. Although the role of insulin-like growth factors in myofascial pain syndrome is not completely understood, there is evidence from a recent study that insulin-like growth factor 2 levels in patients with myofascial pain syndrome are lower than those of healthy individuals and are associated with increased levels of inflammatory biomarkers. Importantly, higher insulin-like growth factor 2 levels are associated with increased pain severity in myofascial pain syndrome patients. This may suggest that too low or high insulin-like growth factor levels may contribute to musculoskeletal disorder process, whereas a midrange levels may optimize healing without contributing to pain hypersensitivity. Future studies are required to address the mechanisms of insulin-like growth factor 2 in myofascial pain syndrome and the optimal level as a therapeutic agent.

Lithium Intoxication in an Elderly Woman

Acute confusional state or delirium in the elderly frequently requires a lengthy differential diagnosis in the emergency room (ER) to determine the factors of its multiple causes. Iatrogeny can be one of the causes, especially in elderly people with polypharmacy. We present a case of a 77-year-old female, independent in activities of daily living, with no cognitive impairment and a history of hypertension, dyslipidemia, and manic-depressive disorder. She arrived at the ER with diarrhea, vomiting, and myalgias. A blood test revealed an acute kidney injury. The patient was discharged with the diagnosis of acute gastroenteritis and prerenal acute kidney injury. The patient returned to the ER two days later due to worsening symptoms, including spatial and temporary disorientation and a marked prostration. The attending physician recommended a lithium blood level test due to the patient's history and the outpatient's psychiatric medication. The tests revealed a value of 2.18 mmol/L (toxic levels: >2.0 mmol/L). Support measures were initiated with diuresis control and vigorous hydration, with subsequent clinical and biochemical improvement (lithium blood levels reduced to 0.97 mmol/L). Lithium toxicity causes acute nausea, vomiting, diarrhea, and neurological symptoms that have a slower onset and correlate with chronic toxicity. A declining renal function and reduced volume of distribution (due to increased body fat mass and decreased total body water) contribute to more significant pharmacological toxicity in the elderly. In this case, dehydration triggered by diarrhea and vomiting may have been a cause or a consequence. Reviewing chronic medication and a detailed investigation of all etiological causes was essential for the patient's rehabilitation, avoiding possible irreversible neurological damage.

Application of Fourier transform infrared spectroscopy (FTIR) techniques in the mid-IR (MIR) and near-IR (NIR) spectroscopy to determine n-alkane and long-chain alcohol contents in plant species and faecal samples

n-Alkanes and long-chain alcohols (LCOH) have been used as faecal markers to assess the feeding behaviour of both wild and domestic herbivore species. However, their chemical analysis is time-consuming and expensive, making it necessary to develop more expeditious methodologies to evaluate concentrations of these markers. This work aimed to evaluate the use of Fourier Transform Infrared Spectroscopy (FTIR) technology in the near infrared (NIR) and mid infrared (MIR) intervals, for the determination of n-alkane and LCOH concentrations of different plant species and faecal samples of domestic herbivores. Spectra of 33 feed samples, namely L. perenne, T. repens, U. gallii, short heathers (mixture of Erica spp. and Calluna vulgaris), improved pasture grasses (mixture of L. perenne and A. capillaris), heath grasses (mixture of P. longifolium and A. curtissii), improved pasture species (mixture of L. perenne, T. repens and A. capillaris) and herbaceous species (mixture of all herbaceous species found in the plot)) and 181 faecal samples (cattle and horses) were recorded. In order to develop calibrations for the prediction of n-alkanes and LCOH concentrations, partial least squares (PLS) regression was used. Regarding the models developed for plant species, the best results were observed for the calibrations using NIR. The best external validation coefficients of determination (R²v) obtained were 0.90 and 0.79 for LCOH and n-alkanes, respectively. For faecal samples, in the NIR interval, results indicate similar external validation predictions (R²v) for both animal species (0.64). On the contrary, in the MIR interval, differences between cattle (0.70) and horses (0.57) faecal samples in R²v were observed. Regarding the models created for both animal species faeces, LCOH (C₂₆-OH and C₃₀-OH concentrations ranging from 713.3 to 4451.9 mg/kg DM, respectively; R²v values ranging from 0.72 to 0.95) and n-alkanes (C31 and C33 concentrations ranging from 112.8 to 643.2 mg/kg DM, respectively; R²v values ranging from 0.19 to 0.90) present in higher concentrations tended to be those with better estimates. Results obtained suggest that the selection of the technique to be used may depend on the type of matrix, being the homogeneity of the matrices one of the most important factors for its success. In order to improve the accuracy and robustness of the models created for the estimation of the concentrations of these markers using these methodologies, the database (greater variability) used for the calibrations of these models must be increased.

Maternal care experience and postpartum depressive symptoms among migrant and native in Portugal

Background

Migration is a risk factor for both, poor maternal experience with healthcare services (MEHCS) and postpartum depressive symptoms (PPDS), a matter of concern due to their adverse consequences. We aimed to assess the association between MEHCS and PPDS taking into account the migration status.

Methods

This is part of a population-based study (baMBINO project), enrolling native (PT; n = 1568), permanent migrant (PM; n = 676) and temporary migrant (TM; n = 757) women recruited at delivery (2017-2019) in 32 Portuguese public hospitals. MEHCS was assessed based on 39 items of the Migrant Friendly Maternal Care Questionnaire asking about how women have experienced maternal care during pregnancy, during delivery and after birth. Items were grouped into 9 components each one assessing a different issue of MEHCS. For each component women were classified as having “good” or “less than good” experience. PPDS were assessed using the Edinburgh Postnatal Depression Scale (cut-off≥12). Multivariate logistic regression model was fitted to estimate the association between MEHCS and PPDS. Adjusted odds ratio (aOR) and respective 95% confidence interval were obtained.

Results

PPDS were reported by 3.8%, 5.8% and 8.2% of PT, PM and TM women, respectively (p &lt; 0.001). After adjustment, 4 out 9 components of MEHCS appeared related with PPDS, such that women reporting less than good experience with “understanding information” (aOR=1.72 95%CI:1.14-2.60), “decisions according to maternal wishes” (aOR=1.56 95% CI:1.04-2.34), “time waiting for healthcare” (aOR=1.50 95%CI:1.04-2.18) and “healthcare provider's attitudes during pregnancy” (aOR=1.58 95%CI:1.01-2.47) showed higher odds of PPDS than women reporting good experience.

Conclusions

Further than the migration status, poor experience with some issues of maternal care seems play a role in the risk of PPDS

Key messages

Investigating the Effects of Differential Learning on Golfers' Pitching Performance as a Function of Handicap

Traditionally, golf instruction has been oriented toward imitation of role models, guided by errors that surround a channel of supposedly correct repetition. Recent motor learning approaches relying on the dynamics of living systems suggest the inclusion of additional noise during practice for supporting players' movement exploration and improving adaptability that in consequence will lead to increased performance. While the effectiveness of this approach has now been demonstrated in many sports, research exploring the effects of differential learning (DL) in golf is scarce, especially when considering different shot distances and players with various handicap levels. Therefore, the purpose of this study was to compare the effects of an enriched learning and information intervention as opposed to a more constrained approach, on the pitching performance of golfers with different handicaps from different distances. A total of 29 adolescent golfers with an average experience of 7.8 years were divided into a DL (n = 15) and a repetitive-oriented (RB, n = 14) group. Both groups were further compared dependent on their handicap level (DL, low handicap n = 7, high handicap n = 8; RB, low handicap n = 5, high handicap n = 9). The TrackMan 4 was used to measure the shot performance for 20 m, 35 m, and 50 m distances (10 shots from each distance) based on a pre- and post-test design. Each group performed the same number of trials (n = 270, 9 executions per distance per session) across 10 sessions. Analysis of covariance (ANCOVA) was used for the statistical analysis, using the pre-test as covariate and the post-test as dependent variable. The DL group revealed advantageous adaptations in the attack and face angle (p ≤ 0.05), while also in the dynamic loft (p ≤ 0.05), mostly for the 35 m and 50 m. In addition, this intervention led to improvements in the score, club head speed, and carry distance for the 50 m when compared to the RB (p ≤ 0.05; small effects). The low handicap players from the DL group also revealed adaptation in the angles' variables (p ≤ 0.05) when compared with high handicap players, who improved the score (p ≤ 0.05) in all distances after intervention. The low handicap players from the RB group improved the score (p ≤ 0.05) and club speed (p ≤ 0.05) for the 20 and 35 m, while the high handicap golfers revealed higher improvements for these variables only in the 50 m distance condition. Overall, coaches may incorporate approaches into their skill training that increase the number of opportunities to improve the performance of both experienced and non-experienced players by promoting the adaptability of movement patterns.

Development of a deprescribing manual for frail older people for use in the COFRAIL study and in primary care

Introduction:

Many older adults are affected by multimorbidity and subsequent polypharmacy which is associated with adverse outcomes. This is especially relevant for frail older patients. Polypharmacy may be reduced via deprescribing. As part of the complex intervention in the COFRAIL study, we developed a deprescribing manual to be used by general practitioners (GPs) in family conferences, in which GPs, patients and caregivers jointly discuss treatments.

Methods:

We selected indications with a high prevalence in older adults in primary care (e.g. diabetes mellitus, hypertension) and conducted a literature search to identify deprescribing criteria for these indications. We additionally reviewed clinical practice guidelines. Based on the extracted information, we created a deprescribing manual which was then piloted in an expert workshop and in family conferences with volunteer patients according to the inclusion and exclusion criteria of the study protocol.

Results:

Initially, 13 indications/topics were selected. The literature search identified deprescribing guides, reviews and clinical trials as well as lists of potentially inappropriate medication and systematic reviews on the risk and benefits of specific drugs and drug classes in older patients. After piloting and revisions, the deprescribing manual now covers 11 indications/topics. In each chapter, patient- and medication-related deprescribing criteria, monitoring and communication strategies, and information about concerns related to the use of specific drugs in older patients are provided.

Discussion:

We found varying deprescribing strategies in the literature, which we consolidated in our deprescribing manual. Whether this approach leads to successful deprescribing in family conferences is being investigated in the cluster-randomised controlled COFRAIL study.

Plain Language Summary

Development of a manual to help doctors to identify which medications can be withdrawn

Many older adults suffer from chronic diseases and take multiple medications concurrently. This can lead to side effects and other undesired events. We developed a manual to help doctors identify which medications can be withdrawn, so that they can discuss this with their patients. This manual was used in the COFRAIL study where doctors, patients and caregivers met in family conferences to discuss their preferences and decide together how future treatments should be handled. The manual contains information on common medications, symptoms and diseases in older patients such as diabetes and high blood pressure. Before the manual was used in the study, it was tested by volunteer patients and their doctors and caregivers to make sure that it is user-friendly.

Effects of roads on small-mammal movements: Opportunities and risks of vegetation management on roadsides

Roads can block animal movement and reduce persistence of species living in road surroundings. Movement restrictions on local populations may even increase extinction risk of abundant small mammals. However, road verges (road managed area between the edge of the road and the beginning of private land) may provide refuge and corridors for small mammals when properly managed. Information on the effects of roads and roadside management on small-mammal movement is still scarce for low traffic roads (<20,000 vehicles per day) crossing well-preserved habitats. We aimed to fill this gap by comparing fine-scale movement patterns of wood mice (Apodemus sylvaticus) in a road and in a similar roadless area without management. Both areas consisted of a well-preserved Mediterranean agro-silvo pastoral system. We studied several movement patterns: road crossings, verge use, length, and direction of movement. Additionally, we assessed how roadside management, animals' sex and residency status, season and microhabitat affect movement at the road area. At the roadless area, we defined a virtual road and verges at equivalent locations to the road area for comparison purposes. We gathered capture-mark-recapture data for two years to characterize movement patterns. Wood mice tended to avoid the road by crossing it less often and moving away from it more frequently than from equivalent locations in the roadless area. Wood mice used road verges more frequently than virtual verges and moved more often parallel to the road than to the virtual road. Road crossings were more frequent after firebreak openings (strips of mowed land) in surrounding areas and near taller shrubs. Also, males used road verges more often than females. Differences on several movement patterns between areas and their trends within the road area can be explained mainly by the presence of the road and roadside vegetation management (e.g., firebreaks openings). We suggest roadside vegetation management practices (e.g., avoid land mowing; maintain vegetation strips) to promote the role of verges as refuges and/or corridors for small mammals.

P-505 Mapping acceptance and commitment therapy (ACT) outcomes in the context of infertility: A systematic review

Study question

How ACT variables are associated or may impact mental health outcomes (i.e., anxiety, stress, and depression symptoms) in patients with an infertility diagnosis?

Summary answer

ACT variables seem to be associated with better mental health outcomes in patients with an infertility diagnosis.

What is known already

Evidence indicates that people with infertility face psychosocial challenges, with a significant number of studies finding that mental health seems to be negatively affected. ACT is part of the family of behavioral and cognitive therapies and was already established as having a beneficial effect on psychological issues in other health conditions. Since infertility is a relevant stressor, we expected that ACT had also a protective role on mental health. To date, no study tried to summarize this evidence, which might help to develop the intervention with ACT components for this population.

Study design, size, duration

A systematic review of the literature was conducted to identify studies assessing Infertility and ACT. A literature search was conducted from inception to October 2021 in the following electronic databases: Web of Science, Pubmed, and B-On. The PRISMA guidelines were followed.

Participants/materials, setting, methods

A search was conducted using combinations of keywords and MeSH (“infertility” AND “Acceptance and Commitment Therapy” AND “depression”; “anxiety”; “stress”). No limitation regarding the type of publication, date, or language was created during the searches. Empirical and quantitative studies were considered if they assessed mental health variables and ACT hexagon model components in patients with infertility.

Main results and the role of chance

Out of 137 studies initially identified, six of them met eligibility criteria and were included in the review. The studies were carried out between 2012 and 2020 and originated from two countries: four from Portugal and two from Iran. The samples were composed by women (three) and couples (three). The results revealed that couples dealing with infertility present higher psychological inflexibility and experiential avoidance scores, and lower scores of acceptance when compared with fertile couples and couples who pursued adoption. Psychological inflexibility seems to be positively correlated with depressive, anxiety, and stress symptoms. Gender differences were also found, i.e., women tend to show higher scores of depression symptoms, psychological inflexibility, and experiential avoidance than men. Women dealing with infertility have the tendency to avoid thoughts, emotions, and situations somehow associated with pregnancy and parenthood as a way of trying to escape from infertility’s painful experience. In general, studies suggest that ACT may be an adequate approach for patients dealing with infertility.

Limitations, reasons for caution

The number of studies was small and they were predominantly from Portugal, increasing the likelihood of a risk of bias of the findings. Cultural variables must be considered and conclusions need to be interpreted with caution.

Wider implications of the findings

Since ACT variables seem to be associated with better mental health outcomes, these results indicated that couples with infertility would benefit from intervention addressing ACT components. Future studies should explore the effectiveness of these interventions in this population.

Trial registration number

not applicable

P-803 DNA-FISH analysis in testicular tissue cells of prepuberal patients with Klinefelter Syndrome

Study question

Can we accurately assess sex-chromosomes number in testicular cells (germ and somatic) of Klinefelter Syndrome (KS) prepuberal patients by DNA-FISH in paraffin embedded sections?

Summary answer

We have evaluated the sex-chromosomes content of testicular cells in KS prepuberal patients and the presence of XY lines evidenced a gonadal mosaicism status.

What is known already

Prepuberal boys with Klinefelter Syndrome usually have fertility problems in adulthood, mainly azoospermia. Due to the symptoms cause by the disease, Spermatogonial Stem Cells (SSCs) are less abundant and spermatogenesis does not occur. These patients do not have any alternative to restore the fertility in the future. When a boy has both XY and XXY cell lines, this patient is mosaic (46,XY/47,XXY). Meaning some cells could undergo spermatogenesis and generate gametes with normal sex-chromosomes number. The aim of this work is to test if KS patients diagnosed as pure can have testicular cell lines with XY chromosome number (mosaic).

Study design, size, duration

We obtained samples from human prepuberal patients diagnosed with pure Klinefelter Syndrome (47,XXY) for the last 5 years. Testicular biopsy fragments are fixed for histological studies and other fragments are cryopreserved. Some fragments are used for immunofluorescence and subsequently processed by DNA-FISH to determine the sex-chromosomes content of testicular cells.

Participants/materials, setting, methods

In this study, we used 10 prepuberal patients with KS and 5 prepuberal patients with other fertility problems with normal chromosome set as controls. We performed immunofluorescence to determine expression of germ cells (VASA) and SSCs (MAGEA4) markers and somatic cells markers such as Leydig cells (StAR) and Sertoli cells (SOX9). Afterwards, we perform DNA-FISH, with probes specific for chromosomes X and Y and chromosome 18 as a control.

Main results and the role of chance

The methodology used allows cytogenetic characterization of testicular tissue in paraffin embedded sections. Testicular mosaicism has been observed in all patients diagnosed as pure KS. We have observed a degree of mosaicism of 66-80% in SSCs, of 20-50% in Sertoli cells and of 30-50% in Leydig cells.

We pursued a protocol with a good FISH efficiency that allows colocalization of previous immunocharacterized testicular cells.

Limitations, reasons for caution

The DNA-FISH technique is made just in a single paraffin section of each KS patient testicular sample. Due to the limited and difficulty to obtain KS testicular tissue, we use a limited number of samples.

Wider implications of the findings

We succeed to demonstrate the mosaicism of testicular cells in prepuberal patients that are diagnosed with KS. Thus, the better understanding of the SSCs with normal chromosome set (XY) could be useful for future in vitro expansion and stem cell therapies.

Trial registration number

not applicable

Amplifying the effects of adding extra players during association football game-based scenarios

This study aimed to compare under-18 association football players’ performance (age = 17.7±1.0 years; playing experience = 9.0 ± 3.2 years) when manipulating the number of teammates and opponents during football game-based practices. Time-motion, individual and tactical-related variables were monitored when manipulating conditions with different number of teammates and opponents (11vs11, No-Sup, No-Inf; 11vs12, Low-Sup, Low-Inf; 11vs13, Mod-Sup, Mod-Inf; and 11vs14, High-Sup, High-Inf). Results showed that adding teammates promoted increases in the longitudinal synchronization from No-Sup to Mod-Sup (Cohen’s d with 95% of confidence intervals: 0.25 [0.12; 0.39]; p < .001) and High-Sup (0.61 [0.41; 0.82]; p < .001), while decreases in the distance to the nearest teammate, both in the offensive and defensive phases (p < .001 and p = .005, respectively). In addition, it was observed lower distance covered while running when playing in High-Sup compared to No-Sup (0.30 [-0.01; 0.61]; p = .002) during the defensive phase. Attacking in numerical inferiority promoted a higher variability in the distance to the nearest teammate from No-Inf to High-Inf (0.83 [0.27; 1.38]; p = .044), while decreasing the physical demands, specifically distance covered while running (-0.49 [-0.99; 0.01]; p = .039). In turn, defending, mainly in high-inferiority, increased the total distance covered compared to No-Inf (0.61 [0.30; 0.91]; p < .001) and led to a decrease in the distance to the nearest teammate (-0.90 [-1.35; -0.44]; p = .002). Overall, coaches may manipulate the number of teammates and opponents to promote distinct effects at the level of cooperation and opposition dynamical interactions.

Pharmacological Targeting of Senescence with ABT-263 in Experimental Heart Failure with Preserved Ejection Fraction

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação Ciência e Tecnlogia

HFpEF is the most common form of heart disease in the elderly and is associated with high morbidity and mortality. Our understanding of HFpEF pathophysiology is limited and development of efficient therapies that alter the clinical course of the disease has proved greatly challenging. Although aging is a risk factor of HFpEF1, the involvement of aging hallmarks such as cell senescent and immunosenescence is unclear. Recently, a link between endothelial senescence and HFpEF development was demonstrated in mice with accelerated aging [1], endorsing anti-aging pharmacologic as potential new therapeutic alternatives for HFpEF. In fact, the senolytic (drugs that selectively promote apoptosis of senescent cells) ABT-263 has already proven efficacy in the context of cardiovascular diseases. Further studies are needed to clarify the relevance of aging and of anti-aging therapies in the context of HFpEF.

Using ZSF1 obese rats (ZSF1-Ob) as model of HFpEF we showed from 18 weeks signs of immunosenescence compared to ZSF1-Ln, namely an increased frequency of circulating myeloid cells and decreased frequency of T and B cells. Concomitantly, expression of pro-inflammatory factors (IL-6, IL-1, TGF-β, TNF-α) was upregulated in peripheral blood mononuclear cells (PBMCs) of ZSF1-Ob which also displayed characteristic features of cell senescence (p21 expression, lysosomal endogenous Beta-galactosidase (SA-B-Gal) senescence-associated secretory phenotype (SASP) and up-regulation of BCL-XL. Importantly, no signs of cellular senescence (SA-B-gal, pH2AX and senescence associated pathways) were found in the main hematopoietic organs (spleen and bone marrow). Alongside, these systemic alterations, an upsurge of cellular senescence was observed in myocardium of ZSF1-Ob rats, particularly in endothelial and hematopoietic cells. Serum of ZSF1-Ob rat was able to induce activation and cellular senescence of cardiac microvascular endothelial cells, indicating that systemic circulating factors may be the upstream mechanism of cellular senescence and dysfunction in HFpEF. Analysis of HFpEF patients and a control cohort adjusted to main co-morbidities further demonstrated accumulation of senescent monocytes in HFpEF patients. In these patients, the senescence marker SA-B-Gal correlated with plasmatic brain natriuretic peptide (BNP) levels and pulmonary artery systolic pressure. Targeting aging hallmarks through the treatment of ZSF1-Ob rat with ABT-263 resulted in a reduction in circulating senescent cells, decreased systemic and local inflammation, re-established immune proportions, restore the levels of circulating BNP and attenuated myocardial remodeling, particularly endothelial dysfunction and fibrosis.

Collectively these findings support that premature cellular senescence contributes to the establishment of a deleterious pro-inflammatory environment in HFpEF and that senolytic agents hold promise for the treatment of this syndrome.

Impact of Particles on Pulmonary Endothelial Cells

According to the WHO, air quality affects around 40 million people, contributing to around 21,000 premature deaths per year. Severe respiratory diseases, such as asthma and chronic obstructive pulmonary disorder, can be promoted by air pollution, which has already been documented; this is one of the reasons why air quality is a very relevant factor for human health and well-being. Aerosols are an aggregation of solid or liquid particles dispersed in the air and can be found in the form of dust or fumes. Aerosols can be easily inhaled or absorbed by the skin, which can lead to adverse health effects according to their sizes that range from the nanometre to the millimetre scale. Based on the PRISMA methodology and using the Rayyan QCRI platform, it was possible to assess more than four hundred research articles. This systematic review study aimed to understand the impact of particles on pulmonary endothelial cells, namely particulate matter in different sizes, cigarette smoke, diesel exhaust particles and carbon black. The main conclusions were that particles induce multiple health effects on endothelial cells, namely endothelial dysfunction, which can lead to apoptosis and necrosis, and it may also cause necroptosis in lung structure.

Transnasal endoscopy: moving from endoscopy to the clinical outpatient-blue sky thinking in oesophageal testing

BACKGROUND

COVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources.

OUR EXPERIENCE

We describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures.

DISCUSSION

TNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.

Ecological Solutions for Linear Infrastructure Networks: The key to green infrastructure development

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Proteomics of sea bass skin-scales exposed to the emerging pollutant fluoxetine compared to estradiol

Teleost fish skin-scales are essential for protection and homeostasis and the largest tissue in direct contact with the environment, but their potential as early indicators of pollutant exposure are hampered by limited knowledge about this model. This study evaluated multi-level impacts of in vivo exposure of European sea bass to fluoxetine (FLX, a selective serotonin-reuptake inhibitor and an emerging pollutant) and 17β-estradiol (E2, a natural hormone and representative of diverse estrogenic endocrine-disrupting pollutants). Exposed fish had significantly increased circulating levels of FLX and its active metabolite nor-FLX that, in contrast to E2, did not have estrogenic effects on most fish plasma and scale indicators. Quantitative proteomics using SWATH-MS identified 985 proteins in the scale total proteome. 213 proteins were significantly modified 5 days after exposure to E2 or FLX and 31 were common to both treatments and responded in the same way. Common biological processes significantly affected by both treatments were protein turnover and cytoskeleton reorganization. E2 specifically up-regulated proteins related to protein production and degradation and down-regulated the cytoskeleton/extracellular matrix and innate immune proteins. FLX caused both up- and down-regulation of protein synthesis and energy metabolism. Multiple estrogen and serotonin receptor and transporter transcripts were altered in sea bass scales after E2 and/or FLX exposure, revealing complex disruptive effects in estrogen/serotonin responsiveness, which may account for the partially overlapping effects of E2 and FLX on the proteome. A large number (103) of FLX-specifically regulated proteins indicated numerous actions independent of estrogen signalling. This study provides the first quantitative proteome of the fish skin-scale barrier, elucidates routes of action and biochemical and molecular signatures of E2 or FLX-exposure and identifies potential physiological consequences and candidate biomarkers of pollutant exposure, for monitoring and risk assessment.

The Perceived Risk of Hospitalization in Primary Health Care – The Importance of Multidimensional Assessment

Ageing has increased the use of health services, with a corresponding rise in avoidable hospitalizations. We aimed to assess and characterize the perceived risk of hospitalization in primary health care (PHC). 118 individuals aged ≥65 years, PHC patients, were assessed using the Community Risk Assessment Instrument by their General Practitioner, who identified their perceived risk of hospitalization, at one year. The instrument is composed of three domains (mental state, daily living activities (ADLs) state and medical state). Multivariate logistic regression was used to identify the best model to predict the risk of hospitalization. Four models were estimated, one for each domain and one with all the variables of the instrument. 58.5% were identified as being at risk of hospitalization. The best predictive models are those that include functionality assessment variables (ADL model and Community Assessment of Risk Instrument model). The model that includes all the variables of three domains presents the best predictive value. Mobility problems (Odds Ratio (OR) 16.18 [CI: 1.63–160.53]), meal preparation (OR 10.93 [CI: 1.59–75.13]), communication (OR 6.91 [CI: 1.37–34.80]) and palliative care (OR 4.84 [CI: 1.14–20.58]) are the best predictors of hospitalization risk. The use of multidimensional assessment tools can allow the timely identification of people at risk, contributing to a reduction in hospitalizations.

Tofacitinib: An Option for Acute Severe Ulcerative Colitis?

Tofacitinib has emerged as a new option for ulcerative colitis. Its rapid absorption, metabolism, and clinical improvement make it an interesting option for rescue therapy in acute severe ulcerative colitis (ASUC), a situation with limited therapeutic options in patients with a long-term disease course and multiple drug failure. The management of ASUC in this setting becomes challenging, underlying the need for new drugs and data on their efficacy and safety. We describe 2 cases of acute episodes in which tofacitinib was used as a rescue therapy.

Acute effects from the half-squat performed using a repetition versus differential approach in youth soccer players

Background

Over the last years there have been a wide body of research exploring the best strategies to promote acute enhancements in players’ performance. Despite that, most studies have been focused on adult and elite players, and different results may be identified when considering players from lower levels of performance and belonging to youth categories. In addition, most studies conducted in this domain focused in repetitive movement patterns, and while adding variability has been considered as a useful approach to enhance players’ performance at short and long-term perspectives, less is known regarding it applicability to acute enhance players physical performance. Therefore, this study aimed to compare the acute enhancement effects of performing the half-squat in a flywheel ergometer between a more-repetitive approach (low noise) and a more variable approach (differential learning, high noise) in youth soccer players.

Methods

A total of sixteen players (age = 16.2 ± 0.6 years) was exposed to four conditions in a randomized order: (1) repetitive intervention for 30 s; (2) repetitive intervention for 10-min; (3) differential learning intervention for 30 s; (4) differential learning intervention for 10-min. Each condition consisted in 3 sets of 6 repetitions of eccentric half squats performed in a flywheel ergometer. Countermovement jump, 10 m and 30 m linear sprint, and change-of-direction ability were measured every session at baseline (pre-test) and after each protocol (post-test).

Results

No potentiation effect was observed overall with any of the interventions. In addition, no differences between protocols were found for sprinting. However, the repetitive intervention impaired jumping performance for both 30 s (small effects, p ≤ .05) and 10-min intervals (small effects, p ≤ .05), as well as in the change-of-direction task for 30 s (p ≤ .05).

Conclusions

These results may be due to the players’ low experience in eccentric flywheel training. Despite these findings, individual potentiation responses emerged from both protocols when considering the individual responses, reinforcing the need to establish more personalized approaches.

MAMMALS IN PORTUGAL: A data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ca. 26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated to habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished geo-referenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of Azores and Madeira that includes 107,852 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (42%), sign surveys (38%), camera trapping (16%), bioacoustics surveys (4%) and radio-tracking and inquiries that represent less than 1% of the records. The data set includes 13 types of records: 1) burrows | soil mounds | tunnel, 2) capture, 3) colony, 4) dead animal | hair | skulls | jaws, 5) genetic confirmation, 6) inquiries, 7) observation of live animal, 8), observation in shelters, 9) photo trapping | video, 10), predators diet | pellets | pine cones/nuts, 11) scat | track | ditch, 12) telemetry and 13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n = 34,754) has the highest number of records followed by Chiroptera (n = 18,858), Carnivora (n = 18,594), Lagomorpha (n = 17,679), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 6400). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus (n = 12,407), Monachus monachus (n = 1512), and Lynx pardinus (n = 197)]. We believe that this data set may stimulate the publication of other European countries data sets which would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications.

Amplifying perceptual demands: How changes in the colour vests affect youth players performance during medium-sided games

This study explored how manipulating the colour of training vests affects footballers' individual and collective performance during a Gk+6vs6+Gk medium-sided game. A total of 21 under-17 years old players were involved in three experimental conditions in a random order for a total of four days: i) CONTROL, two teams using two different colour vests; ii) SAME, both teams wearing blue vests; iii) MIXED, all 6 players per team wore different colour vests. Players' positional data was used to compute time-motion and tactical-related variables, while video analysis was used to collect technical variables. Further, these variables were synchronized with spatiotemporal data allowing to capture ball-related actions in a horizontal 2D plan. All variables were analysed from the offensive and defensive perspective. From the offensive perspective, players performed more and further shots to goal during the CONTROL than in SAME and MIXED (small effects) conditions, with a decreased distance to the nearest defender (small effects). While defending, results revealed lower distance to the nearest teammate (small effects) in the CONTROL than in the SAME and MIXED conditions, and higher team longitudinal synchronization (small effects). In addition, the CONTROL showed in general lower values of team width while defending than in the other 2 conditions. Overall, coaches may use the CONTROL condition to emphasize offensive performance and defensive behaviour over the longitudinal direction with increased physical demands. In turn, coaches may use the manipulation of players vests to emphasize defensive performance, as players seem to behave more cohesively under such scenarios.

Evaluation of Davos self-assisted technique for reduction of anterior glenohumeral dislocations: a comparative study with traction/counter-traction technique

Background

Few studies have compared conventional and self-assisted shoulder reduction maneuvers. The goal of this study was to evaluate the results of self-assisted Davos vs. traction/countertraction (T/Ct) techniques in the treatment of acute anterior shoulder dislocations.

Methods

This was a single-center, prospective study carried out at a tertiary hospital emergency department. Patients aged 18-69 years old, with radiographic confirmation of anterior glenohumeral dislocations, were consecutively allocated to treatment groups. Recorded data included pain at admission (visual analog scale [VAS] score at admission), analgesia before reduction, maximum pain during reduction (maximum VAS score), demographic characteristics, lesion mechanism, laterality, prior dislocation, and immediate complications. The primary outcomes were reduction success rate and pain.

Results

Eighty individuals were included (40/group). Regarding the success rate, no statistically significant differences were found between Davos or T/Ct (87.5% vs. 85%; P = .058). The maximum VAS score was significantly lower in Davos than that in T/Ct (4.18 ± 2.00 vs. 6.30 ± 2.13; P < .001). The effect of analgesia in the maximum VAS score was more evident among Davos patients, with significantly lower pain in the subgroup who were provided analgesia (3.63 ± 2.02 vs. 5.31 ± 2.01; P = .01).

Discussion

Davos was as effective as T/Ct for reduction of acute anterior shoulder dislocations (highest reported success rate: 87.5%) and conditioned a less traumatic experience, with significantly lower pain during reduction (the maximum VAS score was more than 2 points lower in the Davos group; P < .001). Analgesia had a synergistic effect among patients submitted to the Davos technique, suggesting that T/Ct is inherently more painful.

Conclusion

The Davos is a patient-controlled, atraumatic, and safe technique, allowing successful, gentle, and less painful glenohumeral reduction. These findings favor Davos as an easy-to-teach and effective first-line treatment for first-time and recurrent shoulder dislocations.

Effects of stress exposure in captivity on physiology and infection in avian hosts: no evidence of increased Borrelia burgdorferi s.l. infectivity to vector ticks

Exposure to environmental stressors, an increasingly recurring event in natural communities due to anthropogenic-induced environmental change, profoundly impacts disease emergence and spread. One mechanism through which this occurs is through stress-induced immunosuppression increasing disease susceptibility, prevalence, intensity and reactivation in hosts. We experimentally evaluated how exposure to stressors affected both the physiology of avian hosts and the prevalence of the zoonotic bacteria Borrelia burgdorferi sensu lato (s.l.), in two model species-the blackbird Turdus merula and the robin Erithacus rubecula captured in the wild, using xenodiagnoses and analysis of skin biopsies and blood. Although exposure to stressors in captivity induced physiological stress in birds (increased the number of circulating heterophils), there was no evidence of increased infectivity to xenodiagnostic ticks. However, Borrelia detection in the blood for both experimental groups of blackbirds was higher by the end of the captivity period. The infectivity and efficiency of transmission were higher for blackbirds than robins. When comparing different methodologies to determine infection status, xenodiagnosis was a more sensitive method than skin biopsies and blood samples, which could be attributed to mild levels of infection in these avian hosts and/or dynamics and timing of Borrelia infection relapses and redistribution in tissues.