A quality appraisal of economic evaluations of community water fluoridation: A systematic review

OBJECTIVES

To critically appraise the methodological conduct and reporting quality of economic evaluations (EE) of community water fluoridation (CWF).

METHODS

A systematic literature search was conducted in general databases and specialist directories of the economic literature. The Consensus on Health Economic Criteria list (CHEC) appraised the methodological quality while the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) assessed the reporting quality of included studies.

RESULTS

A total of 1,138 records were identified, of which 18 met the inclusion criteria. Cost analysis emerged as the most prevalent type of EE, though a growing trend towards conducting full EEs is observed. CHEC revealed the items most frequently unfulfilled were the study design, measurement and valuation of costs and outcomes, while CHEERS also identified reporting deficiencies in these aspects. Furthermore, the review highlights subtleties in methodological aspects that may not be discerned by CHEC, such as the estimation of the impact of fluoridation and the inclusion of treatment savings within cost estimates.

CONCLUSIONS

While numerous studies were conducted before publication of these assessment instruments, this review reveals that a noteworthy subset of studies exhibited good methodological conduct and reporting quality. There has been a steady improvement in the methodological and reporting quality over time, with recently published EEs largely adhering to best practice guidelines. The evidence presented will assist policymakers in leveraging the available evidence effectively to inform resource allocation decisions. It may also serve as a resource for researchers to enhance the methodological and reporting standards of future EEs of CWF.

The Validity of a Portable Strain-Gauge Apparatus Versus a Commercial Isokinetic Dynamometer for Evaluating Knee Extension Kinetics

Background

Isokinetic dynamometers are widely used when assessing neuromuscular function including knee extension kinetics. However, these dynamometers are often prohibitively expensive and are not portable. Thus strain-gauge technology has grown in popularity.

Purpose

The purpose of this study was to compare kinetic data captured via an isokinetic dynamometer against an affordable and portable strain-gauge with a treatment plinth during maximal isometric knee extensions.

Study Design

Cross-sectional study.

Methods

Healthy participants (8 males and 6 females; age 30.2±7.1 years) volunteered and performed knee extensions at a 90° knee angle on a dynamometer and a treatment plinth with a portable strain-gauge. Peak force (PF), peak rate of force development (PRFD), rate of force development (RFD2080) and impulse (IMP2080) from 20-80% of onset to peak force were assessed using both strain-gauge and isokinetic dynamometer. Between-device differences were evaluated by the Wilcoxon signed-rank test, Cohen's d effect sizes (ES), Pearson's correlation coefficients (r), and Bland-Altman plots.

Results

No significant or meaningful differences were identified between isokinetic and strain-gauge devices (all p≥0.268, ES≤0.35). However, slightly greater (2.5-9.5%) outputs were observed with the isokinetic dynamometer. Very large significant between-device correlations were found for PF (r=0.77, p=0.001) and PRFD (r=0.73, p=0.003), while small and moderate non-significant between-device correlations were found for RFD2080 (r=0.48, p=0.079) and IMP2080 (r=0.59, p=0.060). Bland-Altman plots did not reveal apparent biases from high to low performers.

Conclusions

These results indicate that the strain-gauge device can produce valid maximal and rapid force expression measurements. Similar results, such as those quantified via an isokinetic device, can be obtained without extreme rigour and constraint. The study's findings support using the practically relevant treatment plinth and strain-gauge combination as a suitable alternative to the isokinetic dynamometry for measuring PF and PRFD. Therefore, more rehabilitation and sports performance practitioners can confidently assess knee extension kinetics.

Level of Evidence

3.

Quad bike related trauma in Ireland

INTRODUCTION

A quad bike or an all-terrain vehicle is a four-wheeled powered vehicle generally designed for off-road use. They are widely used for farm-related work and more recently for recreational purposes. The potential for serious injury and death with quad bike use is a growing public health concern. There is an inherent instability in their design and they are typically used on rugged terrain characterised by dangerous driving surfaces. This study examines quad bike related trauma in Ireland using a national trauma registry to identify patient demographics, injury mechanism and type, treatments received and outcomes.

METHODS

All quad bike related trauma cases recorded on the Major Trauma Audit (MTA), National Office of Clinical Audit in Ireland for the period 2014-2019 were gathered and analysed.

RESULTS

There were 69 cases identified and 63 (91 %) of these were male. The median (IQR) age was 27 (19 - 49.1). There were 25 % (n = 17) aged 0-18 years, 64 % (n = 44) aged 19-65 and 12 % (n = 8) aged greater than 65 years. The median injury severity score (ISS) was 10 (IQR 9-22). The most severely injured body region was the head (n = 21, 30 %). No helmet use was recorded in 50 % (n = 34) of cases. October recorded the highest number of cases (n = 9, 13 %), and Sunday was the most common day (n = 17, 25 %). The median length of hospital stay was five days (IQR 3-9). One patient died after arrival to hospital.

CONCLUSION

Quad bike related trauma predominantly affects a young male cohort with serious injury characteristics. A sizeable proportion of patients are under 18 years of age. This data can better inform national policies and public awareness campaigns targeting this trauma subset. The head was the most common severely injured body region, highlighting the potential need for legislative intervention regarding mandatory helmet use. A large cohort of patients required transfer for definitive care which has implications for trauma care pathways and advocates for the development of an integrated trauma system in Ireland.

Can an inertial measurement unit, combined with machine learning, accurately measure ground reaction forces in cricket fast bowling?

This study examined whether an inertial measurement unit (IMU) could measure ground reaction force (GRF) during a cricket fast bowling delivery. Eighteen male fast bowlers had IMUs attached to their upper back and bowling wrist. Each participant bowled 36 deliveries, split into three different intensity zones: low = 70% of maximum perceived bowling effort, medium = 85%, and high = 100%. A force plate was embedded into the bowling crease to measure the ground truth GRF. Three machine learning models were used to estimate GRF from the IMU data. The best results from all models showed a mean absolute percentage error of 22.1% body weights (BW) for vertical and horizontal peak force, 24.1% for vertical impulse, 32.6% and 33.6% for vertical and horizontal loading rates, respectively. The linear support vector machine model had the most consistent results. Although results were similar to other papers that have estimated GRF, the error would likely prevent its use in individual monitoring. However, due to the large differences in raw GRFs between participants, researchers may be able to help identify links among GRF, injury, and performance by categorising values into levels (i.e., low and high).

The variability of dual-task walking parameters using in-shoe inertial sensors in nonconcussed individuals: A randomized within-subject repeated measures design

Background and Aims

There is a need for high utility and portability, and cost-effective technologies that are suitable for assessing dual-task gait after experiencing a concussion. Current technologies utilized such as 3D motion capture and force plates are too complex and expensive for most practitioners. The aim of this study was to quantify the variability of dual-task walking gait parameters using in-shoe inertial sensors in nonconcussed individuals.

Methods

This was a randomized within-subject repeated measures design conducted within a sports laboratory. Twenty healthy, uninjured, nonconcussed participants were recruited for this study. Gait variables of interest were measured across three 2-min continuous walking protocols (12 m, 30 m, 1 min out and back) while performing a cognitive task of counting backward in sevens from a randomly generated number between 300 and 500. Testing was completed over three occasions separated by 7 days, for a total of nine walking trials. Participants completed the testing protocols in a randomized, individual order. The primary outcome was to determine the variability of dual-task walking gait parameters using in-shoe inertial sensors in nonconcussed individuals across three protocols.

Results

Three to four participants were allocated to each randomized protocol order. Regarding the absolute consistency (coefficient of variation [CV]) between testing occasions, no gait measure was found to have variability above 6.5%. Relative consistency (intraclass correlation coefficient [ICC]) was acceptable (>0.70) in 95% of the variables of interest, with only three variables < 0.70. Similar variability was found across the three testing protocols.

Conclusion

In-shoe inertial sensors provide a viable option for monitoring gait parameters. This technology is also reliable across different testing distances, thus offering various testing options for practitioners. Further research needs to be conducted to examine the variability with concussed subjects.

Methodological Critique of Concussive and Non-Concussive Dual Task Walking Assessments: A Scoping Review

OBJECTIVE

To understand the methodological approaches taken by various research groups and determine the kinematic variables that could consistently and reliably differentiate between concussed and non-concussed individuals.

METHODS

MEDLINE via PubMed, CINAHL Complete via EBSCO, EBSCOhost, SPORTDiscus, and Scopus were searched from inception until 31 December 2021, using key terms related to concussion, mild traumatic brain injury, gait, cognition and dual task. Studies that reported spatiotemporal kinematic outcomes were included. Data were extracted using a customised spreadsheet, including detailed information on participant characteristics, assessment protocols, equipment used, and outcomes.

RESULTS

Twenty-three studies involving 1030 participants met the inclusion criteria. Ten outcome measures were reported across these articles. Some metrics such as gait velocity and stride length may be promising but are limited by the status of the current research; the majority of the reported variables were not sensitive enough across technologies to consistently differentiate between concussed and non-concussed individuals. Understanding variable sensitivity was made more difficult given the absence of any reporting of reliability of the protocols and variables in the respective studies.

CONCLUSION

Given the current status of the literature and the methodologies reviewed, there would seem little consensus on which gait parameters are best to determine return to play readiness after concussion. There is potential in this area for such technologies and protocols to be utilised as a tool for identifying and monitoring concussion; however, improving understanding of the variability and validity of technologies and protocols underpins the suggested directions of future research. Inertial measurement units appear to be the most promising technology in this aspect and should guide the focus of future research.

IMPACT

Results of this study may have an impact on what technology is chosen and may be utilised to assist with concussion diagnosis and return to play protocols.

Motorcycle-related trauma in Ireland

Introduction

Motorcyclists are over-represented in collision statistics in Ireland. There is a lack of descriptive studies assessing the impact and injury pattern of this trauma cohort. This study examines this trauma subset using data collected by the Major Trauma Audit (MTA) by the National Office of Clinical Audit (NOCA) to identify patient demographics, injury mechanism and type, treatments received, and outcomes.

Methods

All motorcycle-related trauma cases recorded on the MTA, NOCA in Ireland for the period 2014 to 2019 were gathered and analysed.

Results

There were 704 cases identified; 94% of cases were male. The median (interquartile range (IQR)) age was 38.2 (26.7–49.7). There were 6.4% ( n = 45) aged 0–18 years, 88.2% ( n = 621) aged 18–64 and 5.4% ( n = 38) greater than 65 years. The median injury severity score (ISS) overall of this trauma cohort was 13 (IQR 9–24) but 306 patients (43.5%) had an ISS > 15. The most severe injury body region with 35.4% ( n = 249) was the limbs. Most patients arrived during the summer months with Sunday the highest day of attendance ( n = 181, 25.7%). May to August were the months with the most attendance ( n = 366, 52%). Most patients were discharged home ( n = 372, 52.8%) and 43.8% ( n = 308) required transfer to at least one other hospital for definitive care. There were 19 patients (2.7%) who died after arrival to hospital.

Conclusion

Motorcycle trauma predominantly affects a young male population with moderate severity injury characteristics. A significant proportion of patients present at weekends during the summer months, likely the result of recreational riding. A large cohort of patients requires transfer for definitive care, which has significant implications for trauma care pathways. National policies to enforce safety measures and public awareness for recreational motorcycle use may improve traffic safety and ultimately population health.

The relationship between bowling intensity and ground reaction force in cricket pace bowlers

This study examined the relationship between perceived bowling intensity, ball release speed and ground reaction force (measured by peak force, impulse and loading rate) in male pace bowlers. Twenty participants each bowled 36 deliveries, split evenly across three perceived intensity zones: low = 70% of maximum perceived bowling effort, medium = 85%, and high = 100%. Peak force and loading rate were significantly different across the three perceived intensity zones in the horizontal and vertical directions (Cohen's d range = 0.14-0.45, p < 0.01). When ball release speed increased, peak force and loading rate also increased in the horizontal and vertical directions (η_p² = 0.04-0.18, p < 0.01). Lastly, bowling at submaximal intensities (i.e., low - medium) was associated with larger decreases in peak horizontal force (7.9-12.3% decrease), impulse (15.8-21.4%) and loading rate (7.4-12.7%) compared to decreases in ball release speed (5.4-8.3%). This may have implications for bowling strategies implemented during training and matches, particularly for preserving energy and reducing injury risk.

Does Warming Up With Wearable Resistance Influence Internal and External Training Load in National Level Soccer Players?

BACKGROUND

Adding wearable resistance (WR) to training results in superior performance compared with unloaded conditions. However, it is unclear if adding WR during warm-up influences training load (TL) in the subsequent session. The aim of this research was to track TL in soccer players during the transition from late preseason to early in-season and examine whether adding WR to the lower leg during a warm-up influenced TL measures during warm-ups and on-field training sessions after WR was removed.

HYPOTHESIS

The addition of WR worn on the lower legs during an on-field warm-up would lead to decreases in relatively high-intensity external TL metrics, such as distance covered >6.11 m∙s^-1 and acceleration and deceleration >/<3 m∙s^-2 and increases in internal TL during the warm-up, yet would have little effect on the subsequent training session when WR was removed.

STUDY DESIGN

Matched-pair randomized design.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 28 soccer players were allocated to either a WR training (WRT = 14) or unloaded (control [CON] = 14) group. Both groups performed the same warm-up and on-field training for 8 weeks, with the WRT group wearing 200 g to 600 g loads on their lower leg during the warm-up. External TL was measured via global positioning system data and internal TL was assessed using session rating of perceived exertion (sRPE × time per session).

RESULTS

No statistically significant between-group differences (P ≥ 0.05) were identified for any TL measurement during either warm-ups or training sessions. Lower leg WR resulted in trivial to moderate effects for all external TL metrics (-16.9% to 2.40%; d = -0.61 to 0.14) and sRPE (-0.33%; d = -0.03) during the warm-up and trivial to small effects on all external TL metrics (-8.95% to -0.36%; d = -0.45 to -0.30) and sRPE (3.39%; d = 0.33) during training sessions.

CONCLUSION

Warming up with lower leg WR negatively affects neither the quality and quantity of the warm-up nor the subsequent training session once WR is removed.

CLINICAL RELEVANCE

Using WR on the lower leg during on-field warm-ups may be a means to "microdose" strength training while not unduly increasing TL. However, further research is needed to determine the influence of WR on strength qualities.

Quantifying cricket fast bowling volume, speed and perceived intensity zone using an Apple Watch and machine learning

This study examined whether an inertial measurement unit (IMU) and machine learning models could accurately measure bowling volume (BV), ball release speed (BRS), and perceived intensity zone (PIZ). Forty-four male pace bowlers wore a high measurement range, research-grade IMU (SABELSense) and a consumer-grade IMU (Apple Watch) on both wrists. Each participant bowled 36 deliveries, split into two different PIZs (Zone 1 = 70-85% of maximum bowling effort, Zone 2 = 100% of maximum bowling effort). BRS was measured using a radar gun. Four machine learning models were compared. Gradient boosting models had the best results across all measures (BV: F-score = 1.0; BRS: Mean absolute error = 2.76 km/h; PIZ: F-score = 0.92). There was no significant difference between the SABELSense and Apple Watch on the same hand when measuring BV, BRS, and PIZ. A significant improvement in classifying PIZ was observed for IMUs located on the dominant wrist. For all measures, there was no added benefit of combining IMUs on the dominant and non-dominant wrists.

Multijoint Musculoarticular Stiffness Derived From a Perturbation Is Highly Variable

ABSTRACT

Schofield, M, Tinwala, F, Cronin, J, Hébert-Losier, K, and Uthoff, A. Multijoint musculoarticular stiffness derived from a perturbation is highly variable. J Strength Cond Res 35(9): 2498-2503, 2021-Testing musculoarticular stiffness may provide insights into multijoint elastic properties. Yet, most research has focused on quantifying stiffness, or elastic potential, at a single joint. The purpose of this study was to quantify the test-retest reliability of musculoarticular stiffness derived from the perturbation technique across the bench pull, bench press, and squat movements. Eight resistance-trained men performed bench pull, bench press, and squat repetition maximums, after which a perturbation protocol was tested over multiple days. During the 3 movements, a brief perturbation was applied to the bar. The resulting sinusoidal wave was measured by an underbench force plate and a linear position transducer attached to the bar. From the sinusoidal wave, stiffness was derived and found to be unreliable across movements and days (change in mean: -35.1 to 15.8%; coefficient of variation: 7.1-111%; intraclass correlation: -0.58 to -0.89). Squat data were removed from the analysis entirely because of the inability to consistently determine the perturbations on the force plate. Practitioners need to be aware that musculoarticular stiffness as measured using the perturbation technique on the movements performed in this study has considerable limitations in terms of reproducibility.

Impact of a National Lockdown on Cycling Injuries

Introduction The Sars-CoV-2 pandemic led to a national lockdown in Ireland from March 12th to June 7th, 2020. The present study aimed to assess the change in the pattern of cycling attendances to an Irish ED during a pandemic. Methods This is a retrospective before-and-after study carried out at a university hospital ED. We compared cycling attendances during Lockdown (LD) (13th March-7th June 2020) with Pre-Lockdown (PLD) (January 1st-March 12th, 2020). Furthermore, we also compared lockdown to an historical control period during the equivalent dates in 2019 (i.e. March 13th-June 7th, 2019) Results There were 151 cycling attendances during LD, 122 in PLD and 164 during the control period. The number of cyclists presenting during "rush hour traffic" in the LD period was 30 (19.9%) versus 42 (34.4%) during PLD (p<0.05) and 51 (31.1%) during the control period (p<0.05). During LD, 8 (5.3%) collisions involved a motor vehicle compared to 26 (21.3%) in PLD (p<0.05) and 43 (26.2%) during the control period (p<0.05). Conclusion Lockdown did not result in increased cycling attendances to this ED. The patients who did sustain a cycling-related injury during lockdown were less likely to have collided with a motor vehicle compared to the control period. The reduction in motor vehicle collisions could be attributed to less traffic congestion and highlights the potential benefits of road-user segregation.

Resisted Sprint Training in Youth: The Effectiveness of Backward vs. Forward Sled Towing on Speed, Jumping, and Leg Compliance Measures in High-School Athletes

ABSTRACT

Uthoff, A, Oliver, J, Cronin, J, Winwood, P, Harrison, C, and Lee, JE. Resisted sprint training in youth: the effectiveness of backward vs. forward sled towing on speed, jumping, and leg compliance measures in high-school athletes. J Strength Cond Res 35(8): 2205-2212, 2021-Resisted sprinting (RS) is a popular training method used to enhance sprinting performance in youth. However, research has only explored the effects of forward RS (FRS) training. We examined the effects of FRS and backward RS (BRS) and compared these with a traditional physical education curriculum (CON). One hundred fifteen boys (age 13-15 years) were matched for maturity and allocated to either an FRS (n = 34), BRS (n = 46), or CON (n = 35) group. Training groups towed progressively overloaded sleds (20-55% body mass) 2 d·wk-1 for 8 weeks. Pre-training and post-training data were collected for sprinting times over 10 and 20 m, countermovement jump (CMJ) height, and leg stiffness (KN). Performance remained unchanged for the CON group (all p > 0.05), whereas all variables significantly improved (p < 0.05) after BRS, and all but 10-m performance improved after FRS. Compared with the CON, BRS and FRS significantly (p > 0.05) improved CMJ (Effect size [ES] = 0.67 and 0.38) and KN (ES = 0.94 and 0.69), respectively. No differences were found between training groups. The probabilities of improving sprinting performance after BRS (∼70%) were on average ∼10 and ∼8% better than the FRS and CON groups, respectively. The BRS and FRS showed similar probabilities of improving CMJ (75 and 79%) and KN (80 and 81%), respectively, over the CON group. It seems that BRS may be a means to improve sprint performance, and regardless of direction, RS seems to be a beneficial method for improving jumping height and leg stiffness in youth male athletes.

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

OBJECTIVES

The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.

DESIGN

A prospective online three-part longitudinal survey.

SETTING

Acute hospitals in the UK and Ireland.

PARTICIPANTS

Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.

PRIMARY OUTCOME MEASURES

Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.

RESULTS

The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).

CONCLUSION

Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

TRIAL REGISTRATION NUMBER

ISRCTN10666798.

Psychological distress during the acceleration phase of the COVID-19 pandemic: a survey of doctors practising in emergency medicine, anaesthesia and intensive care medicine in the UK and Ireland

OBJECTIVE

To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland.

METHODS

Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020-26 March 2020 and Ireland: 25 March 2020-2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being.

RESULTS

5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role.

CONCLUSIONS

Findings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term.

TRIAL REGISTRATION NUMBER

ISRCTN10666798.

Can an inertial measurement unit (IMU) in combination with machine learning measure fast bowling speed and perceived intensity in cricket?

This study examined whether an inertial measurement unit (IMU), in combination with machine learning, could accurately predict two indirect measures of bowling intensity through ball release speed (BRS) and perceived intensity zone (PIZ). One IMU was attached to the thoracic back of 44 fast bowlers. Each participant bowled 36 deliveries at two different PIZ zones (Zone 1 = 24 deliveries at 70% to 85% of maximum perceived bowling effort; Zone 2 = 12 deliveries at 100% of maximum perceived bowling effort) in a random order. IMU data (sampling rate = 250 Hz) were downsampled to 125 Hz, 50 Hz, and 25 Hz to determine if model accuracy was affected by the sampling frequency. Data were analysed using four machine learning models. A two-way repeated-measures ANOVA was used to compare the mean absolute error (MAE) and accuracy scores (separately) across the four models and four sampling frequencies. Gradient boosting models were shown to be the most consistent at measuring BRS (MAE = 3.61 km/h) and PIZ (F-score = 88%) across all sampling frequencies. This method could be used to measure BRS and PIZ which may contribute to a better understanding of overall bowling load which may help to reduce injuries.

Cycling related major trauma in Ireland

INTRODUCTION

Cycling as a means of transport or recreational activity is increasing in popularity in Ireland. However, increasing numbers of cyclists may lead to an increased number of bicycle collisions and fatalities. The Road Safety Authority is the statutory body for road safety in Ireland but uses police data alone to collate cycling collision statistics. This may lead to an underestimation of cycling injuries in Ireland. Using hospital statistics may provide a greater understanding of cycling trauma in Ireland.

OBJECTIVE

The present study examines cycling related trauma in Ireland using the Major Trauma Audit (MTA) data collected via the Trauma and Research Network (TARN) from hospitals in Ireland for the period 2014 to 2016. The database was interrogated for demographics, mechanism of injury, injury characteristics and patient outcomes.

RESULTS

There were 410 cycling collisions recorded in the TARN database which represented 4.4% of trauma captured by TARN for the study period. Of this cohort 79% were male compared with 58% in the overall (TARN) trauma cohort (p < 0.001) and the median (IQR) age was 43.8 years (31.0, 55.7) which is younger than the median (IQR) of 58.9 (36.2, 76.0) years for the overall trauma cohort (p < 0.001). Cycling collisions had a median (IQR) injury severity score (ISS) of 10 (9, 20) which was higher than the overall trauma cohort ISS of 9 (9, 17). Of the mechanisms observed for cycling trauma, 31.7% (n = 130) had a collision with a motor vehicle. Of those who did not wear a helmet, 52.2% (n = 47) sustained a head injury compared with 27.5% (n = 44) in the group who were wearing a helmet (p < 0.001).

CONCLUSION

The TARN data presented in this paper builds a more complete overview of the burden of cycling collisions in Ireland. Particular points of focus are that serious cycling injuries occur in a predominantly male population, and that only around 30% of cases are recorded as involving a motor vehicle, with the majority having an unknown mechanism of injury. There was an association between helmets and head injuries in this study, but there are likely other contributing factors such as mechanism of injury, velocity or cycling infrastructure. Using hospital data such as the MTA provides valuable information on the injuries sustained by cyclists, but more prospective studies to capture injury mechanism and contributing factors are needed.

Effects of Warming Up With Lower-Body Wearable Resistance on Physical Performance Measures in Soccer Players Over an 8-Week Training Cycle

Bustos, A, Metral, G, Cronin, J, Uthoff, A, and Dolcetti, J. Effects of warming up with lower-body wearable resistance on physical performance measures in soccer players over an 8-week training cycle. J Strength Cond Res 34(5): 1220-1226, 2020-Warm-ups provide an opportune time to integrate specific movements to improve performance. This study aimed to examine the effects of adding wearable resistance (WR) lower-limb loading to a warm-up on physical performance measures in soccer athletes. Thirty-one national-level soccer players (aged 16-18 years) were matched for speed and allocated to either a WR training (WRT = 15) or an unloaded (CON = 16) group. Both groups performed the same warm-up 2-3x·wk for 8 weeks with the WRT group wearing 200- to 600-g loads on their calves. Pre-training, mid-training, and post-training data were collected for 10- and 20-m sprint times, repeated sprint ability, and vertical countermovement jump (CMJ) and horizontal countermovement jump (standing long jump [SLJ]) performance. Wearable resistance training improved pre-training to post-training 10- and 20-m sprint times more than the unloaded training (effect size [ES] = -1.06 to -0.96, respectively; 60.0-66.7 vs. 18.8-37.5% > smallest worthwhile change [SWC]). Both groups decreased CMJ over the first 4 weeks (ES ≥ 0.45) and increased CMJ performance over the second 4 weeks of training (ES ≥ 0.27). Both the WRT and CON groups improved SLJ performance after the 8-week training block (ES = 0.85 and 0.93, respectively; 86.7 and 62.5% > SWC, respectively), yet no differences were identified between groups. These findings indicate that 8 weeks (23 sessions) of WR training appears to elicit practically meaningful improvements in accelerated sprinting and horizontal jumping performance. Strength and conditioning practitioners should consider including WR in sports where sprinting and horizontal force production are critical performance indicators.

Using geographic information systems to map older people's emergency department attendance for future health planning

Objectives

This study aimed to assess the pattern of use of EDs, factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or older to a large hospital in Dublin.

Methods

A retrospective analysis of 2 years of data from an urban university teaching hospital ED in the southern part of Dublin was reviewed for the period 2014–2015 (n=103 022) to capture the records of attenders. All ED presentations by individuals 65 years and older were extracted for analysis. Address-matched records were analysed using QGIS, a geographic information systems (GIS) analysis and visualisation tool to determine straight-line distances travelled to the ED by age.

Results

Of the 49 538 non-duplicate presentations in the main database, 49.9% of the total are women and 49.1% are men. A subset comprised of 40 801 had address-matched records. When mapped, the data showed a distinct clustering of addresses around the hospital site but this clustering shows different patterns based on age cohort. Average distances travelled to ED are shorter for people 65 and older compared with younger patients. Average distances travelled for those aged 65–74 was 21 km (n=4177 presentations); for the age group 75–84, 18 km (n=2518 presentations) and 13 km for those aged 85 and older (n=2104 presentations). This is validated by statistical tests on the clustered data. Self-referral rates of about 60% were recorded for each age group, although this varied slightly, not significantly, with age.

Conclusions

Health planning at a regional level should account for the significant number of older patients attending EDs. The use of GIS for health planning in particular can assist hospitals to improve their understanding of the origin of the cohort of older ED patients.

Quantification of the validity and reliability of sprint performance metrics computed using inertial sensors: A systematic review

BACKGROUND

Wearable inertial sensors enable sprinting to be biomechanically evaluated in a simple and time efficient manner outside of a laboratory setting.

RESEARCH QUESTION

Are wearable inertial sensors a valid and reliable method for collecting and measuring sprint performance variables compared to referenced systems?

METHODS

PubMed, SPORTDiscus, and Web of Science were searched using the Boolean phrases: ((run* OR sprinting OR sprint*) AND (IMU OR inertial sensor OR wearable sensor OR accelerometer OR gyroscope) AND (valid* OR reliabil*)). Articles with injury-free subjects of any age, sex or activity level were included.

RESULTS

Fifteen studies met the inclusion criteria and were retained for analysis. In summary, higher Intra-class correlation [ICC] or Pearson correlation coefficients (r) were observed for contact time (ICC ≥ 0.80, r ≥ 0.99), trunk angular displacement (r ≥ 0.99), vertical and horizontal force (ICC ≥ 0.88), and theoretical measures of force, velocity and power (r ≥ 0.81). Low coefficient of variation (CV) were found in peak velocity (≤ 1%), average velocity (≤ 3%), and contact time (≤ 3%,). Average and peak velocity, and resultant forces, were found to have a wide range of r (0.32-0.92) and CVs (0.78-20.2%). The lowest r (-0.24 to 0.49) and highest CVs (15-22.4%) were noted for average acceleration, crania-caudal force, instantaneous forces, medio-lateral ground reaction forces, and rate of decrease in ratio of forces.

SIGNIFICANCE

Due to a wide range of methodological differences, a clear understanding of the validity and reliability of different inertial sensors for the analysis of sprinting has yet to be established. Future research into the sensor's placement, attachment method and sampling frequency are among several factors that need further investigation.

Cricket fast bowling detection in a training setting using an inertial measurement unit and machine learning

Fast bowlers are at a high risk of overuse injuries. There are specific bowling frequency ranges known to have negative or protective effects on fast bowlers. Inertial measurement units (IMUs) can classify movements in sports, however, some commercial products can be too expensive for the amateur athlete. As a large number of the world's population has access to an IMU (e.g. smartphones), a system that works on a range of different IMUs may increase the accessibility of automated workload monitoring in sport. Seventeen elite fast bowlers in a training setting were used to train and/or validate five machine learning models by bowling and performing fielding drills. The accuracy of machine learning models trained using data from all three bowling phases (pre-delivery, delivery and post-delivery) were compared to those trained using only the delivery phase at a sampling rate of 250 Hz. Next, models were trained using data down-sampled to 125 Hz, 50 Hz, and 25 Hz to mimic results from lower specification sensors. Models trained using only the delivery phase showed similar accuracy (> 95%) to those trained using all three bowling phases. When delivery-phase data were down-sampled, the accuracy was maintained across all models and sampling frequencies (>96%).

A New Direction to Athletic Performance: Understanding the Acute and Longitudinal Responses to Backward Running

Backward running (BR) is a form of locomotion that occurs in short bursts during many overground field and court sports. It has also traditionally been used in clinical settings as a method to rehabilitate lower body injuries. Comparisons between BR and forward running (FR) have led to the discovery that both may be generated by the same neural circuitry. Comparisons of the acute responses to FR reveal that BR is characterised by a smaller ratio of braking to propulsive forces, increased step frequency, decreased step length, increased muscle activity and reliance on isometric and concentric muscle actions. These biomechanical differences have been critical in informing recent scientific explorations which have discovered that BR can be used as a method for reducing injury and improving a variety of physical attributes deemed advantageous to sports performance. This includes improved lower body strength and power, decreased injury prevalence and improvements in change of direction performance following BR training. The current findings from research help improve our understanding of BR biomechanics and provide evidence which supports BR as a useful method to improve athlete performance. However, further acute and longitudinal research is needed to better understand the utility of BR in athletic performance programs.

Effect of Match Factors on the Running Performance of Elite Female Soccer Players

Trewin, J, Meylan, C, Varley, MC, Cronin, J, and Ling, D. Effect of match factors on the running performance of elite female soccer players. J Strength Cond Res 32(7): 2002-2009, 2018-The purpose of this study was to examine the effects of match factors on the match running of elite female soccer players. Players from the same women's national team (n = 45) were monitored during 47 international fixtures (files = 606) across 4 years (2012-2015) using 10-Hz global positioning system devices. A mixed model was used to analyze the effects of altitude, temperature, match outcome, opposition ranking, and congested schedules. At altitude (>500 m), a small increase in the number of accelerations (effect size [ES] = 0.40) and a small decrease in total distance (ES = -0.54) were observed, whereas at higher temperatures, there were decreases in all metrics (ES = -0.83 to -0.16). Playing a lower ranked team in a draw resulted in a moderate increase in high-speed running (ES = 0.89), with small to moderate decreases in total distance and low-speed running noted in a loss or a win. Winning against higher ranked opponents indicated moderately higher total distance and low-speed running (ES = 0.75), compared with a draw. Although the number of accelerations were higher in a draw against lower ranked opponents, compared with a win and a loss (ES = 0.95 and 0.89, respectively). Practitioners should consider the effect of match factors on match running in elite female soccer.

Rating of Perceived Exertion as a Method of Volume Autoregulation Within a Periodized Program

Helms, ER, Cross, MR, Brown, SR, Storey, A, Cronin, J, and Zourdos, MC. Rating of perceived exertion as a method of volume autoregulation within a periodized program. J Strength Cond Res 32(6): 1627-1636, 2018-The purpose of this investigation was to observe how a rating of perceived exertion (RPE)-based autoregulation strategy impacted volume performed by powerlifters. Twelve (26 ± 7 years, n = 9 men, n = 3 women) nationally qualified powerlifters performed the back squat, bench press, and deadlift 3x per week on nonconsecutive days in a session order of hypertrophy, power, and then strength; for 3 weeks. Each session subjects performed an initial top set for a prescribed number of repetitions at a target RPE. A second top set was performed if the RPE score was too low, then subsequent back-off sets at a reduced load were performed for the same number of repetitions. When the prescribed RPE was reached or exceeded, sets stopped; known as an "RPE stop." The percentage load reduction for back-off sets changed weekly: there were 2, 4, or 6% RPE stop reductions from the top set. The order in which RPE stop weeks were performed was counterbalanced among subjects. Weekly combined relative volume load (squat + bench press + deadlift), expressed as sets x repetitions x percentage 1-repetition maximum was different between weeks (p < 0.001): 2% = 74.6 ± 22.3; 4% = 88.4 ± 23.8; 6% = 114.4 ± 33.4. Combined weekly bench press volume (hypertrophy + power + strength) was significantly higher in accordance with load reduction magnitude (2% > 4% > 6%; p ≤ 0.05), combined squat volume was greater in 6 vs. 2% (p ≤ 0.05), and combined deadlift volume was greater in 6 vs. 2% and 4% (p ≤ 0.05). Therefore, it does seem that volume can be effectively autoregulated using RPE stops as a method to dictate number of sets performed.

Prescribing Target Running Intensities for High-School Athletes: Can Forward and Backward Running Performance Be Autoregulated?

Target running intensities are prescribed to enhance sprint-running performance and progress injured athletes back into competition, yet is unknown whether running speed can be achieved using autoregulation. This study investigated the consistency of running intensities in adolescent athletes using autoregulation to self-select velocity. Thirty-four boys performed 20 m forward running (FR) and backward running (BR) trials at slow, moderate and fast intensities (40⁻55%, 60⁻75% and +90% maximum effort, respectively) on three occasions. Absolute and relative consistency was assessed using the coefficient of variation (CV) and intraclass correlation coefficients (ICC). Systematic changes in 10 and 20 m performance were identified between trials 1⁻2 for moderate and fast BR (p ≤ 0.01) and during moderate BR over 20 m across trials 2⁻3 (p ≤ 0.05). However, comparisons between trials 2⁻3 resulted in low typical percentage error (CV ≤ 4.3%) and very good to excellent relative consistency (ICC ≥ 0.87) for all running speeds and directions. Despite FR being significantly (p ≤ 0.01) faster than BR at slow (26%), moderate (28%) and fast intensities (26%), consistency was similar in both running directions and strongest at the fastest speeds. Following appropriate familiarization, youth athletes may use autoregulation to self-select prescribed FR and BR target running intensities.

Sprint running kinematics and kinetics in pre-peak-height-velocity male children on a non-motorised treadmill: reliability and normative data

The purpose of this study was to quantify the reliability of kinematic and kinetic variables using a sample of pre-peak-height-velocity (PHV) male athletes sprinting on a non-motorised treadmill. Following variables were measured and their normative data presented, average and peak velocity, average and peak power, average and peak horizontal force, average and peak vertical force, average step frequency, average step length, average work. Twenty-five participants performed three 5-s all-out sprints from a standing split start on a non-motorised treadmill on three separate occasions. Per cent change in the means (-3.66 to 3.35%) and coefficients of variation (0.56-7.81%) were thought reliable for all variables. However, average step rate, average horizontal force and average vertical force did not meet the standards (≥0.70) set for acceptable intraclass correlation coefficients (ICC). Due to the homogeneous group, it was expected to receive low ICC values. Therefore, youth sprinting performance can be tested reliably on a non-motorised treadmill, especially if the per cent change in the mean and CV are deemed the important reliability measures. Normative data are given for the participant's age as well as their maturity level for kinematic and kinetic variables.

A Brief Review of Handgrip Strength and Sport Performance

Cronin, J, Lawton, T, Harris, N, Kilding, A, and McMaster, DT. A brief review of handgrip strength and sport performance. J Strength Cond Res 31(11): 3187-3217, 2017-Tests of handgrip strength (HGS) and handgrip force (HGF) are commonly used across a number of sporting populations. Measures of HGS and HGF have also been used by practitioners and researchers to evaluate links with sports performance. This article first evaluates the validity and reliability of various handgrip dynamometers (HGD) and HGF sensors, providing recommendations for procedures to ensure that precise and reliable data are collected as part of an athlete's testing battery. Second, the differences in HGS between elite and subelite athletes and the relationships between HGS, HGF, and sports performance are discussed.

Self-Rated Accuracy of Rating of Perceived Exertion-Based Load Prescription in Powerlifters

This study assessed male (n = 9) and female (n = 3) powerlifters' (18-49 years) ability to select loads using the repetitions in reserve-based rating of perceived exertion (RPE) scale for a single set for squat, bench press, and deadlift. Subjects trained 3× per week. For 3 weeks on nonconsecutive days in the weekly order of hypertrophy (8 repetitions at 8 RPE), power (2 repetitions at 8 RPE), and strength (3 repetitions at 9 RPE), using subject-selected loads intended to match the target RPE. Bench press and squat were performed every session and deadlift during strength and power only. Mean absolute RPE differences (|reported RPE-target RPE|) ranged from 0.22-0.44, with a mean of 0.33 ± 0.28 RPE. There were no significant RPE differences within lifts between sessions for squat or deadlift. However, bench press was closer to the target RPE for strength (0.15 ± 0.42 RPE) vs. power (-0.21 ± 0.35 RPE, p = 0.05). There were no significant differences within session between lifts for power and strength. However, bench press was closer (0.14 ± 0.44 RPE) to the target RPE than squat (-0.19 ± 0.21 RPE) during hypertrophy (p = 0.02). Squat power was closer to the target RPE in week 3 (0.08 ± 0.29 RPE) vs. 1 (-0.46 ± 0.69 RPE, p = 0.03). It seems that powerlifters can accurately select loads to reach a prescribed RPE. However, accuracy for 8-repetition sets at 8 RPE may be better for bench press compared with squat. Rating squat power-type training may take 3 weeks to reach peak accuracy. Finally, bench press RPE accuracy seems better closer rather than further from failure (i.e., 3-repetition 9 RPE sets vs. 2-repetition 8 RPE sets).

Overnight Emergency CT Imaging: A 10-Year Experience at an Irish Tertiary Referral Hospital

In recent years there has been increased utilisation of computed tomography (CT) imaging in developed countries, however there is a paucity of data regarding the utilisation of CT in the emergency overnight setting. We retrospectively analysed trends in 'overnight' (midnight to 8am) CT utilisation over a ten-year period at a single Irish tertiary referral hospital. Over the study period, we observed a significant increase in the proportion of CT imaging that was carried out overnight. There was no significant variation in the yield of pathological findings over the study period, which remained low (64% of CT studies were normal or had non-critical findings). The multiple factors which have contributed to the increased utilization of overnight emergency CT in recent years, the potential for reporting errors overnight and the implications therein for patient safety warrant consideration.

Use of emergency department point-of-care ultrasound in a case of cholecystitis

A 54-year-old man presented with severe right upper quadrant (RUQ) abdominal pain. He denied any infective symptoms. On clinical examination, he was afebrile and anicteric. His abdomen was soft with tenderness elicited on the RUQ. A point-of-care ultrasound in the emergency department demonstrated a distended gallbladder with a thickened wall and an impacted large gallstone at the neck of the gallbladder. Furthermore, the point-of-care ultrasound also identified a highly reflective echo from the anterior surface of the gallstone and marked posterior acoustic shadowing. A diagnosis of cholecysitis was made after confirmatory ultrasonography performed in the radiology department. The patient had a cholecystostomy performed under interventional radiology and was managed with course of intravenous antibiotics for 7 days. He was discharged from hospital with an elective cholecystectomy planned to be performed 8 weeks posthospital discharge.