Identification of Parameters That Predict Sport Climbing Performance

In recent years, extreme sport-related pursuits including climbing have emerged not only as recreational activities but as competitive sports. Today, sport climbing is a rapidly developing, competitive sport included in the 2020 Olympic Games official program. Given recent developments, the understanding of which factors may influence actual climbing performance becomes critical. The present study aimed at identifying key performance parameters as perceived by experts in predicting actual lead sport climbing performance. Ten male (M_age = 28, SD = 6.6 years) expert climbers (7a+ to 8b on-sight French Rating Scale of Difficulty), who were also registered as climbing coaches, participated in semi-structured interviews. Participants’ responses were subjected to inductive-deductive content analysis. Several performance parameters were identified: passing cruxes, strength and conditioning aspects, interaction with the environment, possessing a good climbing movement repertoire, risk management, route management, mental balance, peer communication, and route preview. Route previewing emerged as critical when it comes to preparing and planning ascents, both cognitively and physically. That is, when optimizing decision making in relation to progressing on the route (ascent strategy forecasting) and when enhancing strategic management in relation to the effort exerted on the route (ascent effort forecasting). Participants described how such planning for the ascent allows them to: select an accurate and comprehensive movement repertoire relative to the specific demands of the route and reject ineffective movements; optimize effective movements; and link different movements upward. As the sport of climbing continues to develop, our findings provide a basis for further research that shall examine further how, each of these performance parameters identified, can most effectively be enhanced and optimized to influence performance positively. In addition, the present study provides a comprehensive view of parameters to consider when planning, designing and delivering holistic and coherent training programs aimed at enhancing climbing performance.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Influence of fear of falling on anticipatory postural control of medio-lateral stability during rapid leg flexion

During leg flexion from erect posture, postural stability is organized in advance during "anticipatory postural adjustments" (APA). During these APA, inertial forces are generated that propel the centre of gravity (CoG) laterally towards stance leg side. This study examined how fear of falling (FoF) may influence this anticipatory postural control of medio-lateral (ML) stability. Ten young healthy participants performed a series of leg flexions at maximal velocity from low and high surface heights (6 and 66 cm above ground, respectively). In this latter condition with increased FoF, stance foot was placed at the lateral edge of the support surface to induce maximal postural threat. Results showed that the amplitude of ML inertial forces generated during APA decreased with FoF; this decrease was compensated by an increase in APA duration so that the CoG position at time of swing foot-off was located further towards stance leg side. With these changes in ML APA, the CoG was propelled in the same final (unipodal) position above stance foot as in condition with low FoF. These results contrast with those obtained in the literature during quiet standing which showed that FoF did not have any influence on the ML component of postural control. It is proposed that ML APA are modified with increased FoF, in such a way that the risk of a sideway fall induced by the large CoG motion is attenuated.

Learning throughout life: can a progress file help?

Modern dentistry demands continuous professional development. This paper reports part of a project to develop a lifelong learning tool known as a progress file for members of the dental team.

AIM

To elucidate the views of dentists (as employers/managers) and dental therapists (as employees) on the potential use at work of a progress file. To obtain feedback from these groups on a prototype progress file for dental therapists.

METHOD

Consultations were conducted with an opportunistic sample of 15 dentists and 32 dental therapists. Twenty eight dental therapists trialled the prototype for 6 months and 15 dentists appraised it. Opinion was obtained through interview and questionnaire, yielding largely qualitative data, which was content-analysed.

FINDINGS

Both dentists and therapists were positively disposed towards a progress file at work but considered its success conditional upon factors including input from the team leader and rewarding dentists for time spent on supporting file users. Evaluation of the prototype was mainly positive. Trial data bore out many impressions from the consultations.

CONCLUSION

A progress file that addresses the needs of both employers and employees has potential to help all members of the dental team meet the demands of lifelong learning.

Practice-based learning: views on the development of a reflective learning tool

CONTEXT

This study reports the first part of a funded project to develop a tool to improve and record learning, known as a Progress File. A Progress File typically contains an element of reflection and a means of recording achievement.

AIM

The aim of the study was to collect and understand the attitudes and experiences of students and tutors with regard to reflection, and to determine their views on the development and implementation of a Progress File for one member of the dental team, the dental therapist.

METHOD

A consultation exercise was undertaken in four institutions which train dental therapists. A total of 76 students and tutors were interviewed individually or in groups. Examples of reflective tools were used to prompt discussion and feedback. Emergent themes were derived from content analysis.

RESULTS

Participants identified many uses for the Progress File within and beyond their courses. They also expressed concerns regarding the effectiveness and feasibility of Progress File learning within present educational environments.

DISCUSSION AND CONCLUSION

Successful integration of the Progress File into courses of medical and dental education may depend upon institutional culture change and a move towards a system which facilitates and rewards reflection on learning. The results will inform development of the File.

The relation of the kinetics of pirmenol to its antiarrhythmic efficacy

In a single-blind study the multiple oral dose kinetics of pirmenol were related to its efficacy in eight patients with frequent (mean, 631; range, 167-1374 beats/hour) premature ventricular contractions (PVC). Oral pirmenol was started at 100 mg bid for 48 hours and increased to 150 mg bid in six patients to obtain more than 70% suppression of PVC counts. Efficacy was achieved without side effects. Pirmenol decreased heart rate but not PR interval, QRS duration, or QTc interval. Peak plasma levels after the first 100-mg dose occurred at 1 to 3 hours and ranged from 0.6 to 1.9 micrograms/mL. Plasma elimination half-life ranged from 9.7 to 31 hours (mean, 18.3). From 67.4 to 171.3 mg pirmenol (mean, 102.3 mg) were recovered in the urine in 48 hours after the last dose. Cumulative excretion in divided urine collections was consistent with a mean elimination half-life of 15 to 20 hours. The pharmacokinetics of pirmenol support oral twice-daily administration. The minimum PVC suppressing plasma level is between 0.5 and 1.5 micrograms/mL.

Salivary concentrations of pirmenol as a possible cause of unpleasant taste

Salivary concentrations of the anti-arrhythmic, pirmenol, were compared with plasma concentrations in six patients. Group mean salivary values tended to be higher despite high plasma protein binding, suggesting the possibility of an active transport process. The observed salivary concentrations are reasonably close to those detectable in healthy volunteers as tasting unpleasant.