Psychologically-based interventions for adults with chronic neuropathic pain: A scoping review

OBJECTIVE

As psychologically-based interventions have been shown to have clinical utility for adults with chronic pain generally, a similar benefit might be expected in the management of chronic neuropathic pain (NeuP). However, to date this has not been established, with existing systematic reviews on this topic being hampered by the scarcity of Randomised Controlled Trials (RCTs). This review aimed to identify the type of psychologically-based interventions studied for adults with chronic NeuP. It also aimed to assess whether there are enough RCTs to justify undertaking an updated systematic review.

METHODS

Seven databases and two clinical trial registries were searched for NeuP and psychologically-based interventions from database inception to December 2021, and the search was updated in February 2023. The search was broadened by reviewing the reference list of included studies and contacting field experts. Predetermined study characteristics were extracted.

RESULTS

Of 4682 records screened, 33 (less than 1%) articles met the eligibility criteria. Four broad intervention approaches were observed, including cognitive-behavioural approaches (n = 16), mindfulness/meditation (n = 10), trauma focused therapy (n = 4), and hypnosis (n = 3). Thirteen RCTs were identified, and of these, nine retained 20 participants in each arm at post-treatment.

CONCLUSIONS

Cognitive Behavioural Therapy was the most common therapeutic approach identified, whereas mindfulness/meditation was the most frequently used technique. Almost half to two-thirds of the studies reported significant improvements in either pain, disability, or distress, suggesting psychologically-based interventions are potentially beneficial for adults with chronic NeuP. An updated systematic review seems warranted.

Evaluation of multi-directional speed qualities throughout adolescence in youth soccer: The non-linear nature of transfer

Training and assessment of agility is often prioritised by soccer coaches and practitioners aiming to develop multi-directional speed. Although the importance of agility is advocated throughout childhood and adolescence, limited data evidence agility performance at different stages of adolescence. The purpose of this study was to examine differences in multi-directional speed performance in youth soccer players spanning an entire soccer academy. A total of 86 male junior-elite soccer players volunteered to participate. Anthropometric data were collected, alongside performance data from a battery of physical tests including sprinting, jumping, change of direction, reaction time, and agility. Bayesian models using log-likelihoods from posterior simulations of parameter values displayed linear or curvilinear relationships between both chronological and biological age and performance in all tests other than agility and reaction time. For agility and reaction time tests, performance improved until ~14 years of age or the estimated age of peak height velocity whereby arrested development in performance was observed. Our results demonstrate that while most performance skills improve as chronological or biological age increases, measures of agility and reaction time may not. These findings support the notion that agility performance is complex and multifaceted, eliciting unique, challenging physical demands and non-linear development.

A13 THE RATE OF ADVERSE EVENTS AFTER COVID-19 VACCINATION IS SIMILAR IN PATIENTS WITH CELIAC DISEASE AND NON-CELIAC POPULATION: RESULTS OF A LARGE INTERNATIONAL CROSS-SECTIONAL STUDY

Background

Patients with celiac disease (CeD) reported increased COVID-19 vaccine hesitancy due to a fear of adverse events (AEs). However, the risk of AEs post-COVID-19 vaccination in patients with CeD is unknown.

Purpose

To assess whether the rate of common side effects (SEs) and AEs due to COVID vaccines are higher in patients with CeD compared to a non-CeD population.

Method

We conducted a collaborative international cross-sectional study in 16 countries between April 2022 and July 2022. An online survey was distributed to patients with CeD through patients’ local societies, and to non-CeD from the general population in each country through social media posts, word-of-mouth, and through academic institutions. We collected data on participant demographics, medical conditions, CeD diagnosis, GFD adherence, history of COVID-19 vaccinations (type and doses) and self-reported SEs and AEs post-COVID-19 vaccine. SEs included pain/swelling at the site, fatigue, fever, chills, nausea and/or headaches. AEs included thrombosis, myocarditis, anaphylactic reaction, and hospitalization related to the vaccine. Logistic regression models were used to assess predictors such as CeD diagnosis, age, gender, vaccine type and comorbidities on the likelihood of reporting SEs and AEs post-vaccine.

Result(s)

: A total of 17,795 participants completed the survey, 13,638 with CeD (median age of 45[27]) and 4,157 non-CeD controls (median age of 43[20]). There were no significant differences in sex between CeD and controls. Overall, CeD patients had similar odds of SEs compared with non-CeD individuals (aOR=1.02;95% CI=0.92-1.14). SEs were slightly increased only in the second dose of the vaccine in the CeD population compared to non-CeD individuals (aOR= 1.35; 95% CI=1.19-1.53). The most common reported SEs in CeD and controls were pain/swelling at the injection site (29% vs 23 %, p< 0.0001) and fatigue (29% vs 24%, p<0.0001). The odds of SEs were higher with Moderna Spikevax, AstraZeneca/Oxford and Johnson and Johnson vaccines than after the Pfizer vaccine (p< 0.0001). The overall rate of AEs post-vaccine was similar between patients with CeD and non-CeD individuals (aOR= 1.29; 95% CI= 0.89-1.87). Overall, female gender, older age, GFD adherence, respiratory conditions, obesity and receiving immunosuppressive medications increased the odds of SEs, while only age and a history of allergies increased the odds of AEs.

Conclusion(s)

In this large international study, patients with CeD reported similar rates of SEs and AEs post-COVID vaccine compared to non-CeD individuals. This information is highly relevant as it addresses the main concern leading to COVID-19 vaccine hesitancy in CeD patients.

Disclosure of Interest

None Declared

P-017 A FRAMEWORK FOR MULTIDISCIPLINARY TEAM MANAGEMENT OF ABDOMINAL WALL RECONSTRUCTION

Aim

Incisional hernias are common and can significantly impact a patient's quality of life. Traditionally, abdominal wall reconstruction (AWR) has been performed by general surgeons, or those with special interest, often working in isolation. However, there is increasing awareness of pre-optimisation, risk stratification, enhanced training, and personalising treatment using a wide range of techniques.

Methods & Results

For complex and higher-risk procedures, Multidisciplinary team (MDT) management is considered the standard of care for optimising outcomes. The lack of standardised protocols and clear evidence in AWR means that surgical management can vary greatly. This makes the MDT process even more important due to the complexity of the decision-making involved. We describe a successful MDT process for complex abdominal wall reconstruction at a tertiary referral centre. Patients are reviewed at weekly AWR meetings with a multidisciplinary team, which includes consultants, advanced clinical practitioners and trainees. This is an opportunity for objective risk stratification, radiological review and assessment of the patient's goals before preoptimization and operative planning. Prospective data is collected on all patients to allow for quality improvement and service development.

Conclusion

MDT management of abdominal wall hernia is gaining popularity but remains poorly established in most regions. The involvement of surgical colleagues and other specialists is crucial in developing this growing field of surgery. We hope to expand our team to include Radiologists and Nutritionists, with the possibility of extending to regional networks, as we continue to explore new techniques and methods in managing complex abdominal wall hernias.

Maintaining Power Output with Accumulating Levels of Work Done Is a Key Determinant for Success in Professional Cycling

INTRODUCTION

This study aimed to investigate if performance measures are related to success in professional cycling and to highlight the influence of prior work done on these performance measures and success.

METHODS

Power output data from 26 professional cyclists, in a total of 85 seasons, collected between 2012 and 2019, were analyzed. The cyclists were classified as "climber" or "sprinter" and into category 1 (CAT.1; ≥400 PCSpoints (successful)) and CAT.2 (<400 PCSpoints (less successful)), based on the number of procyclingstats-points (PCSpoints) collected for that particular season. Maximal mean power outputs (MMP) for 20 min, 5 min, 1 min, and 10 s relative to body weight for every season were determined. To investigate the influence of prior work done on these MMP values, six different levels of completed work done were determined, which are based on the amount of completed kilojoules per kilogram (0, 10, 20, 30, 40, and 50 kJ·kg-1). Subsequently, the decline in MMP for each duration (if any) after each level of completed work done was evaluated.

RESULTS

Mixed model revealed that prior work done affects the performance of climbers and sprinters negatively. However, CAT.1 climbers have a smaller decline in 20- and 5-min MMP after high amounts of work done compared with CAT.2 climbers. Similarly, CAT.1 sprinters have a smaller decline in 10-s and 1-min MMP after high amounts of work done compared with CAT.2 sprinters.

CONCLUSIONS

It seems that the ability to maintain high MMP (corresponding with the specialization of a cyclist) after high amounts of work done (i.e., fatigue) is an important parameter for success in professional cyclists. These findings suggest that assessing changes in MMP after different workloads might be highly relevant in professional cycling.

Assessment of bike handling during cycling individual time trials with a novel analytical technique adapted from motorcycle racing

A methodology to study bike handling of cyclists during individual time trials (ITT) is presented. Lateral and longitudinal accelerations were estimated from GPS data of professional cyclists (n=53) racing in two ITT of different length and technical content. Acceleration points were plotted on a plot (g-g diagram) and they were enclosed in an ellipse. A correlation analysis was conducted between the area of the ellipse and the final ITT ranking. It was hypothesized that a larger area was associated to a better performance. An analytical model for the bike-cyclist system dynamics was used to conduct a parametric analysis on the influence of riding position on the shape of the g-g diagram. A moderate (n=27, r=-0.40, p=0.038) and a very large (n=26, r=-0.83, p<0.0001) association were found between the area of the enclosing ellipse and the final ranking in the two ITT. Interestingly, this association was larger in the shorter race with higher technical content. The analytical model suggested that maximal decelerations are highly influenced by the cycling position, road slope and speed. This investigation, for the first time, explores a novel methodology that can provide insights into bike handling, a large unexplored area of cycling performance.

Progression from youth to professional soccer: A longitudinal study of successful and unsuccessful academy graduates

To optimize use of available resources, professional academies develop strategies to assess, monitor, and evaluate players as they progress through adolescence toward adulthood. However, few published reports exist using longitudinal study designs to examine performance throughout adolescence and the transition from youth to professional soccer. We examined differences in the age of player recruitment alongside longitudinal performance differences on field-based fitness tests of successful vs. unsuccessful graduates across the entire age spectrum recruited by a professional soccer academy. Altogether, 537 youth soccer players volunteered to participate. We recorded the age of recruitment, biannual fitness test performance, and subsequent success in attaining a senior professional contract at the club across a period of 12 years. Only 53 (10%) of players were successful in obtaining a professional contract, with 68% of players who became professional being recruited at 12 years of age or older. Individuals recruited at an earlier age did not display a higher probability of success in attaining a professional contract. Bayesian regression models reported a consistent interaction between age and group for data on all performance measures. Moreover, "successful" academy graduates only physically outperformed their "unsuccessful" counterparts from age ~13-14 years onward, with either no differences in performance, or performance on physical fitness tests favoring "unsuccessful" players prior to this age. Findings suggest that high achievers during childhood and early adolescence may not develop into successful senior professionals, raising concerns about the predictive utility of talent identification models.

A Field-Based Cycling Test to Assess Predictors of Endurance Performance and Establishing Training Zones

Sanders, D, Taylor, RJ, Myers, T, and Akubat, I. A field-based cycling test to assess predictors of endurance performance and establishing training zones. J Strength Cond Res 34(12): 3482-3488, 2020-This study evaluates the relationship between a field-based 8-minute time trial (8MTT) and physiological endurance variables assessed with an incremental laboratory test. Second, lactate thresholds assessed in the laboratory were compared with estimated functional threshold power (FTP) from the 8MTT. Nineteen well-trained road cyclists (aged 22 ± 2 years, height 185.9 ± 4.5 cm, body mass 72.8 ± 4.6 kg, V[Combining Dot Above]O2max 64 ± 4 ml·min·kg) participated. Linear regression revealed that mean 8MTT power output (PO) was strongly to very strongly related to PO at 4 mmol·L, PO at initial rise of 1.00 mmol·L, PO at Dmax and modified (mDmax) (r = 0.61-0.82). Mean 8MTT PO was largely to very largely different compared with PO at fixed blood lactate concentration of 2 mmol·L (ES = 3.20) and 4 mmol·L (ES = 1.90), PO at initial rise 1.00 mmol·L (ES = 2.33), PO at Dmax (ES = 3.47) and mDmax (ES = 1.79) but only trivially different from maximal PO (Wmax) (ES = 0.09). The 8MTT based estimated FTP was moderate to very largely different compared with PO at initial rise of 1 mmol·L (ES = 1.37), PO at Dmax (ES = 2.42), PO at mDmax (ES = 0.77) and PO at 4 mmol·L (ES = 0.83). Therefore, even though the 8MTT can be valuable as a performance test in cycling shown through its relationships with predictors of endurance performance, coaches should be cautious when using FTP and PO at laboratory-based thresholds interchangeably to inform training prescription.

Reliability and Validity of Integrated External and Internal Load Ratios as Measures of Fitness in Academy Rugby Union Players

Taylor, RJ, Sanders, D, Myers, T, and Akubat, I. Reliability and validity of integrated external and internal load ratios as measures of fitness in academy rugby union players. J Strength Cond Res 34(6): 1723-1730, 2020-This study aimed to assess the relationships between integrated ratios of external and internal load measures and aerobic fitness in 3 different training exercise protocols. Twelve academy rugby union players (aged; 17.6 ± 0.44 years, height; 179.4 ± 6.3 cm, body mass 83.3 ± 9.7 kg) performed a lactate threshold/V[Combining Dot Above]O2max test (LT/V[Combining Dot Above]O2max) followed by 3 exercise protocols; 760 m continuous shuttle running (20 m shuttle run at 9 km·h), sprint interval training (SIT: 6 × 6 seconds sprint with 54 seconds recovery), and a small-sided game (SSG: 6 vs. 6, 10 minutes on a 39 × 51 m pitch) on 2 occasions. A LT/V[Combining Dot Above]O2max test was used to determine velocity at lactate threshold (vLT) and at the onset of blood lactate accumulation (vOBLA), maximal oxygen uptake (V[Combining Dot Above]O2max) and the heart rate-blood lactate profile for the calculation of internal load (individualized training impulse or iTRIMP). The total distance (TD), PlayerLoad, metabolic power (MP), high-speed distance >15 km·h (HSD), very high-speed distance >18 km·h (VHSD) and individualized high-speed distance based on each player's vOBLA (iHSD) for the 3 exercise protocols were measured using Micro Electro Mechanical Systems/Global Positioning System technology. Bayesian analysis was used to assess the ratios validity and reliability. Ratios demonstrated large-to-very large associations with vOBLA (Rho = 0.64-0.76), vLT (Rho = 0.63-0.71). Reliability of the ratios ranged from 7.06 to 36.28% (coefficient of variation [CV]%). The results suggest that integrated load ratios from the SIT and SSG protocols provide a measure which is reliable with large-to-very large associations to submaximal aerobic fitness in rugby union.

Demands of professional cycling races: Influence of race category and result

This study analyses the influence of race category and result on the demands of professional cycling races. In total, 2920 race files were collected from 20 male professional cyclists, within a variety of race categories: Single-day (1.WT) and multi-day (2.WT) World Tour races, single-day (1.HC) and multi-day (2.HC) Hors Catégorie races and single-day (1.1) and multi-day (2.1) category 1 races. Additionally, the five cycling "monuments" were analysed separately. Maximal mean power outputs (MMP) were measured across a broad range of durations. Volume and load were large to very largely (d = 1.30-4.80) higher in monuments compared to other single-day race categories. Trivial to small differences were observed for most intensity measures between different single-day race categories, with only RPE and sRPE·km^-1 being moderately (d = 0.70-1.50) higher in the monuments. Distance and duration were small to moderately (d = 0.20-0.80) higher in 2.WT races compared to 2.HC and 2.1 multi-day race categories with only small differences in terms of load and intensity. Generally, higher ranked races (i.e. Monuments, 2.WT and GT) tend to present with lower shorter-duration MMPs (e.g. 5-120 sec) compared to races of "lower rank" (with less differences and/or mixed results being present over longer durations), potentially caused by a "blunting" effect of the higher race duration and load of higher ranked races on short duration MMPs. MMP were small to largely higher over shorter durations (<5 min) for a top-10 result compared to no top-10, within the same category.

Effects of Body Weight vs. Lean Body Mass on Wingate Anaerobic Test Performance in Endurance Athletes

The aim of this study was to determine the influence of body weight or lean body mass-based load on Wingate Anaerobic Test performance in male and female endurance trained individuals. Thirty-one participants (22 male cyclists and triathletes and 9 female triathletes) completed two randomized Wingate Anaerobic Test (body weight and lean body mass loads) in stationary start. There were no significant differences in power outputs variables between loads in any group. However, when comparing specific groups within the sample (e. g. cyclists vs cyclists) medium to large effect sizes were observed for Relative Mean Power Output (ES=0.53), Relative Lowest Power (ES=0.99) and Relative Power Muscle Mass (ES=0.54). Regarding gender differences, male cyclists and triathletes displayed higher relative and absolute power outputs (p<0.001) compared to female triathletes regardless of the protocol used. FI was lower in female triathletes compared to male triathletes and cyclists in body weight (p<0.001) and lean body mass (p<0.01) protocols. Body composition and anthropometric characteristics were similar in male cyclists and triathletes, but there were differences between genders. These results suggest that using either body weight-based or lean body mass-based load can be used interchangeably. However, there may be some practically relevant differences when evaluating this on an individual level.

Training Characteristics of Male and Female Professional Road Cyclists: A 4-Year Retrospective Analysis

PURPOSE

To describe the training intensity and load characteristics of professional cyclists using a 4-year retrospective analysis. Particularly, this study aimed to describe the differences in training characteristics between men and women professional cyclists.

METHOD

For 4 consecutive years, training data were collected from 20 male and 10 female professional cyclists. From those training sessions, heart rate, rating of perceived exertion, and power output (PO) were analyzed. Training intensity distribution as time spent in different heart rate and PO zones was quantified. Training load was calculated using different metrics such as Training Stress Score, training impulse, and session rating of perceived exertion. Standardized effect size is reported as Cohen's d.

RESULTS

Small to large higher values were observed for distance, duration, kilojoules spent, and (relative) mean PO in men's training (d = 0.44-1.98). Furthermore, men spent more time in low-intensity zones (ie, zones 1 and 2) compared with women. Trivial differences in training load (ie, Training Stress Score and training impulse) were observed between men's and women's training (d = 0.07-0.12). However, load values expressed per kilometer were moderately (d = 0.67-0.76) higher in women compared with men's training.

CONCLUSIONS

Substantial differences in training characteristics exist between male and female professional cyclists. Particularly, it seems that female professional cyclists compensate their lower training volume, with a higher training intensity, in comparison with male professional cyclists.

A137 COLONOSCOPY RELATED ADVERSE EVENTS IN A POPULATION-BASED COLON SCREENING PROGRAM

Background

The British Columbia Colon Screening Program (BCCSP) is a population-based program enrolling 50–74 year old individuals for biennial FIT (OC-Sensor, cut-off 10 mcg/g) with follow-up colonoscopy for positive FIT. The neoplasia detection rate is 50–55% and over 75% of colonoscopies have a specimen taken. Previously reported colonoscopy adverse event rates for FIT based screening programs vary widely: 0.03–6.2% and 0–2.7% for bleeding and perforation, respectively. Mortality as a result of colonoscopy is rare but has been reported in 0.0004%-0.0074% of colonoscopies. The rate of colonoscopy related adverse events in BCCSP participants is unknown.

Aims

To determine the rate of colonoscopy related serious adverse events within the BCCSP.

Methods

This is a retrospective cohort study of all participants undergoing colonoscopy in BCCSP from November 15, 2013 to December 31, 2017. BCCSP contacts screening participants by phone 14 days post colonoscopy to determine unplanned medical visits the day prior (during bowel preparation) or following the colonoscopy. Unplanned events underwent chart review if the event was a perforation, cardiovascular or respiratory event, or resulted in death, hospitalization, or significant intervention including repeat colonoscopy, interventional radiology, surgery, blood transfusion, cardioversion, casting of a fracture or suturing of a laceration. Chart review was conducted by a Colonoscopy Lead and reviewed by BCCSP Quality Committee. Unplanned events were defined as serious adverse events (SAE) if they resulted in death, hospitalization or significant intervention and further classified as probably, possibly, or unlikely related to the colonoscopy.

Results

A total of 108,004 colonoscopies were performed. Unplanned events were reported in 1753 participants, of which 586 met criteria for review. Of these, 578 were confirmed unplanned events and 409 were SAEs of which 367 (89.7%) were probably, 22 (5.4%) possibly and 20 (4.9%) unlikely associated with colonoscopy. 36/10,000 colonoscopies were associated with a SAE that was probably or possibly related: perforation in 5/10,000, bleeding 22/10,000. Three deaths occurred in the 14 days following colonoscopy that were probably (2 perforations) or possibly related to the colonoscopy (0.3/10,000).

Conclusions

The BCCSP has a colonoscopy SAE rate in keeping with previous publications, particularly in the context of a very high proportion of procedures associated with polypectomy, a known risk factor for perforation and bleeding. This study will help inform screening participants about the risks of colonoscopy in the BC program. Future studies are required to confirm these rates using hospital admission data.

Funding Agencies

None

A85 COLON CANCER SCREENING IN PATIENTS ASSESSED FOR LUNG TRANSPLANTATION

Background

Colorectal Cancer (CRC) mortality is significantly higher after a lung transplant (1). CRC screening for average risk patients in British Columbia is done with Fecal Immunochemical Testing (FIT) every two years (2), however colonoscopy is currently the standard modality in patients undergoing lung transplant assessments in British Columbia. The yield of using FITs or Fecal Occult Blood Testing (FOBT) and colonoscopy in screening for lung transplant assessments in Canada is unknown.

Aims

To review the colon cancer screening results for all lung transplants done in British Columbia from 2013 to 2018.

Methods

This is a retrospective chart review of the 222 lung transplants done from January 2013 to December 2019.

Results

220 patients were transplanted during this time period. 2 patients were re-transplanted. 136 of the 220 lung transplant patients were male (62%). The most common indication for transplantation was interstitial lung disease (44%), followed by chronic obstructive pulmonary disease (30%), cystic fibrosis (7%), and pulmonary hypertension (4%). Colonoscopies were performed in 127 of the 220 patients. Computed tomography (CT) colonography was performed in 15 of the 220 patients, and a FOBT or FIT was performed in 200 of the 220 patients. No colon cancers were found by colonoscopy or CT colonography (0/142). Of the colonoscopies performed, 38 % (49/127) had adenomatous or serrated polyps removed. Of these 36% (18/49) had high risk pathology. The positive predictive value of a FIT/FOBT positive for a polyp was 51.4 % (CI 37.6–65.1%).

Conclusions

The value of non-invasive screening modalities in pre-lung transplant patients are modest. Program screening should be tailored to the lung transplant candidate’s risk of CRC and the risk of an invasive procedure with a known complication rate.

Funding Agencies

None

Sleep Profiles of Elite Swimmers During Different Training Phases

Walsh, JA, Sanders, D, Hamilton, DL, and Walshe, I. Sleep profiles of elite swimmers during different training phases. J Strength Cond Res 33(3): 811-818, 2019-This study aims to describe the sleeping patterns during different training phases in competitive swimmers. Twelve national- and international-level swimmers (3 females and 9 males) were monitored during 4 different phases, consisting of a preparation training phase, a taper phase, a competition phase, and a rest phase. Sleep parameters were assessed using wrist activity monitors and self-reported sleep diaries. There was a moderately higher (d = 0.70-1.00) sleep onset latency during the competition phase compared with taper, train, and rest phases. Trivial to small differences were observed for total sleep time between phases (d = 0.05-0.40). Sleep efficiency was moderately higher (d = 0.60-0.75) in the training and taper phases compared with competition and rest. Restfulness and fragmentation index (FI) were lowest in the rest with differences between phases being small (d = 0.43-0.51) for restfulness and small to moderate (d = 0.43-0.62) for FI. Time in and out of bed was very largely later (d = 1.96-2.34) in rest compared with the other phases. Total nap time was moderately lower in rest (d = 1.13-1.18) compared with the training and competition phases, whereas there was a small difference (d = 0.46) compared with taper. To conclude, while there were trivial to small differences in sleep quantity between phases, there are small to moderate differences in other sleep parameters. Specifically, sleep onset latency was higher during the competition phase. In addition, this study highlights the substantial between-individual variations in sleep responses during different training phases.

Reliability and validity of field-based fitness tests in youth soccer players

This study aimed to establish between-day reliability and validity of commonly used field-based fitness tests in youth soccer players of varied age and playing standards, and to discriminate between players without ("unidentified") or with ("identified") a direct route to professional football through their existing club pathway. Three-hundred-and-seventy-three Scottish youth soccer players (U11-U17) from three different playing standards (amateur, development, performance) completed a battery of commonly used generic field-based fitness tests (grip dynamometry, standing broad jump, countermovement vertical jump, 505 (505COD) and T-Drill (T-Test) change of direction and 10/20 m sprint tests) on two separate occasions within 7-14 days. The majority of field-based fitness tests selected within this study proved to be reliable measures of physical performance (ICC = 0.83-0.97; p < .01). However, COD tests showed weaker reliability in younger participants (ICC = 0.57-0.79; p < .01). The field-based fitness testing battery significantly discriminated between the unidentified and identified players; χ² (7) = 101.646, p < .001, with 70.2% of players being correctly classified. We have shown field-based fitness tests to be reliable measures of physical performance in youth soccer players. However, results from the 505COD and T-Test change of direction tests may be more variable in younger players, potentially due to complex demands of these tests and the limited training age established by these players. While the testing battery selected in this study was able to discriminate between unidentified and identified players, findings were inconsistent when attempting to differentiate between individual playing standards within the "identified" player group (development vs. performance).

The anaerobic power reserve and its applicability in professional road cycling

This study examined if short-duration record power outputs can be predicted with the Anaerobic Power Reserve (APR) model in professional cyclists using a field-based approach. Additionally, we evaluated if modified model parameters could improve predictive ability of the model. Twelve professional cyclists (V̇O_2max 75 ± 6 ml∙kg^-1∙min^-1) participated in this investigation. Using the mean power output during the last stage of an incremental field test, sprint peak power output and an exponential constant describing the decrement in power output over time, a power-duration relationship was established for each participant. Record power outputs of different durations (5 to 180 s) were collected from training and competition data and compared to the predicted power output from the APR model. The originally proposed exponent (k = 0.026) predicted performance within an average of 43 W (Standard Error of Estimate (SEE) of 32 W) and 5.9%. Modified model parameters slightly improved predictive ability to a mean of 34-39 W (SEE of 29 - 35 W) and 4.1 - 5.3%. This study shows that a single exponent model generally fits well with the decrement in power output over time in professional cyclists. Modified model parameters may contribute to improving predictability of the model.

Leadership and the functioning of maternal health services in two rural district hospitals in South Africa

Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but 'firm'. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices influence maternal health care services in resource limited hospitals. Supportive leadership manifested itself in the form of focused efforts to build teamwork, enhance entrepreneurship and in management systems that are geared to improving maternal care.

Delineation between different components of chronic pain using dimension reduction - an ASL fMRI study in hand osteoarthritis

Background

Traditional psychometric measures aimed at characterizing the pain experience often show considerable overlap, due to interlinked affective and modulatory processes under central nervous system control. Neuroimaging studies have been employed to investigate this complexity of pain processing, in an attempt to provide a quantifiable, adjunctive description of pain perception. In this exploratory study, we examine psychometric and neuroimaging data from 38 patients with painful osteoarthritis of the carpometacarpal joint. We had two aims: first, to utilize principal component analysis (PCA) as a dimension reduction strategy across multiple self‐reported endpoints of pain, cognitive and affective functioning; second, to investigate the relationship between identified dimensions and regional cerebral blood flow (rCBF) as an indirect measure of brain activity underpinning their ongoing pain experiences.

Methods

Psychometric data were collected using validated questionnaires. Quantitative estimates of rCBF were acquired using pseudo‐continuous arterial spin‐labelled functional magnetic resonance imaging.

Results

Two principal components were identified that accounted for 73% of data variance; one related to pain scores and a second to psychological traits. Voxel‐wise multiple regression analysis revealed a significant negative association between the ‘pain score’ component and rCBF to a right temporal lobe cluster, including the amygdala and the parahippocampal cortex.

Conclusion

We suggest this association may represent a coping mechanism that aims to reduce fear‐related pain‐anxiety. Further investigation of central brain processing mechanisms in osteoarthritis‐related pain may offer insights into more effective therapeutic strategies.

Significance

This study demonstrates that dimension reduction using PCA allows insight into pain perception and its affective components in relation to brain activation patterns in patients with painful hand osteoarthritis.

Proposal for a national triage system for the management of ventral hernias

Ventral hernia disease is becoming increasingly prevalent and complex. Subspecialisation for patients with challenging conditions requiring surgery has been shown to improve postoperative outcomes. Worldwide, there is an emergence of specialist hernia centres using new and innovative techniques to repair large and complicated ventral hernias. After a national meeting of hernia experts, we present an algorithm to be used as a national triage system for patients with ventral hernias, with the aim of ensuring that patients are operated on by the most appropriate surgeon. Evidence-based clinical risk factors and ventral hernia parameters are used for risk stratification and patient triage. We hope that this algorithm will guide future ventral hernia management in the UK.

Outcomes of a pediatric surgical oncology fellowship in a pediatric cancer institution

Surgery plays an important role as part of the treatment plan in most children with malignant solid tumors in regards to initial biopsy, upfront resection, and delayed resection. Surgeons also play a critical role in the treatment of surgical complications that may arise during medical treatment. The pediatric surgical oncologist should be familiar with the current treatment guidelines, histology implications, chemotherapy and radiation side effects, tumor staging, and overall care of the child with cancer. Specific training in pediatric surgical oncology is not widespread internationally and it represents a potential undervalued intervention for improving global pediatric cancer care.

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

P1 Impact of antioxidant-enriched nutrient bar supplementation on the serum antioxidant markers and physical fitness components of track and field athletes

Lalitha Ramaswamy, Supriya Velraja

P2 The effects of phosphatidic acid supplementation on fitness levels in resistance trained women

Guillermo Escalante, Phil Harvey, Michelle Alencar, Bryan Haddock

P3 The effects of phosphatidic acid supplementation on cardiovascular risk factors in resistance trained men

Phil Harvey, Guillermo Escalante, Michelle Alencar, Bryan Haddock

P4 The efficacy of sodium bicarbonate supplementation on physical capacity and selected biochemical markers in elite wrestlers

Krzysztof Durkalec-Michalski, Jan Jeszka, Bogna Zawieja, Tomasz Podgórski

P5 Effects of different nutritional strategies in hydration and physical performance in healthy well-trained males

Ana Paula Trussardi Fayh, Alexandre Hideki Okano, Amanda Maria de Jesus Ferreira

P6 Reduction of plasma creatine concentrations as an indicator of improved bioavailability

Ralf Jäger, Martin Purpura, Roger C Harris

P7 Effect of three different breakfast meals on energy intake and nutritional status in college-age women

Molly M. Krause, Kiley A. Lavanger, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson

P8 Accuracy of the ASA24® Dietary Recall system for assessing actual dietary intake in normal weight college-age women.

Kiley A. Lavanger, Molly M. Krause, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson

P9 β-aminoisobutyric acid does not regulate exercise induced UCP-3 expression in skeletal muscle

Elisa Morales, Jeffrey Forsse, Thomas Andre, Sarah McKinley, Paul Hwang, Grant Tinsley, Mike Spillane, Peter Grandjean, Darryn Willoughby

P10 The ability of collegiate football athletes to adhere to sport-specific nutritional recommendations

A. Jagim, G. Wright, J. Kisiolek, M. Meinking, J. Ochsenwald, M. Andre, M.T. Jones, J. M. Oliver

P11 A single session of low-volume high intensity interval exercise improves appetite regulation in overweight men

Victor Araújo Ferreira, Daniel Costa de Souza, Victor Oliveira Albuquerque dos Santos, Rodrigo Alberto Vieira Browne, Eduardo Caldas Costa, Ana Paula Trussardi Fayh

P12 Acute effects of oral peppermint oil ingestion on exercise performance in moderately-active college students

Suresh T. Mathews, Haley D. Bishop, Clara R. Bowen, Yishan Liang, Emily A. West, Rebecca R. Rogers, Mallory R. Marshall, John K. Petrella

P13 Associations in body fat and liver triglyceride content with serum health markers in sedentary and exercised rats fed a ketogenic diet, Western diet or standard chow over a 6-week period

A. Maleah Holland, Wesley C. Kephart, Petey W. Mumford, C. Brooks Mobley, Ryan P. Lowery, Jacob M. Wilson, Michael D. Roberts

P14 Physiological changes following competition in male and female physique athletes: A pilot study

Eric T. Trexler, Katie R. Hirsch, Bill I. Campbell, Meredith G. Mock, Abbie E. Smith-Ryan

P15 Relationship between cognition and hydration status in college students at a large Southwestern university

Kate Zemek, Carol Johnston

P16 Whey protein-derived exosomes increase protein synthesis in C2C12 myotubes

C. Brooks Mobley, Petey W. Mumford, David D. Pascoe, Christopher M. Lockwood, Michael E. Miller, Michael D. Roberts

P17 The effect of three different energy drinks on 1.5-mile running performance, oxygen consumption, and perceived exertion

Gabriel J. Sanders, Willard Peveler, Brooke Warning, Corey A. Peacock

P18 The Ketogenic diet improves rotarod performance in young and older rats

Wesley C. Kephart, Petey W. Mumford, Ryan P. Lowery, Michael D. Roberts, Jacob M. Wilson

P19 Absorption of bonded arginine silicate compared to individual arginine and silicon components

David Sandler, Sara Perez Ojalvo, James Komorowski

P20 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on body composition in aspiring female physique athletes engaging in an 8-week resistance training program

Bill I. Campbell, Danielle Aguilar, Andres Vargas, Laurin Conlin, Amey Sanders, Paola Fink-Irizarry, Layne Norton, Ross Perry, Ryley McCallum, Matthew R. Wynn, Jack Lenton

P21 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on maximal strength in aspiring female physique athletes engaging in an 8-week resistance training program

Bill I. Campbell, Chris Gai, Seth Donelson, Shiva Best, Daniel Bove, Kaylee Couvillion, Jeff Dolan, Dante Xing, Kyshia Chernesky, Michael Pawela, Andres D. Toledo, Rachel Jimenez

P22 Monitoring of female collegiate athletes over a competitive season reveals changes in nutritional biomarkers

M. Rabideau, A. Walker, J. Pellegrino, M. Hofacker, B. McFadden, S. Conway, C. Ordway, D. Sanders, R. Monaco, M. S. Fragala, S. M. Arent

P23 Comparison of prediction equations to indirect calorimetry in men and women athletes

Jason D. Stone, Andreas Kreutzer, Jonathan M. Oliver, Jacob Kisiolek, Andrew R. Jagim

P24 Regional variations in sweat-based electrolyte loss and changes in plasma electrolyte content in Division I female athletes over the course of a competitive season

M. Hofacker, A. Walker, J. Pellegrino, M. Rabideau, B. McFadden, S. Conway, D. Sanders, C. Ordway, R. Monaco, M. S. Fragala, S. M. Arent

P25 In-season changes in plasma amino acid levels in Division I NCAA female athletes

Ozlem Tok, Joseph K. Pellegrino, Alan J. Walker, David J. Sanders, Bridget A. McFadden, Meaghan M. Rabideau, Sean P. Conway, Chris E. Ordway, Marissa Bello, Morgan L. Hofacker, Nick S. Mackowski, Anthony J. Poyssick, Eddie Capone, Robert M. Monaco, Maren S. Fragala, Shawn M. Arent

P26 Effects of a ketogenic diet with exercise on serum markers of bone metabolism, IGF-1 and femoral bone mass in rats

Petey W. Mumford, A. Maleah Holland, Wesley C. Kephart, Ryan P. Lowery, C. Brooks Mobley, Romil K. Patel, Annie Newton, Darren T. Beck, Michael D. Roberts, Jacob M. Wilson, Kaelin C. Young

P27 Casein supplementation in trained men and women: morning versus evening

Tobin Silver, Anya Ellerbroek, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio

P28 A high protein diet has no harmful effects: a one-year crossover study in resistance-trained males

Anya Ellerbroek, Tobin Silver, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio

P29 SUP (Stand-up Paddling) athletes: nutritional intake and body composition

Adam Pollock, Anya Ellerbroek, Tobin Silver, Corey Peacock, Jose Antonio

P30 The effects of 8 weeks of colostrum and bio-active peptide supplementation on body composition in recreational male weight lifters

A. Kreutzer, P. Zavala, S. Fleming, M. Jones, J. M. Oliver, A. Jagim

P31 Effects of a Popular Women’s Thermogenic Supplement During an Energy-Restricted High Protein Diet on Changes in Body Composition and Clinical Safety Markers

Cody T. Haun, Petey W. Mumford, Parker N. Hyde, Ciaran M. Fairman, Wesley C. Kephart, Darren T. Beck, Jordan R. Moon, Michael D. Roberts, Kristina L. Kendall, Kaelin C. Young

P32 Three days of caffeine consumption following caffeine withdrawal yields small strength increase in knee flexors

Geoffrey M Hudson, Tara Hannings, Kyle Sprow, Loretta DiPietro

P33 Comparison of cellular nitric oxide production from various sports nutrition ingredients

Doug Kalman, Sara Perez Ojalvo, James Komorowski

P34 The effects of 8 weeks of bio-active peptide supplementation on training adaptations in recreational male weight lifters

P. Zavala, S. Fleming, M. Jones, J. Oliver, A. Jagim

P35 Effects of MusclePharm Assault Black^TM on lower extremity spinal excitability and postactivation potentiation: A pilot study

Brian Wallace, Haley Bergstrom, Kelly Wallace

P36 Effects of four weeks of Ketogenic Diet alone and combined with High intensity Interval Training or Continuous-Moderate intensity on body composition, lipid profile and physical performance on healthy males

Matias Monsalves-Alvarez, Sebastian Oyharçabal, Victoria Espinoza

P37 Effect of branched-chain amino acid supplementation on creatine kinase, muscular performance, and perceived muscle soreness following acute eccentric exercise

Trisha A. VanDusseldorp, Kurt A. Escobar, Kelly E. Johnson, Nathan Cole, Terence Moriarty, Matthew Stratton, Marvin R. Endito, Christine M. Mermier, Chad M. Kerksick

P38 Effects of endurance training on markers of ribosome biogenesis in rodents fed a high fat diet

Matthew A. Romero, C. Brooks Mobley, Melissa Linden, Grace Margaret-Eleanor Meers, R. Scott Rector, Michael D. Roberts

P39 The effects of acute citrulline-malate on lower-body isokinetic performance in recreationally active individuals

Joshua L Gills, Hocheng Lu, Kimberly Parker, Chris Dobbins, Joshua N Guillory, Braden Romer, David Szymanski, Jordan Glenn

P40 The effect pre-ingested L-isoleucine and L-leucine on blood glucose responses and glycemic hormones in healthy inactive adults: Preliminary data.

Daniel E. Newmire, Eric Rivas, Sarah E. Deemer, Robert Wildman, Victor Ben-Ezra

P41 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise?

C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee

P42 Effects of a pre-workout supplement on peak power and power maintenance during lower and upper body testing

Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane

P43 Effects of a pre-workout supplement on peak power production during lower and upper body testing in college-age females

Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane

P44 A comparison of whey versus casein protein supplementation on resting metabolic rate and body composition: a pilot study

Corey A. Peacock, Tobin A. Silver, Megan Colas, Mauricio Mena, Winter Rodriguez, Gabriel J. Sanders, Jose Antonio

P45 A novel mixed-tocotrienol intervention enhances recovery after eccentric exercise: preliminary findings

Andrea Vansickle, Brittany DiFiore, Stephanie Stepp, Grant Slack, Bridget Smith, Kayla Ruffner, Ronald Mendel, Lonnie Lowery

P46 The effects of post-exercise ingestion of a high molecular weight glucose on cycle performance in female cyclists

Katie R. Hirsch, Meredith G. Mock, Malia M.N. Blue, Eric T. Trexler, Erica J. Roelofs, Abbie E. Smith-Ryan

P47 Inclusive vs. exclusive dieting and the effects on body composition in resistance trained individuals

Laurin Conlin, Danielle Aguilar, Bill I. Campbell, Layne Norton, Katie Coles, Eric T. Trexler, Nic Martinez

P48 A whey protein hydrolysate may positively augment resting metabolism compared to intact whey protein

Jordan M. Joy, Roxanne M. Vogel, Thomas H. Hoover, K. Shane Broughton

P49 Seven days of high and low dose creatine nitrate supplementation I: hepatorenal, glucose and muscle enzyme function

R Dalton, R Sowinski, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P50 Seven days of high and low dose creatine nitrate supplementation II: performance

T Grubic, R Dalton, R Sowinski, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P51 Seven days of high and low dose creatine nitrate supplementation III: hemodynamics

R Sowinski, R Dalton, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P52 The efficacy of a β-hydroxy-β-methylbutyrate supplementation on physical capacity, body composition and biochemical markers in highly-trained combat sports athletes

Krzysztof Durkalec-Michalski, Jan Jeszka, Tomasz Podgórski

P53 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise?

C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee

P54 Effects of 30 days of Cleanse™ supplementation on measure of body composition, waist circumference, and markers of gastrointestinal distress in females

Stacie Urbina, Emily Santos, Katelyn Villa, Alyssa Olivencia, Haley Bennett, Marissa Lara, Cliffa Foster, Colin Wilborn, Lem Taylor

P55 The effects of moderate- versus high-load training on body composition, muscle growth, and performance in college aged females

Jason M Cholewa, Amy Hewins, Samantha Gallo, Ashley Micensky, Christian De Angelis, Christopher Carney, Bill Campbell, Laurin Conlin, Layne Norton, Fabricio Rossi

P56 Effect of a multi-ingredient preworkout supplement on cognitive function and perceptions of readiness to perform

MS Koozehchian, PB Collins, R Sowinski, T Grubic, R Dalton, A O’Connor, SY Shin, Y Peter Jung, BK Sanchez, A Coletta, M Cho, A Reyes, C Rasmussen, CP Earnest, PS Murano, M Greenwood, RB Kreider

The economic burden of incisional ventral hernia repair: a multicentric cost analysis

PURPOSE

A systematic review of literature led us to take note that little was known about the costs of incisional ventral hernia repair (IVHR).

METHODS

Therefore we wanted to assess the actual costs of IVHR. The total costs are the sum of direct (hospital costs) and indirect (sick leave) costs. The direct costs were retrieved from a multi-centric cost analysis done among a large panel of 51 French public hospitals, involving 3239 IVHR. One hundred and thirty-two unitary expenditure items were thoroughly evaluated by the accountants of a specialized public agency (ATIH) dedicated to investigate the costs of the French Health Care system. The indirect costs (costs of the post-operative inability to work and loss of profit due to the disruption in the ongoing work) were estimated from the data the Hernia Club registry, involving 790 patients, and over a large panel of different Collective Agreements.

RESULTS

The mean total cost for an IVHR in France in 2011 was estimated to be 6451€, ranging from 4731€ for unemployed patients to 10,107€ for employed patients whose indirect costs (5376€) were slightly higher than the direct costs.

CONCLUSION

Reducing the incidence of incisional hernia after abdominal surgery with 5 % for instance by implementation of the European Hernia Society Guidelines on closure of abdominal wall incisions, or maybe even by use of prophylactic mesh augmentation in high risk patients could result in a national cost savings of 4 million Euros.