Longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players

This is the first study to assess longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players. Thirteen forwards and 11 backs were tested three times over a 10-month period. Assessments included: standing height and body mass, body composition measured by dual x-ray absorptiometry (DXA), a blood panel, resting metabolic rate (RMR) assessed by indirect calorimetry, aerobic capacity (i.e.,[Formula: see text]) evaluated by an incremental treadmill test, and isometric force production measured by a force plate. During the pre-season phase, lean mass increased significantly by ~2% for backs (testing point 1: 47 kg; testing point 2: 48 kg) and forwards (testing point 1: 50 kg; testing point 2: 51 kg) (p = ≤ 0.05). Backs significantly increased their [Formula: see text] by 22% from testing point 1 (40 ml kg-1 min-1) to testing point 3 (49 ml kg-1 min-1) (p = ≤ 0.04). The [Formula: see text] of forwards increased by 10% from testing point 1 (41 ml kg-1 min-1) to testing point 3 (45 ml kg-1 min-1), however this change was not significant (p = ≥ 0.05). Body mass (values represent the range of means across the three testing points) (backs: 68 kg; forwards: 77-78 kg), fat mass percentage (backs: 25-26%; forwards: 30-31%), resting metabolic rate (backs: 7 MJ day-1; forwards: 7 MJ day-1), isometric mid-thigh pull (backs: 2106-2180 N; forwards: 2155-2241 N), isometric bench press (backs: 799-822 N; forwards: 999-1024 N), isometric prone row (backs: 625-628 N; forwards: 667-678 N) and bloods (backs: ferritin 21-29 ug/L, haemoglobin 137-140 g/L, iron 17-21 umol/L, transferrin 3 g/L, transferring saturation 23-28%; forwards: ferritin 31-33 ug/L, haemoglobin 141-145 g/L, iron 20-23 umol/L, transferrin 3 g/L, transferrin saturation 26-31%) did not change (p = ≥ 0.05). This study provides novel longitudinal data which can be used to better prepare women rugby league players for the unique demands of their sport, underpinning female athlete health.

Making informed choices on incorporating chemoprevention into carE (MiCHOICE, SWOG 1904): Design and methods of a cluster randomized controlled trial

INTRODUCTION

Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy.

METHODS/DESIGN

We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation.

RESULTS/DISCUSSION

With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S.

CLINICAL SETTINGS

TRIAL REGISTRATION

NCT04496739.

Associations between anterior knee pain and 2-year patellofemoral cartilage worsening: The MOST study

OBJECTIVE

Anterior knee pain (AKP) is associated with patellofemoral osteoarthritis (PFOA), but longitudinal studies are lacking. If AKP precedes PFOA, it may create an opportunity to identify and intervene earlier in the disease process. The purpose of this study was to examine the longitudinal relation of AKP to worsening patellofemoral (PF) cartilage over two years.

DESIGN

Participants were recruited from the Multicenter Osteoarthritis Study, a longitudinal study of individuals with or at risk for knee osteoarthritis (OA). Exclusion criteria included bilateral knee replacements, arthritis other than OA, and radiographic PFOA. At baseline, participants completed a knee pain map questionnaire and underwent knee magnetic resonance imaging (MRI). Imaging was repeated at 2-year follow-up. Exposure was presence of frequent AKP. Outcome was worsening cartilage damage in the PF joint defined as increase in MRI Osteoarthritis Knee Score from baseline to 2 years. Log-binomial models were used to calculate risk ratios (RR).

RESULTS

One knee from 1083 participants (age 56.7 ± 6.6 years; body mass index 28.0 ± 4.9 kg/m2) was included. Frequent AKP and frequent isolated AKP were present at baseline in 14.5% and 3.6%, respectively. Frequent AKP was associated with an increased risk (RR: 1.78, 95% confidence interval: 1.21, 2.62) of 2-year worsening cartilage damage in the lateral PF compartment. No association was found between frequent AKP and worsening in the medial PF joint.

CONCLUSION

Frequent AKP at baseline was associated with worsening cartilage damage in the lateral PF joint over 2 years.

The speed and acceleration of the ball carrier and tackler into contact during front-on tackles in rugby league

The aim was to use a combination of video analysis and microtechnology (10 Hz global positioning system [GPS]) to quantify and compare the speed and acceleration of ball-carriers and tacklers during the pre-contact phase (contact - 0.5s) of the tackle event during rugby league match-play. Data were collected from 44 professional male rugby league players from two Super League clubs across two competitive matches. Tackle events were coded and subject to three stages of inclusion criteria to identify front-on tackles. 10 Hz GPS data was synchronised with video to extract the speed and acceleration of the ball-carrier and tackler into each front-on tackle (n = 214). Linear mixed effects models (effect size [ES], confidence intervals, p-values) compared differences. Overall, ball-carriers (4.73 ± 1.12 m∙s-1) had greater speed into front-on tackles than tacklers (2.82 ± 1.07 m∙s-1; ES = 1.69). Ball-carriers accelerated (0.67 ± 1.01 m∙s-2) into contact whilst tacklers decelerated (-1.26 ± 1.36 m∙s-2; ES = 1.74). Positional comparisons showed speed was greater during back vs. back (ES = 0.66) and back vs. forward (ES = 0.40) than forward vs. forward tackle events. Findings can be used to inform strategies to improve performance and player welfare.

Moving beyond velocity derivatives; using global positioning system data to extract sequential movement patterns at different levels of rugby league match-play

This study aims to (a) quantify the movement patterns during rugby league match-play and (b) identify if differences exist by levels of competition within the movement patterns and units through the sequential movement pattern (SMP) algorithm. Global Positioning System data were analysed from three competition levels; four Super League regular (regular-SL), three Super League (semi-)Finals (final-SL) and four international rugby league (international) matches. The SMP framework extracted movement pattern data for each athlete within the dataset. Between competition levels, differences were analysed using linear discriminant analysis (LDA). Movement patterns were decomposed into their composite movement units; then Kruskal-Wallis rank-sum and Dunn post-hoc were used to show differences. The SMP algorithm found 121 movement patterns comprised mainly of "walk" and "jog" based movement units. The LDA had an accuracy score of 0.81, showing good separation between competition levels. Linear discriminant 1 and 2 explained 86% and 14% of the variance. The Kruskal-Wallis found differences between competition levels for 9 of 17 movement units. Differences were primarily present between regular-SL and international with other combinations showing less differences. Movement units which showed significant differences between competition levels were mainly composed of low velocities with mixed acceleration and turning angles. The SMP algorithm found 121 movement patterns across all levels of rugby league match-play, of which, 9 were found to show significant differences between competition levels. Of these nine, all showed significant differences present between international and domestic, whereas only four found differences present within the domestic levels. This study shows the SMP algorithm can be used to differentiate between levels of rugby league and that higher levels of competition may have greater velocity demands.Highlights This study shows that movement patterns and movement units can be used to investigate team sports through the application of the SMP frameworkOne hundred and twenty-one movement patterns were found to be present within rugby league match-play, with the walk- and jog-based movement units most prevalent. No movement pattern was unique to a single competition level.Further analysis revealed that the majority of movement units analysed had significant differences between international and domestic rugby league, whereas only four movement units (i.e. f,m,n,q) had significant differences within the two domestic rugby league levels.International rugby league had higher occurrences of the movement patterns consisting of higher velocity movement units (ie. T,S,y). This suggests that international rugby league players may need greater high velocity exposure in training.

1058 ESTABLISHING A VIRTUAL MULTIDISCIPLINARY TEAM MEETING FOR CARE HOME RESIDENTS IN NEWCASTLE-UPON-TYNE

Introduction

Care home (CH) residents are frail with complex physical and mental health needs. Healthcare provided is often by different organisations and fragmented. Optimising quality of life and reducing avoidable hospital attendance is crucial. The Newcastle Specialist Care Home Support Team (SCHST) provides care for 2,482 residents across 55 Newcastle CHs. Between April 2019–2020, there were 2,428 unplanned hospital attendances in this cohort. SCHST looked to establish multidisciplinary team (MDT) meetings to streamline care by collaboration and integrating pre-existing services. We aimed to establish weekly virtual MDT meetings to facilitate coordinated care for CH residents, reduce unplanned hospital attendances and improve communications between services, reducing need for additional referrals.

Method

Members identified to comprise the MDT included SCHST staff, Geriatricians, Old Age Psychiatrists, Pharmacists and GPs. Weekly meetings via Microsoft Teams were established, with the SCHST undertaking initial assessments of those referred. Management plans were formulated and actioned with feedback to GPs, CH staff and relatives. Residents were either discharged, planned for MDT re-review, or planned for in-person CH review. Interventions include medications optimisation, CH staff education, psychiatric and comprehensive geriatric assessments.

Results

From April-Nov 2021, 77 residents were referred to MDT. The number of reviews ranged from 1–6 (median = 2). All residents received an initial assessment by SCHST, with only 18 requiring in-person geriatrician input. Analysis of 22 residents showed fewer unplanned admissions in the 6 months following MDT review, compared to 6 months before. (Pre-MDT median 2 (range 0–6); post-MDT 0 (0–9); p < 0.05).

Conclusion

Preliminary data suggest that the virtual Care Home MDT may reduce the number of unplanned hospital admissions of care home residents, with less than one quarter requiring face-to-face geriatrician reviews. The CH MDT has shown to provide effective delivery of care, whilst reducing workload and improving efficiency, through collaborative interdisciplinary working.

The anthropometric and physical qualities of women’s rugby league Super League and international players; identifying differences in playing position and level

Participation in women’s rugby league has been growing since the foundation of the English women’s rugby league Super League in 2017. However, the evidence base to inform women’s rugby league remains sparse. This study provides the largest quantification of anthropometric and physical qualities of women’s rugby league players to date, identifying differences between positions (forwards & backs) and playing level (Women’s Super League [WSL] vs. International). The height, weight, body composition, lower body strength, jump height, speed and aerobic capacity of 207 players were quantified during the pre-season period. Linear mixed models and effects sizes were used to determine differences between positions and levels. Forwards were significantly (p < 0.05) heavier (forwards: 82.5 ± 14.8kg; backs: 67.7 ± 9.2kg) and have a greater body fat % (forwards: 37.7 ± 6.9%; backs: 30.4 ± 6.3%) than backs. Backs had significantly greater lower body power measured via jump height (forwards: 23.5 ± 4.4cm; backs: 27.6 ± 4.9cm), speed over 10m (forwards: 2.12 ± 0.14s; backs: 1.98 ± 0.11s), 20m (forwards: 3.71 ± 0.27s; backs: 3.46 ± 0.20s), 30m (forwards: 5.29 ± 0.41s; backs: 4.90 ± 0.33s), 40m (forwards: 6.91 ± 0.61s; backs: 6.33 ± 0.46s) and aerobic capacity (forwards: 453.4 ± 258.8m; backs: 665.0 ± 298.2m) than forwards. Additionally, international players were found to have greater anthropometric and physical qualities in comparison to their WSL counterparts. This study adds to the limited evidence base surrounding the anthropometric and physical qualities of elite women’s rugby league players. Comparative values for anthropometric and physical qualities are provided which practitioners may use to evaluate the strengths and weaknesses of players, informing training programs to prepare players for the demands of women’s rugby league.

Impact of left heart disease risk factors on risk stratification and treatment response in pulmonary arterial hypertension

Background

Contemporary registries have documented a change in the epidemiology of PAH patients displaying increasing co-morbidities associated with left heart disease (LHD). These patients are often excluded from randomized clinical trials. It is unclear whether the presence of LHD comorbidities may adversely impact the accuracy of risk stratification and response to PAH therapy.

Method

Data was extracted from the Pulmonary Hypertension Society of Australia and New Zealand registry for incident patients with a diagnosis with idiopathic/heritable/toxin-induced (I/H/D)-PAH and connective tissue disease (CTD) associated PAH from 2011 - 2020. Patients without available medication and follow up data were excluded. We used the AMBITION trial exclusion criteria to define the subpopulation with LHD risk factors and haemodynamic phenotype (PAH-rLHD).

Results

489 patients (I/H/D-PAH=251, CTD-PAH=238) were included in our analysis, with 103 (21.0%) fulfilling the definition of PAH-rLHD (34 had ≥3 risk factors for left heart disease (rLHD-hypertension, diabetes, obesity or ischaemic heart disease) and 76 had borderline haemodynamics (mean capillary wedge pressure 13–15 with pulmonary vascular resistance &lt;500 dynes sec/cm5) including 7 who met both criteria). Compared to classical PAH, patients with PAH-rLHD were older at diagnosis (66±13 vs 58±19, p&lt;0.001), had lower pulmonary vascular resistance (PVR: 393±266 vs 708±391, p=0.031) but worse exercise capacity (6MWD: 286±130m vs 327±136m, p=0.005). PAH-rLHD were more likely to be started on initial monotherapy, compared with “classical” PAH (73% vs 56%, p=0.002). In the monotherapy groups, endothelin receptor antagonists (ERA) were used in 73% PAH-rLHD, compared with 66% in classical PAH group. Both groups exhibited similar response to both mono- and combination therapy with commensurate improvements in WHO functional class (mean change 0.3±0.6 vs 0.3±0.8, p=0.443) and 6-minute walk distance (mean change 44±82 vs 48±101, p=0.723). There was no difference in survival between classical PAH and PAH-rLHD (log rank, p=0.29). The REVEAL 2.0 risk score effectively discriminated risk in both populations at baseline and first follow up (classical PAH: baseline C statistic 0.750, follow up 0.774 and PAH-rLHD: baseline C statistic 0.756, follow up 0.791).

Conclusion

Despite lower PVR at diagnosis, PAH-rLHD patients and “classical” PAH demonstrate similar response to first-line therapy with similar long term survival. The REVEAL 2.0 risk score can be effectively applied to the subpopulation of PAH-rLHD in real life clinical practice.

Funding Acknowledgement

Type of funding sources: None.

Sequential movement pattern-mining (SMP) in field-based team-sport: A framework for quantifying spatiotemporal data and improve training specificity?

Athlete external load is typically quantified as volumes or discretised threshold values using distance, speed and time. A framework accounting for the movement sequences of athletes has previously been proposed using radio frequency data. This study developed a framework to identify sequential movement sequences using GPS-derived spatiotemporal data in team-sports and establish its stability. Thirteen rugby league players during one match were analysed to demonstrate the application of the framework. The framework (Sequential Movement Pattern-mining [SMP]) applies techniques to analyse i) geospatial data (i.e., decimal degree latitude and longitude), ii) determine players turning angles, iii) improve movement descriptor assignment, thus improving movement unit formation and iv) improve the classification and identification of players' frequent SMP. The SMP framework allows for sub-sequences of movement units to be condensed, removing repeated elements, which offers a novel technique for the quantification of similarities or dis-similarities between players and playing positions. The SMP framework provides a robust and stable method that allows, for the first time the analysis of GPS-derived data and identifies the frequent SMP of field-based team-sport athletes. The application of the SMP framework in practice could optimise the outcomes of training of field-based team-sport athletes by improving training specificity.

Maritime Interfacility Transport of Two Laboring Mothers - A Case Report

Background: Interfacility transport of laboring mothers is an infrequent endeavor associated with additional risk in the best of circumstances. Case Presentation: We report on a case where two laboring mothers were transported at night via fireboat, resulting in the delivery of one child while underway and delivery of another soon after arrival at the receiving facility. Conclusions: The objective of this case report is to describe the decision-making process and medical care for these two mothers during a nontraditional EMS transport.

Chlamydia psittaci infection as a cause of respiratory disease in neonatal foals

BACKGROUND

During 2016-2018, 15 critically ill neonatal foals with acute respiratory distress associated with Chlamydia psittaci infection were presented to three referral hospitals in New South Wales. Chlamydia psittaci has not previously been associated with the development of neonatal respiratory disease.

OBJECTIVES

To investigate and describe the clinical features and outcome of C. psittaci infection in neonatal foals.

STUDY DESIGN

Multicentre retrospective case series.

METHODS

The clinical, clinicopathological, necropsy and histological features of 15 foals with confirmed C. psittaci infection were reviewed and reported.

RESULTS

Thirteen foals with C. psittaci infection died or were subjected to euthanasia within 36 h of hospitalisation and two foals survived to discharge. Findings during post-mortem examination of nonsurviving foals included bronchopneumonia, pulmonary congestion, hepatic congestion and hepatic inflammation. Detection of C. psittaci was achieved using polymerase chain reaction (PCR) testing of swabs of nasal secretions (4/6) and rectal mucosa (5/7) from live foals, lung tissues of foals at necropsy (11/14) and foetal membranes (4/5).

MAIN LIMITATIONS

Small numbers of confirmed cases of neonatal C. psittaci infection and inconsistent sampling methods.

CONCLUSIONS

Chlamydia psittaci should be considered a differential diagnosis for neonatal foals with signs of severe systemic disease, including equine neonatal acute respiratory distress syndrome (EqNARDS). Chlamydia psittaci is a zoonotic pathogen and a personal protective equipment (PPE) should be worn for the management of foals with suspected or confirmed infection.

228 Potentially Inappropriate Prescribing in Community Nursing Units: Prevalence and Potential for Optimisation

Background

It is well researched that individuals in long-term care (LTC) are prescribed a greater number of medications, the leading risk factor for inappropriate prescribing, and are thus at greater risk of adverse drug reactions as a result. Many tools with explicit criteria are described in the literature for assessing potentially inappropriate prescribing (PIP) in the general geriatric population, but few have been developed to examine prescribing in LTC.

Methods

This was a point prevalence observational study of patients aged >65 years residing in three HSE-run LTC facilities in Cork. Demographic characteristics, medical diagnoses and medication regimes at time of admission (TOA) to LTC, and time of data collection were recorded and reviewed using STOPPFrail and NORGEP-NH criteria.

Results

98 patients met the inclusion criteria, with 66% being female. The median age was 83 years (IQR 77-88 years), and median length of stay was 31 months (IQR 14-53 months). The median number of medications per person on admission was 8 (IQR 6-11), which increased to 9 (IQR 7-11) at time of review (TOR)(p<0.001). PIP was found in 70 (84.3%) patients at TOA, and 79(80.6%) at TOR using STOPPFrail, and was recorded as 81 (97.6%) at TOA, and 95(96.9%) at TOR using NORGEP-NH. Among the STOPPFrail criteria most commonly implicated were continuous use of nutritional supplements and high dose PPI therapy. With NORGEP, the most commonly implicated were use of antidepressants and antihypertensives. There was an increase in number of patients prescribed benzodiazepines, z-drugs, anti-depressants and anti-psychotics from TOA to TOR, while statins were prescribed less often at TOR (p<0.001).

Conclusion

Potentially inappropriate prescribing is highly prevalent in older residents of community hospitals using validated prescribing indicators. Criteria such as those used in this study could be used to highlight potentially inappropriate or futile medications in older, vulnerable patients. Regular medication review is recommended to facilitate deprescribing of such medications.

A Geospatial Analysis of Adult Major Trauma Transit Time in Dublin

Aims To estimate ambulance transit time of Major Trauma patients from scene to Emergency Department (ED) in order to inform future trauma network design. Methods Dublin Fire Brigade data was analysed and each Major Trauma incident was mapped. Actual distance and time to the receiving ED was measured and estimates of distances and times from each of these incidents to any ED in Dublin (any potential Major Trauma Centre) were formulated using Google Maps in Internet Explorer 11. Results Adult trauma (n=500) was evenly distributed throughout Dublin. The median transit time to each ED varied from 5 to 8 minutes with a longest time of 26 minutes. The calculated median transit time from an incident to any ED was 18 minutes with a maximum estimated transit time of 40 minutes. Conclusion The data demonstrated that all patients could get to any Dublin ED with a median time of 18 minutes and within the internationally recommended transfer time of 45 minutes to a Major Trauma Centre.