The safety of paediatric surgery between COVID-19 surges: an observational study

Despite the ongoing coronavirus disease 2019 (COVID‐19) pandemic, elective paediatric surgery must continue safely through the first, second and subsequent waves of disease. This study presents outcome data from a children's hospital in north‐west England, the region with the highest prevalence of COVID‐19 in England. Children and young people undergoing elective surgery isolated within their household for 14 days, then presented for real‐time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus disease‐2 (SARS‐CoV‐2) within 72 h of their procedure (or rapid testing within 24 h in high‐risk cases), and completed a screening questionnaire on admission. Planned surgery resumed on 26 May 2020; in the four subsequent weeks, there were 197 patients for emergency and 501 for elective procedures. A total of 488 out of 501 (97.4%) elective admissions proceeded, representing a 2.6% COVID‐19‐related cancellation rate. There was no difference in the incidence of SARS‐CoV‐2 among children and young people who had or had not isolated for 14 days (p > 0.99). One out of 685 (0.1%) children who had surgery re‐presented to the hospital with symptoms potentially consistent with SARS‐CoV‐2 within 14 days of surgery. Outcomes were similar to those in the same time period in 2019 for length of stay (p = 1.0); unplanned critical care admissions (p = 0.59); and 14‐day hospital re‐admission (p = 0.17). However, the current cohort were younger (p = 0.037); of increased complexity (p < 0.001) and underwent more complex surgery (p < 0.001). The combined use of household self‐isolation, testing and screening questionnaires has allowed the re‐initiation of elective paediatric surgery at high volume while maintaining pre‐COVID‐19 outcomes in children and young people undergoing surgery. This may provide a model for addressing the ongoing challenges posed by COVID‐19, as well as future pandemics.

When does the influence of maturation on anthropometric and physical fitness characteristics increase and subside?

The relationships between maturation and anthropometric and physical performance characteristics are dynamic and often asynchronous; confounding the capability to accurately evaluate performance during adolescence. This study aimed to (i) examine the influence of chronological age (CA) and somatic maturation (YPHV) upon anthropometric and physical performance parameters, and (ii) identify the transition/change time points in these relationships using segmental regression. N = 969 soccer players (8-18 years of age) completed anthropometric and physical test assessments, including a countermovement jump (CMJ), agility T test, 10 and 20 m sprints, and multistage fitness test (MSFT). When modeled against CA and YPHV, results identified time point phases with increased rates of stature (CA-7.5, YPHV-8.6 cm/y at 10.7-15.2 years or -3.2 to +0.8 YPHV) and body mass gain (CA-7.1, YPHV-7.5 kg/y at 11.9-16.1 years or -1.6 to +4.0 YPHV), followed by gain reductions. Increased rates of sprint performance development (31%-43% gains) occurred at 11.8-15.8 CA or -1.8 to +1.2 YPHV, with gains subsiding thereafter. CMJ, T test, and MSFT gains appeared relatively linear with no change in developmental rate apparent. Developmental tempos did again, however, subside at circa (CMJ and T test) to post-PHV (MSFT). Based on our sample and analysis, periods of increased developmental rates (stature, mass, sprint) were apparent alongside progressive gains for other physical measures, before all subsided at particular age and maturation time points. Findings highlight dynamic asynchronous development of players, physical attributes, and the need to account for the influence of maturation on athletic performance until post-PHV.

Force coordination strategies in on-water single sculling: Are asymmetries related to better rowing performance?

Asymmetries of the rowing stroke cycle have been assessed with reference to kinematics and foot-force measures in laboratory testing environments. It remains unclear how asymmetries in propulsive kinetic measures are related to on-water rowing performance. A new approach for the evaluation of both global and local asymmetries across the entire movement was used to assess the continuous role of asymmetries and whether these change according to the level of competitive representation. Twenty-seven highly skilled female rowers (national and international competition level), rowing at 32 strokes per minute in a single scull boat, were evaluated. A symmetry index (SI) and functional data analysis (FDA) techniques were applied to a continuous difference time-series, which described fluctuating asymmetry in propulsive pin forces for each rower. Univariate ANOVAs revealed that differences in asymmetries were present as a factor of competition level for the SI and results of FDA. International athletes were more likely to utilize an asymmetry strategy with increased stroke-side (port-side) force early in the drive phase and increased bow-side (starboard) force through the second half of the drive. This was likely the result of international performers customizing their movement strategies relative to known boat mechanical offsets. The first half of the drive phase was also found to be an adaptive part of the rowing stroke cycle, suggesting asymmetries may have a functional role in successful execution of movements during the rowing stroke.

Assessment of propulsive pin force and oar angle time-series using functional data analysis in on-water rowing

The graphical presentation of the propulsive force applied at the pin plotted relative to the horizontal angle of the oar has been used practically in on-water rowing for the qualitative assessment of skill. How the pattern is related to performance variables has not been well identified, particularly for highly trained sculling athletes. Bivariate functional principal components analysis (bfPCA) was used on force-angle data to identify the main modes of variance in curves representing twenty-seven female rowers of different competition levels (national level and international level), rowing at 32 strokes per minute in a single scull boat. Discriminant function analysis showed moderate classification of rowers using force-angle graphs across both sides of the boat, with rate of force development identified as a potentially important characteristic for international rowers. Additionally for the bow-side, spending less time in the first half of the drive phase was also identified as an important feature for international rowers. Multiple linear regression of scores from the bfPCAs showed that a more pronounced front-peaked profile was associated with a higher average boat velocity. The results of this demonstrate that different characteristics of the force-angle graph may be associated with different metrics of performance.

The prevalence, influential factors and mechanisms of relative age effects in UK Rugby League

Relative age effects (RAEs), reflecting observed inequalities in participation and attainment as a result of annual age-grouping policies in youth sport, are common in most team sports. The aims of this study were to determine if and when RAEs become apparent in Rugby League, determine how influential variables (e.g., gender) lead and clarify whether player retention at junior representative levels can explain persistent RAEs. Player data were collected for the male and female community games ranging from Under 7s to Senior (N=15,060) levels, junior representative selections (i.e., Regional) and professional players (N=298). Chi-square analyses found significant (P<0.05) uneven birth date distributions beginning at the earliest stages of the game and throughout into senior professionals. In junior representative selections, 47.0% of Regional and 55.7% of National representative players were born in Quartile 1, with RAE risk increasing with performance level. Gender and nationality were also found to moderate RAE risk. When tracking representative juniors, over 50% were retained for similar competition the following season. Findings clearly demonstrate that RAEs exist throughout Rugby League with early selection, performance level and retention processes, appearing to be key contributing factors responsible for RAE persistence.

Influences of competition level, gender, player nationality, career stage and playing position on relative age effects

Relative age, referring to the chronological age differences between individuals within annually age-grouped cohorts, is regarded as influential to an athlete's development, constraining athletic skill acquisition. While many studies have suggested different mechanisms for this effect, they have typically examined varying sports, precluding an examination of the possible inter-play between factors. Our three studies try to bridge this gap by investigating several moderators for relative age effects (RAEs) in one sport. Handball is a sport with position-specific demands, high cultural relevance and a performance context with established developmental structures and levels of representation for males and females. In Study 1, we investigated the influence of competition level and gender on RAEs before adulthood. In Study 2, elite participation, player nationality and stage of career are considered during adulthood. In Study 3, playing position and laterality (i.e., right vs left handedness) are investigated as moderators. Collectively, the results emphasize the complex inter-play of direct and indirect influences on RAEs in sports, providing evidence toward explaining how RAEs influence the development and maintenance of expertise.

A firework in the mouth

A case is described of a patient in whom pieces of firework were embedded in the tongue following explosion of the firework in the mouth.