Mean ES Research Articles

A Systematic Review of the Effects of Strength and Power Training on Performance in Cross-Country Skiers.

To identify and evaluate current scientific literature concerning the effect of strength, power and speed training on relevant physiological and biomechanical characteristics and performance of competitive cross-country skiers (XCS), the databases Scopus and PubMed were searched systematically for original articles in peer-reviewed journals. Of the 599 studies retrieved, 12 met the inclusion criteria (i.e., assessment of outcome measures with relevance for XCS performance; involvement of traditional resistance training; application of external resistance to the body; intervention longer than 4 weeks; randomized controlled trial). The methodological rigor of each study was assessed using the PEDro scale, which were mostly poor-to-fair, with good methodological quality in only two articles. All of the strength/power/speed interventions improved 1RM (0.8-6.8 ES), but findings with respect to jump performance, ability to generate force rapidly and body composition were mixed. Interventions demonstrated moderate-to-high ES on XCS specific performance compared with control (mean ES = 0.56), but the pattern observed was not consistent. None of the interventions changed anaerobic capacity, while in most studies VO2max was either unchanged or increased. Work economy or efficiency was enhanced by most of the interventions. In conclusion, present research indicates that strength training improves general strength, with moderate effects on XCS performance, and inconclusive effects on work economy and VO2max/VO2peak. Strength training with high loads, explosive strength training, or sprint interval training seem to be promising tools for modern XCS training. Future investigations should include long-term (e.g., >6 months) strength training to allow sufficient time for increased strength and speed to influence actual XCS performance. Moreover, they should include both sexes, as well as upper- and lower-body muscles (trained separately and together) and employ free weights and core training. Methodological differences and limitations highlighted here may explain discrepancies in findings and should be taken into consideration in future research in this area.

How Coaches Can Improve Their Teams' Match Performance-The Influence of In-Game Changes of Tactical Formation in Professional Soccer.

The tactical formation has been shown to influence the match performance of professional soccer players. This study aimed to examine the effects of in-game changes in tactical formation on match performance and to analyze coach-specific differences. We investigated three consecutive seasons of an elite team in the German Bundesliga which were managed by three different coaches, respectively. For every season, the formation changes that occurred during games were recorded. The match performance was measured on a team level using the variables “goals,” “chances,” and “scoring zone” entries (≙successful attacking sequence) for the own/opposing team. Non-parametric tests were used to compare the 10 min before with the 10 min after the formation change, as well as games with and without formation change. In the 10 min after the formation change, the team achieved more goals/chances/scoring zone entries than in the 10 min before the formation change (mean ES = 0.52). Similarly, the team conceded fewer opposing goals/chances/scoring zone entries in the 10 min after the formation change (mean ES = 0.35). Furthermore, the results indicate that the success of the respective formation change was dependent on the responsible coach. Depending on the season, the extent of the impacts varied (season 1: mean ES = 0.71; season 2: mean ES = 0.26; and season 3: mean ES = 0.22). Over all three seasons, the formation changes had a positive effect on the match performance of the analyzed team, highlighting their importance in professional soccer. Depending on the season, formation changes had varying impacts on the performance, indicating coach-specific differences. Therefore, the quality of the formation changes of the different coaches varied. The provided information can support coaches in understanding the effects of their in-game decisions.

0456 Comparative Safety and Efficacy of Hypnotics: A Quantitative Risk-Benefit Analysis

Abstract Introduction Hypnotics continue to be preferentially used in practice for the treatment of chronic insomnia, yet the comparative safety and efficacy of medication options are unclear. While several position statements and network meta-analyses have provided some guidance, none have provided a quantitative assessment of risk-benefit. In the present analysis, each therapeutic class commonly used for chronic insomnia is quantitatively ranked with respect to safety, efficacy, and risk-benefit. Methods Safety data for FDA-approved hypnotics were extracted from the package insert adverse event tables and standardized to form a placebo-adjusted adverse event rate per 1000 (AEr). Efficacy data were extracted from randomized controlled trials identified in professional society position statements and published systematic reviews. The efficacy metric was computed from placebo adjusted pre-post change scores for self-reported sleep continuity (i.e., sleep latency [SL], wake after sleep onset [WASO], and total sleep time [TST]) and represented as a summed composite effect size score (SWT). Risk-benefit (R/B) was represented as a ratio between AEr and SWT. Comparative safety, efficacy, and risk-benefit metrics were calculated for five therapeutic classes: Benzodiazepines (BZs), non-benzodiazepine benzodiazepine receptor agonists (BZRAs), dual orexin receptor antagonists (DORAs), melatonin receptor agonists (MELAs), and sedating antidepressants (SADs). Results With respect to safety, MELAs had the lowest adverse event rate (AEr=43.1) and BZRAs had the highest rate (AEr=255.0). With respect to efficacy, BZs were the most efficacious (SWT=1.94, Mean ES=0.59) and MELAs were least efficacious (SWT=0.11, Mean ES=0.02). Overall, with respect to risk-benefit, SADs had the most favorable profile (R/B=69.5), while MELAs had the least favorable profile (R/B=395.7). Conclusion The optimal selection of hypnotics requires consideration of both risk and benefit. Findings suggest that SADs can be considered the first-line pharmacotherapeutic option due to the superior risk-benefit profile. If treatment responses are inadequate or if SADs are contraindicated, risk-benefit rankings may serve as a decision tree as part of a medical algorithm protocol to guide treatment selection for patients with chronic insomnia. Support (If Any) Sleep Research Society Mentor-Mentee Award (Cheung); K24AG055602 & R01AG054521 (Perlis)

Successful Evaluation of Spinal Mobility Measurements With the Epionics SPINE Device in Patients With Axial Spondyloarthritis Compared to Controls.

Epionics SPINE (ES), a novel device that measures spinal movements using electronic sensors including range of motion (RoM) and speed (range of kinematics [RoK]), has already been validated in patients with mechanical back pain and healthy individuals. This study aimed to evaluate ES for quantification of spinal mobility in patients with axial spondyloarthritis (axSpA). A total of 153 individuals, 39 female and 114 male, were examined including 134 patients with axSpA, of whom 40 had nonradiographic (nr)-axSpA, 94 had radiographic (r)-axSpA; 19 were healthy controls (HCs). The results were compared using mean ES scores and modeling was performed using multivariable logistic regression models resulting in good validity and high discriminative power. ES measurements showed meaningful differences between patients with axSpA and HCs (all P < 0.001), as well as between r- and nr-axSpA (P < 0.01). In patients with axSpA, a negative correlation between ES and Bath Ankylosing Spondylitis Metrology Index values was found: -0.76 ≤ r ≤ -0.52 (P < 0.05). Bath Ankylosing Spondylitis Functional Index scores showed a similar trend (r > -0.39). Patients with r-axSpA had a more limited and slower spinal mobility than those with nr-axSpA. Other patient-reported outcomes almost did not correlate. This study shows that the ES is an objective performance measure and a valid tool to assess spinal mobility in axSpA, also based on the Outcomes Measures in Rheumatology (OMERACT) criteria. RoK and RoM scores provide additional information on physical function of patients with axSpA.

Spatiotemporal Variations and Influencing Factors of Terrestrial Evapotranspiration and Its Components during Different Impoundment Periods in the Three Gorges Reservoir Area

Identifying the spatiotemporal variations and influencing climate factors of evapotranspiration (ET) and its components (vegetation transpiration (Ec), soil evaporation (Es), and canopy interception evaporation (Ei)) can greatly improve our understanding of water cycle, carbon cycle, and biogeochemical processes in a warming climate. As the world′s largest hydropower project, the construction of the Three Gorges Project (TGP) coupled with the significant land use/land cover change affected the regional water and energy exchange in the Three Gorges Reservoir Area (TGRA). This study aimed to reveal the spatiotemporal variations and influencing climate factors in ET and its components using PML-V2 products in TGRA during 2000–2020. Results showed that the mean annual ET, Ec, Es, and Ei in TGRA were 585.12, 328.49, 173.07, and 83.56 mm, respectively. The temporal variation of ET was dominated by Ec, with no significant change in the time trend. Es decreased (2.92 mm/y) and Ei increased (1.66 mm/y) significantly mainly in the cultivated land. ET, Ec, and Ei showed a similar seasonal variation pattern with a single peak, while Es presented a bimodal pattern. From the pre-impoundment to the first impoundment period, ET and Ec mainly increased in the head of TGRA, meanwhile, Es in urban area increased significantly by 27.8%. In the subsequent impoundment periods, ET and Ec changed slightly while Es sharply decreased. The Ei increased persistently during different impoundment period. The dominant climate factors affecting changes in Ec and Es were air temperature, vapor pressure deficit, and sunshine hours, while the variation of Ei was mainly affected by air temperature, vapor pressure deficit, and precipitation.

Treadmill and Running Speed Effects on Acceleration Impacts: Curved Non-Motorized Treadmill vs. Conventional Motorized Treadmill.

An increase in the popularity of running can be seen over the last decades, with a large number of injuries on it. Most of the running injuries are related to impact accelerations and are due to overuse. In order to reduce the risk of injury or to improve performance and health new treadmill designs have been created, as it can be the curved non-motorized treadmill. The aim of this study was to analyse impact accelerations, spatio-temporal parameters and perceptual differences while running on curved non-motorized treadmill (cNMT) compared to motorized treadmill (MT) at different speeds. Therefore, 27 recreational runners completed two tests consisting of 10 min warm-up and three bouts of 8 min running at 2.77 m/s, 3.33 m/s and self-selected speed on cNMT and MT, previously randomised. Although the surface did not influence spatio-temporal parameters, a reduction in impact accelerations, head acceleration rate (mean effect size [ES] = 0.86), tibia peak (mean ES = 0.45) and tibia magnitude (mean ES = 0.55), was observed while running on cNMT in comparison with running on MT. Moreover, higher heart rate (HR) (mean ES = 0.51) and rating of perceived effort (RPE) (mean ES = 0.34) were found while running on cNMT. These findings demonstrated that higher intensity training and lower impact accelerations are experimented on cNMT, what can be used by trainers and athletes while planning training sessions.

Current State of the Evidence: Examining the Effects of Orton-Gillingham Reading Interventions for Students With or at Risk for Word-Level Reading Disabilities.

Over the past decade, parent advocacy groups led a grassroots movement resulting in most states adopting dyslexia-specific legislation, with many states mandating the use of the Orton-Gillingham approach to reading instruction. Orton-Gillingham is a direct, explicit, multisensory, structured, sequential, diagnostic, and prescriptive approach to reading for students with or at risk for word-level reading disabilities (WLRD). Evidence from a prior synthesis and What Works Clearinghouse reports yielded findings lacking support for the effectiveness of Orton-Gillingham interventions. We conducted a meta-analysis to examine the effects of Orton-Gillingham reading interventions on the reading outcomes of students with or at risk for WLRD. Findings suggested Orton-Gillingham reading interventions do not statistically significantly improve foundational skill outcomes (i.e., phonological awareness, phonics, fluency, spelling; effect size [ES] = 0.22; p = .40), although the mean ES was positive in favor of Orton-Gillingham-based approaches. Similarly, there were not significant differences for vocabulary and comprehension outcomes (ES = 0.14; p = .59) for students with or at risk for WLRD. More high-quality, rigorous research with larger samples of students with WLRD is needed to fully understand the effects of Orton-Gillingham interventions on the reading outcomes for this population.

SF-36 is a fast and easy way of assessing quality of life and correlates with exercise capacity in patients undergoing cardiac rehabilitation

Cardiac rehabilitation (CR) is associated with improvement of quality of life (QOL) and exercice capacity (EC). Less is known on how EC interplays with QOL. To analyse the correlation between the 36-item Short Form Health Survey (SF-36) and EC. We used both dimensions (physical score, PS, and emotional score, ES) of the french validated version of the SF-36 to assess QOL before and after 8 weeks of CR in all patients admitted between January and Mars 2019, in a single ambulatory CR center. Clinical, biological and echocardiographic datas were retrospectively analysed as well as exercice capacity on stress test: performance in Watts and METs, 6 minutes walking test (6-MWT in meters) and aerobic capacity (VO2 in mL/min/kg). A total of 129 patients were included (see Table 1 ). Using a dedicated excel file, assessment of SF-36 was fast (less than 1 minute). According to t -test, both EC and QOL improved after CR: the mean EC, PS and ES respectively raised from 113 ± 32 to 134 ± 42 Watts ( P < 10 −41 ), 55 ± 21% to 68 ± 21% ( P < 10 −11 ) and 62 ± 23% to 72 ± 18% ( P < 10 −11 ). After Pearson correlation testing, PS and ES did correlate with each other ( r = 0.7, P < 10 −33 ). Physical score correlated with EC in Watts ( r = 0.34, P < 10 −7 , Fig. 1 ), METs ( r = 0.33, P < 10 −6 ), 6-MWT ( r = 0.33, P < 10 −3 ), VO2max ( r = 0.28, P = 0.006), effort duration in minutes ( r = 0.31, P < 10 −5 ) and also with male sex ( r = 0.14, P = 0.32), but not with age, LVEF, anaerobic threshold, hemoglobine and natriuretic peptides. Emotional score correlated with EC in Watts ( r = 0.20, P = 0.003), METs ( r = 0.20, p.004), VO2max ( r = 0.26, P = 0.01) and effort duration in minutes ( r = 0.22, P = 0.001). SF-36 is a fast, validated and easy way of assessing global QOL in patient undergoing ambulatory CR, and is positively correlated with exercise capacity and male sex, but not age and LVEF. Its use should be systematic to evaluate efficacy of a CR program on improving QOL.

Effect of Long-Term Repeated Interval Rehabilitation on the Gross Motor Function Measure in Children with Cerebral Palsy.

The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common. In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP. The study was a retrospective analysis of children with CP (2-13 years) participating for a second (n = 262) and third year (n = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference). After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]). Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.

Supplemental reading interventions implemented by paraprofessionals: A meta‐analysis

AbstractPreventative and intensive reading intervention can be administered to at‐risk students in a systematic way to help facilitate gains on literacy outcomes. Despite this fact, there are clear barriers to implementation. One solution may be to use paraprofessionals to provide supplemental reading instruction. This study employed meta‐analytic procedures to address two questions: (a) what is the overall effectiveness of paraprofessionals as implementers of reading interventions? and (b) in which areas are paraprofessionals most effective? A literature search of research from 2001 to 2017 yielded 76 studies. Nine studies meeting a priori inclusion criteria were coded for demographic information and six common reading outcomes. The mean ES across outcomes was 0.55, and spelling and decoding emerged as areas to inform future research. Although these meta‐analytic findings must be interpreted with caution due to issues of sample size and heterogeneity of variance, involving paraprofessionals as reading interventionists appears to be a highly promising strategy.

Effectiveness of digital-based interventions for children with mathematical learning difficulties: A meta-analysis

The purpose of this work was to meta-analyze empirical evidence about the effectiveness of digital-based interventions for students with mathematical learning difficulties. Furthermore, we investigated whether the school level of the participants and the software instructional approach were decisive modulated factors. A systematic search of randomized controlled studies published between 2003 and 2019 was conducted. A total of 15 studies with 1073 participants met the study selection criterion. A random effects meta-analysis indicated that digital-based interventions generally improved mathematical performance (mean ES = 0.55), though there was a significant heterogeneity across studies. There was no evidence that videogames offer additional advantages with respect to digital-based drilling and tutoring approaches. Moreover, effect size was not moderated when interventions were delivered in primary school or in preschool.

Change in Defense Mechanisms and Depression in a Pilot Study of Antidepressive Medications Plus 20 Sessions of Psychotherapy for Recurrent Major Depression.

Treatment studies of major depression commonly focus on symptoms, leaving aside change in putative psychological risk factors. This pilot study examines the relationship between changes in eight depressive defenses and depressive symptoms. Twelve adults with acute recurrent major depression were given antidepressive medications and randomized to 20 sessions of either cognitive behavioral therapy or dynamic psychotherapy and followed for 1 year. Defenses were assessed using the Defense Mechanism Rating Scales (DMRS) and Defense Style Questionnaire (DSQ) at intake, termination, and 1-year follow-up. Depression improved highly significantly on both the Hamilton Rating Scale for Depression and Beck Depression Inventory, respectively, eight (67%) and nine (75%) patients attained recovery by 1 year. Depressive defenses improved significantly by termination (mean ES = 0.97; 95% confidence interval, 0.30-2.16), but retrogressed somewhat by 1 year. A mean of 12.17% (SD = 10.60) depressive defenses remained; only five subjects (50%) attained normative levels. Although causal relationships were not established, depressive defenses are promising candidates for mediating treatment effects on outcome of major depression.

Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization

To examine the association of psychological factors and pediatric health care utilization. Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). Child and parent MH problems are significantly associated with increased HCU.

Approximating Shepp’s constants for the Slepian process

Slepian process S(t) is a stationary Gaussian process with zero mean and covariance ES(t)S(t′)=max{0,1−|t−t′|}. For any T≥0 and real h, define FT(h)=Prmaxt∈[0,T]S(t)<h and the constants Λ(h)=−limT→∞1TlogFT(h) and λ(h)=exp{−Λ(h)}; we will call them ‘Shepp’s constants’. The aim of the paper is construction of accurate approximations for FT(h) and hence for the Shepp’s constants. We demonstrate that at least some of the approximations are extremely accurate.

On the correspondence between dream content and target material under laboratory conditions: A meta-analysis of dream-ESP studies, 1966-2016.

In order to further our understanding about the limits of human consciousness and the dream state, we report meta-analytic results on experimental dream-ESP studies for the period 1966 to 2016. Dream-ESP can be defined as a form of extra-sensory perception (ESP) in which a dreaming perceiver ostensibly gains information about a randomly selected target without using the normal sensory modalities or logical inference. Studies fell into two categories: the Maimonides Dream Lab (MDL) studies (n = 14), and independent (non-MDL) studies (n = 36). The MDL dataset yielded mean ES = .33 (SD = 0.37); the non-MDL studies yielded mean ES = .14 (SD = 0.27). The difference between the two mean values was not significant. A homogeneous dataset (N = 50) yielded a mean z of 0.75 (ES = .20, SD = 0.31), with corresponding significant Stouffer Z = 5.32, p = 5.19 × 10-8, suggesting that dream content can be used to identify target materials correctly and more often than would be expected by chance. No significant differences were found between: (a) three modes of ESP (telepathy, clairvoyance, precognition), (b) senders, (c) perceivers, or (d) REM/non-REM monitoring. The ES difference between dynamic targets (e.g., movie-film) and static (e.g., photographs) targets was not significant. We also found that significant improvements in the quality of the studies was not related to ES, but ES did decline over the 51-year period. Bayesian analysis of the same homogeneous dataset yielded results supporting the ‘frequentist’ finding that the null hypothesis should be rejected. We conclude that the dream-ESP paradigm in parapsychology is worthy of continued investigation, but we recommend design improvements.

Contemporary management of aortic stenosis in the elderly. Insights from a recent French registry

Indications for TAVI are being extended towards patients who are not at high surgical risk. Elderly patients are frequently considered at high risk but little is known about their contemporary management. This prospective multicentre registry aimed to assess the therapeutic decision in elderly patients with severe symptomatic aortic stenosis, according to age and surgical risk. In September–October 2016, consecutive patients aged ≥ 75 years were included in 32 French centres with on-site TAVI and surgery facilities. The primary endpoint was Heart Team therapeutic decision between medical management, TAVI and surgery. 1049 patients with a therapeutic decision were included. Mean age was 84 ± 5 years, 560 patients (53%) were female. In total, 235 patients were aged <80 years, 364 between 80 and 85 and 450 ≥85. Mean EuroSCORE II (ESII) was 5.9 ± 6.0%. Surgical risk was classified as high (ESII > 8%) in 188 patients (18%), intermediate (ESII 4–8%) in 340 (32%), and low (ESII < 4%) in 521 (50%). Decision was medical therapy in 102 patients (10%), surgery in 199 (19%) and TAVI in 748 (71%). Mean ES II was 9.1 ± 9.1% in the medical group, 2.9 ± 2.1% in the surgery group and 6.2 ± 5.8% in the TAVI group. TAVI was chosen for 79% of high-risk patients, 80% for intermediate-risk patients and 63% for low-risk patients. Among the 947 patients with a decision of TAVI or surgery, the choice of TAVI was associated with older age ( P < 0.0001), higher ES II ( P = 0.008) and an interaction between age and ES II ( P = 0.02). In the 521 low-risk patients, surgery was the choice in the majority of patients aged between 75 and 80, while TAVI was the most frequent intervention after 80 ( Fig. 1 ). 1) Either TAVI or surgery is considered in 90% of patients ≥75 years. 2) At the end of 2016, Heart Teams already extended indications for TAVI towards elderly patients at intermediate risk. 3) The impact of risk scores on the choice between TAVI and surgery strongly depends on age.

The Effect Of Exercise On Endothelial Function And Glycemic Control In Type 2 Diabetes

PURPOSE: Vascular endothelial dysfunction induced by hyperglycemia and elevated insulin resistance is a potent risk factor for cardiovascular disease (CVD) and likely contributes to multiple chronic disease complications associated with aging like dementia. The aim of this study was to systematically review and quantify the effects of exercise on endothelial function (EF) in type 2 diabetes (T2D). METHODS: Five electronic databases were searched (until June 2017) for studies that met the following criteria: (i) randomized controlled trials; (ii) T2D aged ≥18 years; (iii) measured EF by brachial artery flow-mediated dilation (FMD); (iv) structured and supervised exercise intervention for ≥8 weeks. RESULTS: Thirteen cohorts of eight studies (306 patients, average age 59 years) met the inclusion criteria. Exercise training significantly increased FMD (mean ES = 0.41, 95% CI = 0.21 to 0.62, P < 0.001). Low to moderate intensity subgroups and aerobic exercise (AE) subgroups significantly increased FMD more than moderate to high intensity subgroups and combined AE and resistance exercise (RE) subgroups respectively (P < 0.01, P < 0.05). Exercise training significantly decreased glycated hemoglobin (HbA1c) (mean ES = -0.40, 95% CI = -0.61 to -0.19, P < 0.001). Low to moderate intensity subgroups significantly decreased HbA1c more than moderate to high intensity subgroups (P < 0.05). CONCLUSIONS: Our results suggest that in patients with T2D, lower intensity exercise has physiological meaningful effects on EF, in support of the emerging concept that the lower efforts of exercise are not necessarily less cardioprotective than higher intensity training.

Contemporary management of aortic stenosis in the elderly. Insights from a recent French registry

Indications for transcatheter aortic valve implantation (TAVI) are being extended towards patients who are not at high risk for surgery. Elderly patients are frequently considered at high risk for surgery; however, little is known about their contemporary management. This prospective multicentre registry was designed to assess the therapeutic decision in elderly patients with severe symptomatic aortic stenosis (AS), according to age and surgical risk. From 1st September to 31st October 2016, consecutive patients aged ≥ 75 years and referred for severe symptomatic AS were included in 32 French centres with on-site TAVI and surgery facilities. The primary endpoint was Heart Team therapeutic decision between medical management, TAVI and surgery. In total, 1101 patients were included, of whom 1049 had a therapeutic decision (pending decision in 52) and form the population of the study. Mean age was 84 ± 5 years, 560 patients (53%) were female; 235 patients were aged < 80 years, 364 between 80 and 85 and 450 ≥ 85. Mean EuroSCORE I was 17.8 ± 12.8% and mean EuroSCORE II (ESII) 5.9 ± 6.0%. Surgical risk was assessed using ES II and was classified as high (ESII > 8%) in 188 patients (18%), intermediate (ESII 4–8%) in 340 (32%), and low (ESII < 4%) in 521 (50%). Decision was medical therapy in 102 patients (9.7%), including balloon valvuloplasty in 23, surgery in 199 (19.0%) and TAVI in 748 (71.3%). Mean ES II was 9.1 ± 9.1% in the medical group, 2.9 ± 2.1% in the surgery group and 6.2 ± 5.8% in the TAVI group. TAVI was chosen for 79% of high-risk patients, 80% for intermediate-risk patients and 63% for low-risk patients. When considering the 947 patients who had a decision of TAVI or surgery, the choice of TAVI over surgery was associated with older age ( P < 0.0001), higher ES II ( P = 0.008) and an interaction between age and ES II ( P = 0.02). The significant interaction means that the influence of surgical risk on the therapeutic decision depends on age. Indeed, in the 521 low-risk patients, surgery was the choice in the majority of patients aged between 75 and 80, while TAVI was the most frequent intervention after 80 ( Fig. 1 ). This contemporary survey shows that either TAVI or surgery is considered in 90% of patients aged ≥ 75 years with severe symptomatic AS. At the end of 2016, Heart Teams already extended indications for TAVI towards elderly patients at intermediate risk. The impact of risk scores on the choice between TAVI and surgery strongly depends on age. Even in low-risk patients, TAVI is now the most frequent intervention after the age of 80.

Effect of bilberry juice on indices of muscle damage and inflammation in runners completing a half-marathon: a randomised, placebo-controlled trial

BackgroundEmerging evidence indicates that fruits rich in polyphenols may attenuate exercise-induced muscle damage and associated markers of inflammation and soreness. This study was conducted to determine whether bilberry juice (BJ), which is particularly rich in polyphenols, reduces markers of muscle damage in runners completing a half marathon.MethodsA total of 21 recreationally trained runners (age 30.9 ± 10.4 y; mass 71.6 ± 11.0 kg; M = 16; F = 5) were recruited to a single blind, randomised, placebo-controlled, parallel study. Participants were block randomised to consume 2 × 200 ml of BJ or energy-matched control drink (PLA) for 5 d before the Sheffield Half Marathon, on race day, and for 2 days post-race. Measurements of delayed onset muscle soreness (DOMS), muscle damage (creatine kinase; CK) and inflammation (c-reactive protein; CRP) were taken at baseline, pre-race, post-race, 24 h post-race and 48 h post-race. The effect of treatment on outcome measures was analysed using magnitude-based inferences based on data from 19 participants; 2 participants were excluded from the analyses because they did not provide samples for all time points.ResultsThe half marathon caused elevations in DOMS, CRP and CK. BJ had a possibly harmful effect on DOMS from pre-race to immediately post-race (11.6%, 90% CI ± 14.7%), a likely harmful effect on CRP from pre-race to 24 h post-race (mean difference ES 0.56, 90% CI ± 0.72) and a possibly harmful effect on CRP from pre-race to 48 h post-race (ES 0.12, 90% CI ± 0.69). At other time points, the differences between the BJ and PLA groups in DOMS and CRP were unclear, possibly trivial or likely trivial. Differences in the changes in CK between BJ and PLA were unclear at every time point other than from baseline to pre-race, where BJ had a possibly harmful effect on reducing muscle damage (ES 0.23, 90% CI ± 0.57).ConclusionDespite being a rich source of antioxidant and anti-inflammatory phytochemicals, BJ evoked small to moderate increases in exercise-induced DOMS and CRP. Further larger studies are required to confirm these unexpected preliminary results.

Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis.

Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.