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E03 Cardio-pulmonary exercise testing aids chronic obstructive pulmonary disease diagnosis in the perioperative evaluation of patients undergoing radical cystectomy
No full textChronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition distinguished by structural changes and mucus build-up which causes dyspnoea. COPD is universally diagnosed by a spirometry test. A Forced Expiratory Volume in one second (FEV1)/Forced Vital Capacity (FVC) of <0.7, is often used to justify COPD diagnosis (Hopkinson et al., 2019, Brit Med J, 366, l4486). Reliance on spirometry tests alone may only highlight airway obstruction and not identify other consequences of COPD like impaired gas exchange which is implicated in the development of postoperative pulmonary complications. Cardio-pulmonary exercise testing (CPET) provides a more detailed look into the pathophysiology of COPD and is routinely used in perioperative settings to determine a patient’s fitness for surgery. The aims of this study were to 1) identify the number of bladder cancer patients with undiagnosed COPD, and 2) compare COPD-related CPET variables between bladder cancer patients medically diagnosed with COPD (COPDMED) who had the potential to be diagnosed at the time of CPET (COPDCPET) and those without COPD (non-COPD). All testing was performed per the American Thoracic Society/American College of Chest Physicians guidelines (2003, Am J Resp Crit Care Med, 167, 211-277). COPD-related CPET variables recorded included Minute Ventilation (V̇E; L·min-1), Peak Oxygen Consumption (V̇O2peak; mL·kg-1·min-1), the Anaerobic Threshold (AT; mL·kg-1·min-1), Ventilatory Equivalence for Carbon Dioxide (V̇E/V̇CO2), Breathing Reserve (BR; %). Eighty-two patients with bladder cancer (COPDMED [n=9], non-COPD [n=73]) underwent preoperative spirometry and CPET. In the non-COPD patients, 21 (29%) had an FEV1/FVC< 0.7, indicative of COPD and thus groups as COPDCPET. Within the COPDCPET group, 8 (40%) had an FEV1 between 50-70% of predicted which indicated moderate COPD. There was no difference found in all CPET variables measured between COPDMED and COPDCPET (P > 0.05). When COPDMED and COPDCPET were combined and compared against the non-COPD, there was a difference found in their median (95% CI) V̇Erest (13.3 [12.3-14.2] vs 11.75 [11.2-12.6] L·min-1, P = 0.02, g = 0.28). V̇O2peak (14.95 [13.64-18.12] vs 17.16 [16.35-19.11] mL·kg-1·min-1, P = 0.049, g = 0.29). V̇E/V̇CO2 at the AT (38 [36-40] vs 36 [34-37], P = 0.04, g = 0.49). There was also a difference in mean +/- SD BR (36 +/- 17 % vs 47 +/- 14 %, P = 0.004, g = 0.69). This study demonstrates the underdiagnosis of COPD in perioperative settings. Future research should assess the use of targeted COPD optimisation preoperatively
E06 The effect of programmed resistance training on the muscle myofibrillar proteome
No full textResistance training increases muscle size but little is known about the dynamic processes that underpin the gains in muscle mass. We investigated rat muscle during 30 days of unilateral programmed resistance training (PRT) using the stable isotope (deuterium oxide; D2O) in vivo and proteomics. Three-month-old, male Wistar rats (body weight 348 ± 20 g) were assigned to four groups (n = 4, in each), including a control group and experimental groups that received D2O for 10, 20 or 30 days. Under ethically approved procedures, deuterium was administered, and a stimulating device was surgically implanted to activate the left peroneal nerve and cause maximal contraction of the dorsiflexors (inc. tibialis anterior; TA) and partial contraction of the plantar flexors. PRT consisted of 1 bout per day of 5 sets of 10 repetitions (1 repetition consisted of 2 s stimulation at 100 Hz with 2 s rest between repetitions and 2.5 min between sets). One hour after the final training bout (i.e. day 10, 20, or 30) animals were killed and the left (stimulated) and right (contralateral control) TA were extracted and weighed. Muscles were fractionated into myofibrillar and sarcoplasmic components. Protein content was calculated via Bradford assay and proteomic analysis of myofibrillar proteins was conducted via liquid chromatography-tandem mass spectrometry of peptide digests. Statistical analysis was conducted using R (v4.3.2.) and functional annotation was performed using the STRING database. Two-way mixed ANOVA was used to investigate differences between condition (stimulated vs contralateral control) and time (0, 10, 20, or 30 days). The protein content of stimulated TA increased (P < 0.05) from 0.579 ± 0.05 mg at day zero to 1.096 ± 0.15 mg after 30 days of PRT, whereas the protein content of control TA (0.618 ± 0.04 mg) was consistent across the 30-day experimental period. Proteomic analysis encompassed 244 proteins and the abundance of 45 proteins exhibited a significant (P < 0.05) interaction between condition and time. Stimulated muscle was enriched in mitochondrial enzymes. For example, the beta-subunit of ATPase synthase (ATPB) increased from 14.6 ± 4.5 to 74 ± 15.6 μg in stimulated TA and was 17 ± 5 in control TA. PRT also increased the abundance of neonatal myosin heavy chain (MYH8), four-and-a-half LIM domains protein 1 (FHL1) and muscular LMNA interacting protein (MLIP). These findings suggest the energy requirements of daily PRT are met by mitochondrial metabolism and PRT may be associated with activation of the muscle developmental programme
J09 Peak angular momentum of pirouettes by a university-level contemporary dance cohort
No full textTurning movements are an important movement to master in many dance styles. For advanced or professional dancers, the pirouette (completing one or more turns with a specific stylistic form) is difficult to master and increasing the revolutions heightens difficulty further. The purpose of this study was to investigate peak angular momentum generation (PAM) of completing single- and attempting triple-revolution pirouettes for contemporary dance students. Adaptations made by dancers whilst rotating and imbalances within the centre of mass over the base of support were identified. Ethical approval was received. Seven female university-level contemporary dance students completed five successful single-revolution pirouettes en dehors (PeDh) and attempting to complete five successful triple-revolution PeDh whilst being recorded using a three-dimensional VICON motion capture system. PAM and torso lean (TL) and a two-dimensional foot vector (FV) were then calculated using a six degree of freedom model (Visual3D). A one-way ANOVA (P < 0.05) compared mean variance between single-, double-, and triple-revolution pirouettes. Significant effects were determined for all variables in each pirouette condition. A Tukey post-hoc test (P < 0.05) determined overall significant differences between PAM (F2, 37 = 15.8, ⍵² = 0.426), TL (F2, 37 = 3.4, ⍵² = 0.108), and FV (F2, 30 = 4.9, ⍵² = 0.192) for the midpoint turn of each pirouette condition. Independent samples T-Tests ( < 0.05) were conducted to compare PAM (t11 = 1.8, d = 1.026), TL (t11 = 0.1, d = 0.030), and FV (t6 = 0.6, d = 0.433) between successful and unsuccessful double pirouettes, with no differences reported. This test was repeated for successful and unsuccessful triple pirouettes. Again, no differences were observed for PAM (t15 = −2.2, d = −1.093), TL (t15 = −1.6, d = −0.802), and FV (t15 = −1.3, d = −0.648). This study concluded that PAM increased as the number of pirouette revolutions increased. Furthermore, a minimum threshold for PAM was calculated to produce successful double (0.597 kg·ms2⎺¹) and triple (0.637 kg·ms2⎺¹) pirouettes. Observations from the pirouette trials and FV data illustrated that dancers ‘hop’ when an imbalance is sensed, in an attempt to regain balance and continue pirouette revolutions. However, this method predominately produced unsuccessful pirouettes as the initial PAM was not achieved. This research can be applied to dance coaching as it provides an initial insight into mechanisms to support successful pirouette technique
J30 Nutritional and non-nutritional strategies in bodybuilding: Impact on kidney function
No full textBodybuilders routinely engage in many dietary and other practices purported to be harmful to kidney health. Thus, a structured narrative review of the literature was performed. The search strategy and parameters identifying areas of importance closely followed the PRISMA statement guidelines. This resulted in 13 relevant full-text articles consisting of 8 case reports and 5 case series, published since 2000. Kidney disease was described in 75 bodybuilders, with diagnoses ranging from acute kidney injury (AKI), acute tubular necrosis , focal segmental glomerular sclerosis (FSGS), nephrocalcinosis, acute interstitial nephritis , nephrosclerosis, chronic interstitial nephritis, an assortment of other glomerulonephritides. The development of AKI, FSGS and nephrocalcinosis may be particular risks. There is little evidence that high-protein diets and moderate creatine supplementation pose risks to individuals with normal kidney function though long-term high protein intake in those with underlying impairment of kidney function is inadvisable. The links between anabolic androgenic steroid use and FSGS are stronger, and there are undoubted dangers of nephrocalcinosis in those taking high doses of vitamins A, D and E. Dehydrating practices, including diuretic misuse, and NSAID use also carry potential risks. It is difficult to predict the effects of multiple practices carried out in concert. Investigations into subclinical kidney damage associated with these practices have rarely been undertaken. Future research is warranted to identify the clinical and subclinical harm associated with individual practices and combinations to enable appropriate and timely advice
H02 Parental perspectives of early adolescent neighbourhood outdoor play and physical activity: barriers and facilitators
No full textIntroduction: Outdoor neighbourhood play supports physiological and psychological health among early adolescents (EA), typically aged 10-14. Existing research is often grounded in socioecological theory emphasising the interconnectedness of individuals and their environments. It has also typically focused on parental perspectives of facilitators and barriers of neighbourhood play in younger children. Aims: This study aimed to ascertain facilitators and barriers of outdoor neighbourhood play as perceived by EA parents. Methods: A purposive sample (n=11) of parents engaged in individual semi-structured interviews online via Microsoft Teams. Transcripts underwent reflexive inductive thematic analysis, identifying six themes aligned with the research question within a socioecological framework. Results: Most parents (n=10) demonstrated an awareness and appreciation of the advantages of outdoor neighbourhood play. They identified barriers and facilitators to outdoor neighbourhood play across intrapersonal, interpersonal, community and policy levels. Safety concerns emerged as a barrier to outdoor play. However, technology mediated reported concerns and was perceived as a facilitator to outdoor play when combined with age-appropriate community clubs and improved built environment facilities. Conclusion: Parents acknowledged the advantages of outdoor neighbourhood play. Parents may restrict their EA’s participation due to safety concerns. The study highlighted a deficiency in age-appropriate facilities supporting safe outdoor neighbourhood play. Future research should focus on developing appropriate facilities and improving social cohesion to mitigate perceived safety concerns of parents. Such attempts may benefit from using technology to assuage parental safety concerns further and enhance overall safety of neighbourhood outdoor play experiences for EA
J01 The role of inspiratory muscle fatigue and its impact on strength and respiratory function
No full textInspiratory muscles are essential for breathing and during exercise. However, excessive effort on the respiratory system can cause the inspiratory muscles, such as the external intercostals and the diaphragm, to become fatigued, therefore impairing performance (Wuthrich et al., 2013, Exp Physiol, 12, 1705–1717). Inspiratory muscle fatigue is when there is a loss in the capacity to produce force and/or velocity in a muscle, meaning they become tired and weak due to increased work demands (Tsukamoto et al., 2019, J Phys Ther Sci, 31, 318–325). Inspiratory muscle fatigue impacts performance because the force produced by the inspiratory muscles starts to decline which therefore causes them to fatigue as they cannot work to the maximum capacity no longer. This is vital in aerobic exercises such as rowing, cycling and running as the demand for oxygen is higher to perform the tasks. The diaphragm is the most dominant respiratory muscle involved in inspiration, alongside the external intercostal muscles. During inspiration, the diaphragm contracts and flattens, and the external intercostal muscles contract, pulling the ribcage up and outwards. The main function of these muscles is to allow a maximum amount of oxygen into the lungs by increasing the surface area in the thoracic cavity (Siafakas et al., 1999, Thorax, 54, 458–465). Several studies have explored delaying muscle fatigue by using inspiratory muscle training in healthy individuals. This is because it improves the strength of the respiratory muscles by increasing the endurance and capacity of the diaphragm. Results highlighted that maximum inspiratory pressure increased between 16 and 18% (Segizbaeva et al., 2014, Hum Physiol, 40, 683-689), a 7% increase in inspiratory muscle strength (Smith et al., 2021, Am J Physiol, 312, 1013-1018), a delay in muscle fatigue, and an improvement in performance. There is limited research on cycling, rowing, and running; therefore, this study aims to determine whether any of these exercises delay or increase muscle fatigue and to determine if maximal inspiratory pressure and maximal expiratory pressure improve respiratory function. This study aims to recruit 9–12 participants, which will involve four visits to the laboratory. Exercises include a 10-kilometre cycling session, a 3-kilometre treadmill running session, and a 2-kilometre rowing session, and these will be done in a randomised order. Visit 1 includes familiarisation; visit 2 involves baseline measures being recorded and test 1 being conducted; visit 3 includes test 2 being administered; and visit 4 involves test 3 being conducted. The measurements that will be collected at each kilometre are heart rate, rate of perceived exertion, and dyspnea. Blood lactate, maximal inspiratory pressure, and maximum expiratory pressure, however, will be collected before and after each test. At this present time, results are pending. My hypothesis for this study would be that all the cardio-based exercises will see an improvement in respiratory function and strength, with treadmill running having the biggest improvement as, throughout the 4 weeks, adaptation would have occurred
J31 The effect of football heading on sidestep cutting biomechanics
No full textHeading is an integral part of football, with ~20 headers or aerial duels executed per game to intercept, pass or score. However, concerns have recently been raised about the potential short and long-term health impacts of repeated heading. There is evidence suggesting increased risks of sub-concussive trauma – head impacts that do not result in obvious symptoms of concussion but affect cognition and motor function (Montenigro et al., 2017, J Neurotra, 34, 328-340). Repeated heading has been demonstrated to alter brain-muscle communication and affect movement control (Parr et al., 2023, Front Hu Neuro, 17, 1145700) and mechanics of simple tasks such as jumping (Lapointe et al., 2018, Int J Psychophys, 132, 93-98). However, whether these observed cognition and motor impairments translate to the biomechanics of complex multidirectional sport-specific movements such as sidestep cutting is not known. This is an important area to understand because sidestep cutting, an acute change of direction which is ubiquitous in football, is an important performance-determining factor and also a common inciting event for lower-limb injuries (Alentorn-Geli et al., 2009, Knee Sur Sports Trauma, Arth, 17, 705-729) such as the anterior cruciate ligament (ACL) rupture. Due to its propensity to generate high multiplanar knee joint loading during the stance phase of the manoeuvre (Dempsey et al., 2009, Am J Sports Med, 37, 2194-2200), there are often high stresses on the lower limbs which can result in musculoskeletal injury. To date, a copious number of studies have analysed the biomechanics of the sidestep cutting manoeuvre, showing that knee loading is sensitive to the constraints and strategies used to manoeuvre (Dos’Santos et al., 2019, Strength Cond J, 41, 40-54). Accordingly, this present study aims to determine whether there is an effect of repeated heading on sidestep-cutting biomechanics and, if so, the nature of this effect. Participants (n=40) will perform reactive and pre-planned sidestep cutting manoeuvres before completing 15 virtual (n=20) or physical (n=20) ball-heading. They will then repeat the cutting tasks immediately after the bout of heading. Whole-body optical motion capture, ground reaction forces, tri-planar lower-limb joint angles and moments during the stance phase will be analysed to test the effects of football heading on sidestep cutting biomechanics. Results may indicate whether exposure to football heading is a potential risk factor for lower-limb/ACL injury and thus inform the development of training sessions, athlete monitoring, and organisational/national heading guidance and policy for matches and training
Clinical Legal Education and the Future of Pro-Bono in Nigeria: A Guarantee for Access to Justice for Accused Persons Awaiting Trial
Get PDFThe idea of access to justice is strongly related to the doctrine of the rule of law, and the effectiveness of a nation’s judicial system is mostly evaluated by its citizens' access to justice. Human rights are guaranteed and protected by instruments including the Constitution of the Federal Republic of Nigeria 1999 (as amended). However, when these rights are not protected (fair hearing, access to court) owing to financial constraints and lack of access to legal counsel, justice cannot be guaranteed. The large number of accused persons awaiting trial in Nigeria is ascribed to several factors, including missing files, inability to post a bond or provide surety, delay in the DPP's advice to the police over which case to pursue, the police's failure to promptly investigate and prosecute, among others. In Nigeria, despite the voluntary legal services provided by the government, lawyers, and clinical law students, the legal system towards indigents does not abate. This article explores the problems and potential solutions to providing increased legal aid services to accused persons awaiting trial in Nigeria. An interdisciplinary approach was adopted in this study, where primary data was gathered from prison visits made by Nigerian Law School, Yola Campus Law Clinic to the Yola and Jimeta medium security correctional centres. The barriers to accessing legal aid in light of the available legal aid services are critically examined here
The Impact of Policy Work on Employability Skills in the Policy Project Connected to the Criminal Appeals Clinic at the Open University
Get PDFThe impact of policy work in allowing students to obtain skills in case work should not be understated. At the Open University (OU) one of our modules on our law degree incorporates clinical legal education. The Criminal Justice Clinic (CJC) is a digital clinic that sits within that. The purpose of the CJC is to assist clients that state they have been wrongly convicted of serious criminal offences and are serving long sentences in prison. It aims to assist with social justice and provide students with professional skills. Students research and advise on live criminal cases under the supervision of a solicitor. They apply legal principles to determine whether there are any grounds for an appeal to be made. Students have full access to case papers. It is an innovative project as it aims to teach students legal professional skills working on difficult cases in a digital only setting.
Last year we set up a system where students undertake a policy project before commencing work in the clinic. This assists them with acquiring the skills that they need when they work on live criminal cases and helps them understand the background to what they are doing. Students were split into groups and given a policy project to look at and at the end they provided a report. They worked collaboratively to do so and needed to complete the project within a specific time frame. This paper looks at the practicalities of doing such a project digitally and considers the impact on employability skills
The Stateless Legal Clinic: Innovative Models for Addressing Unmet Legal Need in Australia through Clinical Legal Education
Get PDFThe Stateless Legal Clinic is a unique service providing legal education and aid to eligible stateless children in their application for Australian citizenship. It also provides law students at the University of Melbourne with the opportunity to gain practical legal experience and engage in experiential learning, through a clinical legal education elective subject offered within the Juris Doctor (JD) degree. The Stateless Legal Clinic aims to address a critical gap in legal services for stateless children in Australia and situates clinical legal education within the relatively new and emerging discipline of ‘statelessness studies.’ Through an examination of Australia's legal framework for addressing the global human rights issue of statelessness, this article examines the design and operation of the Stateless Legal Clinic, arguing that clinical legal education can provide innovative models for increasing access to justice for communities often overlooked or under-serviced by the legal industry