• Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: a randomized controlled trial

      Wright, Amy; Stone, Keeron; Martinelli, Louis; Fryer, Simon; Smith, Grace; Lambrick, Danielle; Stoner, Lee; Jobson, Simon; Faulkner, James; University of Winchester; University of Gloucestershire; Hobbs Rehabilitation; University of Gloucestershire; University of Chester; University of Southampton; University of North Carolina; University of Winchester; University of Winchester (SAGE, 2020-12-27)
      Objectives:To assess the effect of a home-based over-ground robotic-assisted gait training program using the AlterG Bionic Leg orthosis on clinical functional outcomes in people with chronic stroke. Design:Randomized controlled trial. Setting:Home. Participants:Thirty-four ambulatory chronic stroke patients who recieve usual physiotherapy. Intervention:Usual physiotherapy plus either (1)10-week over-ground robotic-assisted gait training program (n=16), using the device for 30 minutes per day, or (2)control group (n=18), 30 minutes of physical activity per day. Measurements:The primary outcome was the Six-Minute Walk Test. Secondary outcomes included: Timed-Up-and-Go, Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale. Physical activity and sedentary time were assessed using accelerometry. All measurements were completed at baseline, 10- and 22-weeks after baseline. Results:Significant increases in walking distance were observed for the Six-Minute Walk Test between baseline and 10-weeks for over-ground robotic-assisted gait training (135±81m vs. 158±93m, respectively; P0.001) but not for control (122±92m vs. 119±84m, respectively). Findings were similar for Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale (all P0.01). For over-ground robotic-assisted gait training, there were increases in time spent stepping, number of steps taken, number of sit-to-stand transitions, and reductions in time spent sitting/supine between baseline and 10-weeks (all P<.05). The differences observed in all of the aforementioned outcome measures were maintained at 22-weeks, 12 weeks after completing the intervention (all P >.05). Conclusion:Over-ground robotic-assisted gait training combined with physiotherapy in chronic stroke patients led to significant improvements in clinical functional outcomes and physical activity compared to the control group. Improvements were maintained at 22 weeks.
    • The role of brain size on mammalian population densities

      González-Suárez, Manuela; Gonzalez-Voyer, Alejandro; von Hardenberg, Achaz; Santini, Luca; University of Reading; Universidad Autonoma de Mexico; University of Chester; Italian National Research Council (Wiley, 2020-12-22)
      1. The local abundance or population density of different organisms often varies widely. Understanding what determines this variation is an important, but not yet fully resolved question in ecology. Differences in population density are partly driven by variation in body size and diet among organisms. Here we propose that the size of an organism’ brain could be an additional, overlooked, driver of mammalian population densities. 2. We explore two possible contrasting mechanisms by which brain size, measured by its mass, could affect population density. First, because of the energetic demands of larger brains and their influence on life history, we predict mammals with larger relative brain masses would occur at lower population densities. Alternatively, larger brains are generally associated with a greater ability to exploit new resources, which would provide a competitive advantage leading to higher population densities among large‐brained mammals. 3. We tested these predictions using phylogenetic path analysis, modelling hypothesized direct and indirect relationships between diet, body mass, brain mass and population density for 656 non‐volant terrestrial mammalian species. We analysed all data together and separately for marsupials and the four taxonomic orders with most species in the dataset (Carnivora, Cetartiodactyla, Primates, Rodentia). 4. For all species combined, a single model was supported showing lower population density associated with larger brains, larger bodies and more specialized diets. The negative effect of brain mass was also supported for separate analyses in Primates and Carnivora. In other groups (Rodentia, Cetartiodactyla and marsupials) the relationship was less clear: supported models included a direct link from brain mass to population density but 95% confidence intervals of the path coefficients overlapped zero. 5. Results support our hypothesis that brain mass can explain variation in species’ average population density, with large‐brained species having greater area requirements, although the relationship may vary across taxonomic groups. Future research is needed to clarify whether the role of brain mass on population density varies as a function of environmental (e.g. environmental stability) and biotic conditions (e.g. level of competition).
    • Public Policy for Obesity Prevention in Lebanon

      Fallows, Stephen; Kennedy, Lynne; Al Kattan, Malika (University of Chester, 2020-12)
      Background: In Lebanon, the population is experiencing nutrition transition and a high prevalence of obesity. Studies have shown that the Lebanese people are shifting their dietary behaviours from the traditional Lebanese diet, a variation of the Mediterranean diet, towards a westernised diet and are being physically inactive. To achieve a population behaviour change and address the obesity epidemic, the root causes of these behaviours and food choices should be explored and addressed. This approach requires joint efforts from different sectors such as the government, healthcare, and civil society to develop action plans and enact policies. In Lebanon, the factors that influence eating behaviours and physical activity are still not explored, national level policies are still lacking, and researchers have called for an urgent need to implement policies to halt the rise of obesity prevalence. Aims and objectives: The general aim of this thesis is to explore the perceived factors that influence adults’ eating behaviours and physical activity using the socio-ecological model as the conceptual framework. In addition, this PhD research explores the relevant contribution and the position of different stakeholders towards obesity prevention in Lebanon. Finally, this thesis draws on lessons learned from countries worldwide that help in developing guidelines for obesity prevention in Lebanon. Methods: Two studies were conducted for this PhD research. In the first study, the Photovoice method was used to engage Lebanese adults from the North Governorate to explore different factors that influence their eating behaviours and physical activity and to identify their perceptions towards the actions needed to address obesity. The second study involved a series of one-to-one face-to-face semi-structured interviews which were conducted with key stakeholders from different public and private sectors (government, civil society, education, and healthcare). These interviews aimed to explore the key stakeholders’ perceptions towards obesity and its causes, their relevant contribution towards obesity prevention, their priority of action to address obesity, and finally the barriers to effective action to reduce obesity in Lebanon. Results: The findings of the two qualitative studies show that obesity is commonly perceived as a body image issue rather than a health issue. Some of the main factors that were perceived to influence Lebanese adults’ eating behaviours and physical activity were: females’ (wives’ and mothers’) employment, social gatherings, and social norms (e.g. food and meal sharing), safety concerns, the availability of countless unhealthy food options that are relatively cheaper than healthy food, the lack of a physical environment that encourages physical activity, and food marketing and advertisements. The results of the stakeholder’s interviews show that the key stakeholders are aware of the nutrition transition and some of the underlying environmental factors that caused these behaviour changes. Yet, most of the key stakeholders framed obesity in an “individualistic approach” by focusing on unhealthy dietary behaviours, the physical inactivity and placed the responsibility on individuals for their lifestyle. Due to their approach, most of them focused their actions on raising awareness such as the role of education. Some of the barriers to effective policy action to address obesity in Lebanon are the political instability, lack of public demand for action, and lack of coordinated multi-sectoral actions. Implications: The recognition of obesity as a disease as well as strengthening the public, stakeholders’, and policymakers’ support towards obesity prevention strategies are essential to overcome the “policy inertia” in Lebanon. The key areas that need to be addressed for obesity prevention are raising awareness on obesity health consequences, increasing access to healthy food in public and private settings, limiting unhealthy food advertisements, and fiscal measures such as taxing unhealthy food and subsidising healthy food. To facilitate the implementation of policies that aim to prevent obesity, a systematic plan of action should be developed. To engage stakeholders from different sectors and establish a national multi-sectoral collaboration, national strategies and policies that follow a Health in all Policies Approach (HiPA) are recommended. This requires strong leadership from the government. Conclusions: There is an urgent need to shift the actions beyond targeting the individual by implementing public policies to address the obesogenic environment in Lebanon. Recommendations for research, policy actions, and practice are provided to guide the action towards establishing an appropriate public policy that recognises the need to adopt a socioecological model of implementation.
    • Nutrition knowledge and dietary intake of hurlers

      Murphy, John; orcid: 0000-0002-8337-722X; O’Reilly, James (SAGE Publications, 2020-11-26)
      The current study investigated the association between sports nutrition knowledge and dietary quality in a sample of adult Irish male hurling players. Nutrition knowledge was measured by the validated Sports Nutrition Knowledge Questionnaire (SNKQ). Diet quality was measured by the Australian Recommended Food Score (ARFS) calculated from food frequency questionnaire data. Analysis of variance and linear modelling were used to assess associations between variables. A total of 265 (129 elite, 136 sub-elite) players were recruited. No significant difference in nutrition knowledge (SNKQ) was found between groups. Results showed a significant difference (p = 0.02; d = 0.39 ± 0.25; small) in food score (ARFS) between groups. A weak, positive association (r = 0.3, p = 0.007) was found between nutrition knowledge and food score. Elite level players, aged 28–32, with college degrees, that have previously received nutritional guidance displayed the highest levels of both nutrition knowledge and food score. Higher levels of nutrition knowledge and food score were expected in elite players, however were only found in food score. Nutrition knowledge does contribute to dietary quality although future interventions should focus on specific gaps in knowledge such as how to meet total energy/carbohydrate requirements.
    • Fitness Monitoring in Elite Soccer Players: Group vs. Individual Analyses.

      Rabbani, Alireza; Kargarfard, Mehdi; Twist, Craig (2020-11)
      The aims of this study were to (a) examine changes in group and individual HR measures during a submaximal warm-up test, and (b) investigate the relationship between accumulated internal training loads and HR changes during an in-season phase among elite soccer players (n = 14). Before and after an in-season phase (24 days), exercise HR (HRex) and HR recovery (HRR) expressed either as the number of beats recovered (HRR60s) or as the mean HR (HRpost1) during 1 minute of recovery were analyzed. Heart rate measures were expressed as the % of maximal HR. Session rating of perceived exertion (sRPE) was computed for all training/match sessions. Group and individual HR changes were analyzed using magnitude-based inferences. Pearson correlation coefficients were also used to examine the relationships. Group analyses of HR changes revealed there were possibly to likely trivial changes in all HR measures. When analyzing individual data, no substantial change was observed for HRR60s%. However, substantial changes in HRex% and HRpost1% were observed for 4/14 and 5/14 players, respectively. The relationships between HRex% and HRpost1% were nearly perfect (r = 0.90, confidence limits [0.82-0.95]). The associations between changes in HRex% and HRpost1% were also nearly perfect (r = 0.92, 0.80-0.97). A very large inverse correlation was observed between HRex% and accumulated sRPE (r = -0.75, -0.44 to -0.90). This study highlights the value of conducting individual vs. group aerobic fitness monitoring. This study also showed the importance of how HRR is reported when aerobic fitness monitoring of elite soccer players.
    • Occurrence of chemical pollutants in major e-waste sites in West Africa and usefulness of cytotoxicity and induction of ethoxyresorufin-O-deethylase (EROD) in determining the effects of some detected brominated flame retardants and e-waste soil-derived extracts.

      Eze, Chukwuebuka ThankGod; orcid: 0000-0001-8076-2926; email: thankgod.eze@fuoye.edu.ng; Michelangeli, Francesco; Otitoloju, Adebayo Akeem; Eze, Obianuju Oluchukwu; Ibraheem, Omodele; Ogbuene, Emeka Bright; Ogunwole, Germaine Akinola (2020-10-25)
      We investigated the occurrence of chemical pollutants in major e-waste sites in West Africa and usefulness of cytotoxicity and induction of ethoxyresorufin-O-deethylase (EROD) in determining the effects of some detected brominated flame retardants (BFRs) and e-waste soil-derived extracts. Analysis of the e-waste site samples using AAS and GC-MS techniques revealed the presence of a range of toxic metals as well as persistent and toxic organic pollutants, respectively, in the vicinity of the e-waste sites. As expected, the occurrence (%) of all the detected chemical pollutants in experimental soils significantly (P < 0.05) differs from occurrence (%) in control soil. The calculated LC values on RBL-2H3 cells of the detected tetrabromobisphenol A (TBBPA) and hexabromocyclododecane (HBCD) were 3.75 μM and 4.2 μM, respectively. Tribromophenol (TBP), dibromobiphenyl (DBB), and decabromodiphenyl ether (DBDE) were remarkably less toxic on RBL-2H3 cells compared with TBBPA and HBCD as they did not reduce RBL-2H3 cell viability below 50% in the tested concentration range (0-20 μM). The study revealed that TBBPA and HBCD could induce significant RBL-2H3 cell death through caspase-dependent apoptosis. The study further shows that the cytotoxicity of some of these BFRs could increase synergistically when in mixtures and potentially activate inflammation through the stimulation of mast cell degranulation. The e-waste soil-derived extracts induced a concentration-dependent increase in EROD activity in the exposed RTG-W1 cells. Ultimately, nonpolar extracts had higher EROD-inducing potency compared with polar extracts and hence suggesting the presence in higher amounts of AhR agonists in nonpolar e-waste soil-derived extracts than polar extracts. Overall, there is urgent need for actions in order to improve the environmental quality of the e-waste sites.
    • Contrasting responses to salinity and future ocean acidification in arctic populations of the amphipod Gammarus setosus

      Brown, James; Whiteley, Nia; Bailey, Allison; Graham, Helen; Hop, Haakon; Rastrick, Samuel; University of Chester; Bangor University; Norwegian Polar Institute; Institute of Marine Research; Norwegian Polar Institute; Institute of Marine Research (Elsevier, 2020-10-07)
      Climate change is leading to alterations in salinity and carbonate chemistry in arctic/sub-arctic marine ecosystems. We examined three nominal populations of the circumpolar arctic/subarctic amphipod, Gammarus setosus, along a salinity gradient in the Kongsfjorden-Krossfjorden area of Svalbard. Field and laboratory experiments assessed physiological (haemolymph osmolality and gill Na+/K+-ATPase activity, NKA) and energetic responses (metabolic rates, MO2, and Cellular Energy Allocation, CEA). In the field, all populations had similar osmregulatory capacities and MO2, but lower-salinity populations had lower CEA. Reduced salinity (S = 23) and elevated pCO2 (~1000 μatm) in the laboratory for one month increased gill NKA activities and reduced CEA in all populations, but increased MO2 in the higher-salinity population. Elevated pCO2 did not interact with salinity and had no effect on NKA activities or CEA, but reduced MO2 in all populations. Reduced CEA in lower-rather than higher-salinity populations may have longer term effects on other energy demanding processes (growth and reproduction).
    • Ecotoxicological and regulatory aspects of environmental sustainability of nanopesticides.

      Grillo, Renato; email: renato.grillo@unesp.br; Fraceto, Leonardo F; Amorim, Mónica J B; Scott-Fordsmand, Janeck James; Schoonjans, Reinhilde; Chaudhry, Qasim (2020-10-02)
      Recent years have seen the development of various colloidal formulations of pesticides and other agrochemicals aimed at use in sustainable agriculture. These formulations include inorganic, organic or hybrid particulates, or nanocarriers composed of biodegradable polymers, that can provide a better control of the release of active ingredients. The very small particle sizes and high surface areas of nanopesticides may however also lead to some unintended (eco)toxicological effects due to the way in which they interact with the target and non-target species and the environment. The current level of knowledge on ecotoxicological effects of nanopesticides is scarce, especially in regard to the fate and behaviour of such formulations in the environment. Nanopesticides will however have to cross a stringent regulatory scrutiny before marketing in most countries for health and environmental risks under a range of regulatory frameworks that require pre-market notification, risk assessment and approval, followed by labelling, post-market monitoring and surveillance. This review provides an overview of the key regulatory and ecotoxicological aspects relating to nanopesticides that will need to be considered for environmentally-sustainable use in agriculture. [Abstract copyright: Copyright © 2020 Elsevier B.V. All rights reserved.]
    • Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss.

      Kirwan, Richard; orcid: 0000-0003-4645-0077; email: r.p.kirwan@2018.ljmu.ac.uk; McCullough, Deaglan; orcid: 0000-0002-9882-9639; Butler, Tom; orcid: 0000-0003-0818-1566; email: t.butler@chester.ac.uk; Perez de Heredia, Fatima; orcid: 0000-0002-2537-3327; Davies, Ian G; orcid: 0000-0003-3722-8466; Stewart, Claire; orcid: 0000-0002-8104-4819 (2020-10-01)
      The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.
    • History of traction

      Flynn, Sandra (Elsevier, 2020-10-01)
    • Nicotinamide restricts neural precursor proliferation to enhance catecholaminergic neuronal subtype differentiation from mouse embryonic stem cells

      Borlongan, Cesar V.; Griffin, Síle M.; orcid: 0000-0002-6670-5084; email: silemgriffin@gmail.com; Pickard, Mark R.; Hawkins, Clive P.; Williams, Adrian C.; Fricker, Rosemary A.; orcid: 0000-0001-8768-510X (Public Library of Science, 2020-09-14)
      Emerging evidence indicates that a strong relationship exists between brain regenerative therapies and nutrition. Early life nutrition plays an important role during embryonic brain development, and there are clear consequences to an imbalance in nutritional factors on both the production and survival of mature neuronal populations and the infant’s risk of diseases in later life. Our research and that of others suggest that vitamins play a fundamental role in the formation of neurons and their survival. There is a growing body of evidence that nicotinamide, the water-soluble amide form of vitamin B3, is implicated in the conversion of pluripotent stem cells to clinically relevant cells for regenerative therapies. This study investigated the ability of nicotinamide to promote the development of mature catecholaminergic neuronal populations (associated with Parkinson’s disease) from mouse embryonic stem cells, as well as investigating the underlying mechanisms of nicotinamide’s action. Nicotinamide selectively enhanced the production of tyrosine hydroxylase-expressing neurons and serotonergic neurons from mouse embryonic stem cell cultures (Sox1GFP knock-in 46C cell line). A 5-Ethynyl-2´-deoxyuridine (EdU) assay ascertained that nicotinamide, when added in the initial phase, reduced cell proliferation. Nicotinamide drove tyrosine hydroxylase-expressing neuron differentiation as effectively as an established cocktail of signalling factors, reducing the proliferation of neural progenitors and accelerating neuronal maturation, neurite outgrowth and neurotransmitter expression. These novel findings show that nicotinamide enhanced and enriched catecholaminergic differentiation and inhibited cell proliferation by directing cell cycle arrest in mouse embryonic stem cell cultures, thus driving a critical neural proliferation-to-differentiation switch from neural progenitors to neurons. Further research into the role of vitamin metabolites in embryogenesis will significantly advance cell-based regenerative medicine, and help realize their role as crucial developmental signalling molecules in brain development.
    • Perceptions and experiences of occupational sedentary behaviour and cardiometabolic responses to reducing sitting time at work

      Deery, Elizabeth C. (University of Chester, 2020-09-10)
      Sedentary behaviour is linked to cardiometabolic health, independent of physical activity (PA), in a majority of the UK population. The workplace accounts for around 70% of daily sitting time, thus making it a popular domain for intervention. This thesis included a critical review and four studies which evaluated the use of sit-stand desks in relation to; perceptions and experiences; acute blood glucose responses; longerterm cardiometabolic health changes and self-reported use and finally the vascular health changes. Within this thesis a review of the literature was carried out, and examined evidence relating to occupational sedentary behaviour and its impact on health amongst adults, as well as the effectiveness of interventions to reduce occupational sitting time. The review highlighted that whilst many sit-stand desk interventions effectively reduced occupational sitting time, findings regarding both acute and chronic cardiometabolic responses to such interventions were equivocal. The review also highlighted that perceptions of sit-stand desk use are underinvestigated, particularly in the UK context. Study one used focus groups to examine the perceptions and experiences of sit-stand desk work amongst UK based officeworkers. Expected health beliefs and personal health history were important drivers of behaviour change whilst experienced benefits, organisational culture and peers were important in maintaining behaviour change. Study two examined the acute bloodglucose responses to sit-stand desk work using continuous glucose monitoring (CGM) and assessed changes to workplace sitting, standing and stepping time. Objectively measured workplace sitting time decreased by ~50% and total daily sitting percentage reduced from 70% to 45%. However there were no significant differences in postprandial blood glucose excursion between conditions. Occupational sitting time of this sample was much lower than that previously reported within the literature and may explain differences in findings. Study three examined a longer-term (6 and 12 month) intervention, assessing self-reported sitting time, self-reported physical activity and cardiometabolic health markers including anthropometric measurements, predicted aerobic capacity, blood pressure and blood profiles. Self-reported sitting time significantly decreased over 6 and 12 month interventions. A decrease was also seen in the control group prior to the intervention period suggesting a possible trial effect. Despite this change to self-reported sitting, there was no significant impact on cardiometabolic health markers. Study four explored the impact of an 8-week sit-stand desk intervention on flow-mediated dilation (FMD), blood pressure and blood profile whilst measuring fidelity to the intervention using both self-report and objective measures of PA and sitting time. There was a significant decrease in self-report total daily sitting time however, objectively measured sitting time and cardiometabolic health markers did not significantly differ over the intervention period. Moreover, a significant difference was observed between self-report and objectively measured sitting time at midpoint, in the intervention group only. To conclude, whilst sit-stand desks are an attractive means to work, which participants perceive to be of benefit physically, mentally and in their work performance, the installation of sit-stand desks in isolation does not appear to be a sufficient means by which to impact on longerterm occupational sitting time. Additionally, self-report methods may not be a suitable means to measure changes to sitting time during an intervention. Future research should aim to explore the behaviour change techniques effective in reducing occupational sitting time, whether interventions which successfully decrease occupational sitting time bring about cardiometabolic benefits and disparities between perceived and measured outcomes of sit-stand desk interventions on activity levels, health markers, and performance markers.
    • The influence of warm-up duration on simulated rugby league interchange match performance

      Williams, Robert; Gillham, Scott; Highton, Jamie; Twist, Craig; University of Chester (Taylor & Francis, 2020-09-10)
      Objective: The study was conducted to understand the effects of a short (10-minute) and a long (30-minute) duration warm-up on subsequent readiness to exercise and movement during simulated rugby league match play. Methods: Using a randomised cross-over design, 13 male rugby players (age: 23.6 ± 4.1 y) completed a 10- or 30-minute warm-up immediately before 2 x 23 min rugby league movement simulation protocol. Comparisons of the responses to the warm-up and during the simulation were made between each trial. Results: Total distance, high- and low speed running and tympanic temperature (ES = 0.56 to 20.8) were all higher in the 30 min warm-up, with differences in relative distance and heart rate unclear (ES = -0.36 to 0.06). Differences in participants’ readiness to exercise after the warm-ups were unclear (ES = 0.25). Differences between trials for movement characteristics (ES = -0.13 to -0.32), RPE (ES = -0.13 to 0.04) and B[La] after the simulation were mostly unclear, with only trivial changes in high-speed running (ES = 0.08) and a lower heart rate (ES = -0.26) between the two playing bouts after the 30 min warm-up trial. Conclusion: Practitioners can use warm-ups between 10 or 30 minutes for rugby league interchange players without any implications for subsequent match running performance.
    • Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes

      Halter, Mary; orcid: 0000-0001-6636-0621; Drennan, Vari; orcid: 0000-0002-8915-5185; Wang, Chao; Wheeler, Carly; Gage, Heather; Nice, Laura; de Lusignan, Simon; orcid: 0000-0001-5613-6810; Gabe, Jonathan; Brearley, Sally; Ennis, James; et al. (BMJ Publishing Group, 2020-09-01)
      Objectives: To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. Design: Mixed-methods study: retrospective chart review using 4 months’ anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. Setting: Three emergency departments in England. Participants: The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. Primary and secondary outcome measures: The primary outcome was unplanned re-attendance at the same emergency department within 7 days. Secondary outcomes: consultation processes, clinical adequacy of care, and staff and patient experience. Results: Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p<0.001), after adjustment for patient characteristics, triage severity of condition and statistically significant clinician intraclass correlation. Clinical reviewers found almost all patients’ charts clinically adequate. Physician associates were evaluated as assessing patients in a similar way to foundation year two doctors-in-training and providing continuity in the team. Patients were positive about the care they had received from a physician associate, but had poor understanding of the role. Conclusions: Physician associates in emergency departments in England treated patients with a range of conditions safely, and at a similar level to foundation year two doctors-in-training, providing clinical operational efficiencies.
    • The role of specific biomarkers, as predictors of post-operative complications following flexible ureterorenoscopy (FURS), for the treatment of kidney stones: a single-centre observational clinical pilot-study in 37 patients

      Hughes, Stephen Fôn; orcid: 0000-0001-6558-9037; email: Stephen.hughes6@wales.nhs.uk; Moyes, Alyson Jayne; Lamb, Rebecca May; Ella-tongwiis, Peter; Bell, Christopher; Moussa, Ahmed; Shergill, Iqbal (BioMed Central, 2020-08-14)
      Abstract: Background: The number of patients diagnosed and subsequently treated for kidney stones is increasing, and as such the number of post-operative complications is likely to increase. At present, little is known about the role of specific biomarkers, following flexible ureterorenoscopy (FURS) for the surgical treatment of kidney stones. The main aim of the study was to evaluate the role of kidney and infection biomarkers, in patients undergoing FURS. Methods: Included were 37 patients (24 males, 13 females), who underwent elective FURS, for the treatment of kidney stones. Venous blood samples were collected from each patient: pre-operatively, and at 30 min, 2 and 4 h post-operatively. Changes to kidney (NGAL, Cystatin-C) and infection (MPO, PCT) biomarkers was quantified by means of ELISA, Biomerieux mini-vidas and Konelab 20 analysers. Results: Four patients developed post-operative complications (3 - UTIs with urinary retention, 1 - urosepsis. NGAL concentration increased significantly following FURS (p = 0.034). Although no significant changes were seen in Cystatin C, MPO and PCT (p ≥ 0.05) some key clinical observation were noted. Limiting factors for this study were the small number of patients recruited and restriction in blood sampling beyond 4 h. Conclusions: Although not confirmative, changes seen to biomarkers such as Cystatin C, NGAL and MPO in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications which can develop following FURS.
    • White-faced Darter distribution is associated with coniferous forests in Great Britain

      Geary, Matthew; von Hardenberg, Achaz; Conservation Biology Research Group, Department of Biological Science, University of Chester, Chester, CH1 4BJ (Wiley, 2020-08-11)
      Abstract 1) Understanding of dragonfly distributions is often geographically comprehensive but less so in ecological terms. 2) White-faced darter (Leucorhinnia dubia) is a lowland peatbog specialist dragonfly which has experienced population declines in Great Britain. White-faced darter are thought to rely on peat-rich pool complexes within woodland but this has not yet been empirically tested. 3) We used dragonfly recording data collected by volunteers of the British Dragonfly Society from 2005 to 2018 to model habitat preference for white-faced darter using species distribution models across Great Britain and, with a more detailed landcover dataset, specifically in the North of Scotland. 4) Across the whole of Great Britain our models used the proportion of coniferous forest within 1km as the most important predictor of habitat suitability but were not able to predict all current populations in England. 5) In the North of Scotland our models were more successful and suggest that habitats characterised by native coniferous forest and areas high potential evapotranspiration represent the most suitable habitat for white-faced darter. 6) We recommend that future white-faced darter monitoring should be expanded to include areas currently poorly surveyed but with high suitability in the North of Scotland. 7) Our results also suggest that white-faced darter management should concentrate on maintaining Sphagnum rich pool complexes and the maintenance and restoration of native forests in which these pool complexes occur.
    • Seascape genomics reveals population isolation in the reef-building honeycomb worm, Sabellaria alveolata (L.)

      Dubois, Stanislas; Muir, Anna P; orcid: 0000-0002-6896-6915; Ross, Rebecca; Firth, Louise; Knights, Antony; Lima, Fernando; Seabra, Rui; Corre, Erwan; Le Corguillé, Gildas; Nunes, Flavia; et al. (BMC, 2020-08-10)
      Background: Under the threat of climate change populations can disperse, acclimatise or evolve in order to avoid fitness loss. In light of this, it is important to understand neutral gene flow patterns as a measure of dispersal potential, but also adaptive genetic variation as a measure of evolutionary potential. In order to assess genetic variation and how this relates to environment in the honeycomb worm (Sabellaria alveolata (L.)), a reef-building polychaete that supports high biodiversity, we carried out RAD sequencing using individuals from along its complete latitudinal range. Patterns of neutral population genetic structure were compared to larval dispersal as predicted by ocean circulation modelling, and outlier analyses and genotype-environment association tests were used to attempt to identify loci under selection in relation to local temperature data. Results: We genotyped 482 filtered SNPs, from 68 individuals across nine sites, 27 of which were identified as outliers using BAYESCAN and ARLEQUIN. All outlier loci were potentially under balancing selection, despite previous evidence of local adaptation in the system. Limited gene flow was observed among reef-sites (FST = 0.28 ± 0.10), in line with the low dispersal potential identified by the larval dispersal models. The North Atlantic reef emerged as a distinct population and this was linked to high local larval retention and the effect of the North Atlantic Current on dispersal. Conclusions: As an isolated population, with limited potential for natural genetic or demographic augmentation from other reefs, the North Atlantic site warrants conservation attention in order to preserve not only this species, but above all the crucial functional ecological roles that are associated with their bioconstructions. Our study highlights the utility of using seascape genomics to identify populations of conservation concern.
    • Physiological and anthropometric determinants of critical power, W′ and the reconstitution of W′ in trained and untrained male cyclists

      Chorley, Alan; Bott, Richard P; Marwood, Simon; Lamb, Kevin L; University of Chester (Springer, 2020-08-09)
      Abstract Purpose This study examined the relationship of physiological and anthropometric characteristics with parameters of the critical power (CP) model, and in particular the reconstitution of W′ following successive bouts of maximal exercise, amongst trained and untrained cyclists. Methods Twenty male adults (trained nine; untrained 11; age 39 ± 15 year; mass 74.7 ± 8.7 kg; V̇O2max 58.0 ± 8.7 mL kg−1 min−1) completed three incremental ramps (20 W min−1) to exhaustion interspersed with 2-min recoveries. Pearson’s correlation coefficients were used to assess relationships for W′ reconstitution after the first recovery (W′rec1), the delta in W′ reconstituted between recoveries (ΔW′rec), CP and W′. Results CP was strongly related to V̇O2max for both trained (r = 0.82) and untrained participants (r = 0.71), whereas W′ was related to V̇O2max when both groups were considered together (r = 0.54). W′rec1 was strongly related to V̇O2max for the trained (r = 0.81) but not untrained (r = 0.18); similarly, ΔW′rec was strongly related to V̇O2max (r = − 0.85) and CP (r = − 0.71) in the trained group only. Conclusions Notable physiological relationships between parameters of aerobic fitness and the measurements of W′ reconstitution were observed, which differed among groups. The amount of W′ reconstitution and the maintenance of W′ reconstitution that occurred with repeated bouts of maximal exercise were found to be related to key measures of aerobic fitness such as CP and V̇O2max. This data demonstrates that trained cyclists wishing to improve their rate of W′ reconstitution following repeated efforts should focus training on improving key aspects of aerobic fitness such as V̇O2max and CP.
    • Assessment of energy availability and associated risk factors in professional female soccer players

      Moss, Samantha; Randell, Rebecca; Burgess, Darren; Ridley, Stephanie; Ó Cairealláin, Cairbre; Allison, Richard; Rollo, Ian; University of Chester; Gatorade Sports Science Institute, Arsenal Football Club, Tipperary GAA, Melbourne Football Club (Taylor & Francis, 2020-08-06)
      This study aimed to assess energy availability (EA), alongside possible risk factors of reduced or low EA of professional female soccer players during a competitive season. Thirteen players (age: 23.7 ± 3.4 y, stature: 1.69 ± 0.08 m, body mass: 63.7 ± 7.0 kg) engaged in a 5-day (two rest days, one light training, heavy training and match day) monitoring period. Energy intake (EI) and expenditure during exercise (EEE) were measured. EA was calculated and categorised as optimal, reduced or low (≥45, 31-44, ≤30 kcal·kg FFM-1·day-1, respectively). Relationships between EA and bone mineral density, resting metabolic rate (RMR), plasma micronutrient status, biochemical markers and survey data were assessed. EA was optimal for 15%, reduced for 62% and low for 23% of players. Higher EA was observed on rest days compared to others (P<0.05). EA was higher for the light compared to the heavy training day (P<0.001). EEE differed significantly between days (P<0.05). EI (2124 ± 444 kcal), carbohydrate (3.31 ± 0.64 g·kg·day-1) and protein (1.83 ± 0.41 g·kg·day-1) intake remained similar (P>0.05). Survey data revealed 23% scored ≥ 8 on the Low Energy Availability in Females Questionnaire and met criteria for low RMR (ratio <0.90). Relationships between EA and risk factors were inconclusive. Most players displayed reduced EA and did not alter EI or carbohydrate intake to training or match demands. Although cases of low EA were identified, further work is needed to investigate possible long-term effects and risk factors of low and reduced EA separately to inform player recommendations.
    • The importance of long-term genetic monitoring of reintroduced populations: inbreeding in the natterjack toad (Epidalea calamita)

      Muir, Anna P.; Phillips, Susanna; Geary, Matt; Allmark, Matthew; Bennett, Sarah; Norman, Kim; Ball, Rachel J; Peters, Catherine; University of Chester; Cheshire Wildlife Trust; Eni UK Ltd (British Herpetological Society, 2020-07-31)
      Genetic monitoring is an important, but frequently lacking, component of management actions to support long-term persistence in reintroduced populations. Populations that remain small, due to demographic processes and genetic diversity, are more likely to experience a second extinction event. The natterjack toad (Epidelea calamita) is legally protected in Britain and was the subject of a reintroduction programme in the 1990s. However, subsequent genetic assessment has been mostly lacking. The aim of this study was to assess the genetic diversity of two reintroduced populations of natterjack toads in order to inform conservation management. Adults were sampled and nine microsatellites amplified to assess neutral genetic variation within each site and for comparison with the source population. Inbreeding was observed at the reintroduction sites, as evidenced by high FIS values (0.43 and 0.72), low observed compared to expected heterozygosities, and significant deviation from Hardy-Weinberg equilibrium. Observed heterozygosity is currently lower in the reintroduction sites than it was in the source population at the time of the reintroductions (Red Rocks: 0.15±0.20; Talacre: 0.12±0.20; Ainsdale (source): 0.29). Evidence for a bottleneck was not found, although this is likely a result of sampling overlapping generations. No within-site population structuring was observed. Such low genetic diversity has not previously been recorded in any natterjack population. Genetic rescue, combined with pool creation, is the most viable option for safeguarding the species at these sites into the future. Our work highlights the importance of ongoing genetic monitoring, in collaboration with conservation organisations, to support conservation management.