Publications by authors named "J Luke Pryor"

614 Publications

Short term heat acclimation reduces heat strain during a first, but not second, consecutive exercise-heat exposure.

J Sci Med Sport 2021 Apr 6. Epub 2021 Apr 6.

Korey Stringer Institute, Department of Kinesiology, University of Connecticut, USA.

Objectives: Determine whether five days of heat acclimation reduces cardiovascular and thermoregulatory strain during consecutive exercise-heat exposures on the sixth day in the heat.

Design: Pair-matched randomized control trial.

Methods: Twenty-four males completed two, 120min exercise sessions (Session 1, Session 2) in a single day before (Day 1) and after (Day 6) four additional days of exercise in either hot (HOT: 40°C, 40% relative humidity, n=16) or temperate (CON: 23°C, 25% relative humidity, n=8) environments. A mixed-methods heat acclimation approach was implemented. Day 2 consisted of 120min of moderate-high intensity treadmill exercise. Days 3-5 consisted of 90min of moderate-high intensity exercise, with HOT completing this in a hyperthermia clamped manner at rectal temperature ≥38.5°C, and CON<38.5°C.

Results: Session 1 end of exercise rectal temperature and heart rate were lower on Day 6 compared to Day 1 for HOT (p=0.012, p=0.003) but not CON (p=0.152, p=0.437). Session 2 end of exercise rectal temperature was not different between days for HOT (p=0.104) or CON (p=0.275). Session 2 end of exercise heart rate was lower on Day 6 compared to Day 1 for HOT (p=0.004) and CON (p=0.039). Session 1 sweat sensitivity was greater on Day 6 compared to Day 1 for HOT (p=0.039) but not CON (p=0.257). Sweat rate was unchanged for HOT and CON between days during Session 1 (p=0.184, p=0.962) and Session 2 (p=0.051, p=0.793), respectively.

Conclusions: Five days of heat acclimation reduced cardiovascular strain but not thermoregulatory strain during the second, consecutive exercise-heat exposure. CLINICALTRIALS.

Gov Identifier: NCT04053465.
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http://dx.doi.org/10.1016/j.jsams.2021.03.020DOI Listing
April 2021

Maternal nutrient restriction in late pregnancy programs postnatal metabolism and pituitary development in beef heifers.

PLoS One 2021 8;16(4):e0249924. Epub 2021 Apr 8.

Department of Animal Science, Texas A&M University, College Station, Texas, United States of America.

Maternal undernutrition during pregnancy followed by ad libitum access to nutrients during postnatal life induces postnatal metabolic disruptions in multiple species. Therefore, an experiment was conducted to evaluate postnatal growth, metabolism, and development of beef heifers exposed to late gestation maternal nutrient restriction. Pregnancies were generated via transfer of in vitro embryos produced using X-bearing sperm from a single Angus sire. Pregnant dams were randomly assigned to receive either 100% (control; n = 9) or 70% (restricted; n = 9) of their total energy requirements from gestational day 158 to parturition. From post-natal day (PND) 301 until slaughter (PND485), heifers were individually fed ad libitum in a Calan gate facility. Calves from restricted dams were lighter than controls at birth (P<0.05) through PND70 (P<0.05) with no difference in body weight from PND105 through PND485 (P>0.10). To assess pancreatic function, glucose tolerance tests were performed on PND315 and PND482 and a diet effect was seen with glucose area under the curve being greater (P<0.05) in calves born to restricted dams compared to controls. At slaughter, total internal fat was greater (P<0.05) in heifers born to restricted dams, while whole pituitary weight was lighter (P<0.05). Heifers from restricted dams had fewer growth hormone-positive cells (somatotrophs) compared to controls (P<0.05). Results demonstrate an impaired ability to clear peripheral glucose in heifers born to restricted dams leading to increased deposition of internal fat. A reduction in the number of somatotrophs may contribute to the adipogenic phenotype of heifers born to restricted dams due to growth hormone's known anabolic roles in growth, lipolysis, and pancreatic islet function.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249924PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8031383PMC
April 2021

Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia.

Nutrients 2021 Mar 28;13(4). Epub 2021 Mar 28.

College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.

Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of 'trigger' foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.
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http://dx.doi.org/10.3390/nu13041109DOI Listing
March 2021

Effects of modern military backpack loads on walking speed and cardiometabolic responses of US Army Soldiers.

Appl Ergon 2021 Feb 27;94:103395. Epub 2021 Feb 27.

US Army Research Institute of Environmental Medicine (USARIEM), 10 General Greene Avenue, Natick, MA, 01760, USA. Electronic address:

Introduction: Military leaders must understand how modern military equipment loads affect trade-offs between movement speed and physiological strain to optimize pacing strategies.

Purpose: To evaluate the effects of load carried in a recently developed military backpack on the walking speed and cardiometabolic responses of dismounted warfighters.

Methods: Fifteen soldiers (1 woman, 14 men; age, 22 ± 2 years; height, 173 ± 7 cm; body mass (BM), 73 ± 10 kg) completed incremental walking tests with four external load conditions (0, 22, 44, or 66% BM) using the US Army's newest backpack: the Modular Lightweight Load-Carrying Equipment 4000 (MOLLE 4000). Oxygen uptake (V̇O) and heart rate (HR) were evaluated relative to maximal values (V̇O and HR respectively). Testing ceased when participants completed the highest tested speed (1.97 m s), exceeded a respiratory exchange ratio (RER) of 1.00, or reached volitional exhaustion.

Results: Peak speed significantly decreased (p < 0.03) with successively heavier loads (0% BM, 1.95 ± 0.06 m s; 22% BM, 1.87 ± 0.10 m s; 44% BM, 1.69 ± 0.13 m s; 66% BM, 1.48 ± 0.13 m s). Peak V̇O was significantly lower (p < 0.01) with 0% BM (47 ± 5% V̇O) than each load (22% BM, 58 ± 8% V̇O; 44% BM, 63 ± 10% V̇O; 66% BM, 61 ± 11% V̇O). Peak HR was significantly lower (p < 0.01) with 0% BM (71 ± 5% HR) versus each load (22% BM, 83 ± 6% HR; 44% BM, 87 ± 6% HR; 66% BM, 88 ± 6% HR).

Conclusion: Overburdened warfighters suffer severe impairments in walking speed even when carrying recently developed military load carriage equipment. Our results suggest that the relative work intensity of heavy load carriage may be better described when expressed relative to HR versus V̇O.
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http://dx.doi.org/10.1016/j.apergo.2021.103395DOI Listing
February 2021

Problems people with spinal cord injury experience accessing help with bowel care when hospitalised outside a specialist spinal injury service.

J Clin Nurs 2021 Feb 16. Epub 2021 Feb 16.

Royal Rehab, Ryde, NSW, Australia.

Aims And Objectives: To examine the nature of problems experienced by people with spinal cord injury (SCI) when accessing help to maintain recommended bowel regimes while hospitalised outside a specialist spinal injury service.

Background: Bowel dysfunction is one particularly undesirable aspect of life with a SCI, with constipation and incontinence common.

Design: Descriptive qualitative.

Methods: Accounts of problems encountered in hospitals in New South Wales Australia collected during interviews with 11 people living with SCI and 12 responses provided by spinal clinicians via an online survey were subjected to thematic analysis. The COREQ guidelines were followed for reporting.

Results: There were similarities across data collected from both sources. Individuals with SCI described instances where their bowel care needs did not fit with the pace and processes in acute hospitals. The clinician data pointed to a failure of healthcare professionals to assist people with SCI to maintain bowel care regimes recommended by specialist spinal services. Both groups described times when bowel care received was unreliable and fragmented, along with reports of staff who were unwilling and/or unable to provide the assistance required. Many and varied physical and psychosocial repercussions for individuals were associated with these system failures. In some instances, rather than restoring health, being admitted to hospital represented a significant health risk.

Conclusion: A failure of hospital systems to meet the bowel care needs of people with SCI when hospitalised outside a specialist spinal unit was identified. System and individual factors contributed to these problems, hence addressing them requires both system and individual responses.

Relevance To Clinical Practice: If this problem is left unaddressed, the health and quality of life of people with SCI will continue to be compromised. Nursing scope of practice needs to be clarified and communicated to nurses outside specialist spinal injury units in relation to their role in maintaining bowel care regimes recommended for their patients by spinal specialists, and nurses need to ensure they possess the skills required. To allocate the time needed to provide this care, individual nurses need the support of the whole nursing team, including managers who are prepared to arrange additional staff when needed.
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http://dx.doi.org/10.1111/jocn.15717DOI Listing
February 2021

Pain Management Strategies in Contemporary Penile Implant Recipients.

Curr Urol Rep 2021 Feb 3;22(3):17. Epub 2021 Feb 3.

Department of Urology, Einstein Healthcare Network, 1200 Tabor Road, Moss/3 Sley, Philadelphia, PA, 19141, USA.

Purpose Of Review: To review the most recent literature citing opioid-sparing multimodal analgesic strategies used to manage perioperative pain in patients who underwent inflatable penile prosthesis (IPP) surgery and to provide the penile implant surgeon a variety of non-opioid-based pain management strategies for IPP management.

Recent Findings: Interventions performed in the pre-operative, intraoperative, and post-operative arenas have all been shown to effectively lower pain scores and reduce opioid consumption. Certain surgical techniques performed during IPP surgery have helped with post-operative discomfort patients may feel after surgery. Multimodal analgesia (MMA) protocols adopted from other surgical fields and other urologic subspecialties that are implemented in IPP surgery have promising results with regard to post-operative pain control and opioid consumption. Protocols that implement a combination of refined surgical technique and multimodal analgesia offer substantial benefit to patients undergoing IPP surgery. Further work is needed to assess long-term pain control and opioid use in patients that undergo IPP surgery using these innovative strategies.
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http://dx.doi.org/10.1007/s11934-021-01033-1DOI Listing
February 2021

Pharmacological HIF-1 stabilization promotes intestinal epithelial healing through regulation of α-integrin expression and function.

Am J Physiol Gastrointest Liver Physiol 2021 Apr 20;320(4):G420-G438. Epub 2021 Jan 20.

School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.

Intestinal epithelia are critical for maintaining gastrointestinal homeostasis. Epithelial barrier injury, causing inflammation and vascular damage, results in inflammatory hypoxia, and thus, healing occurs in an oxygen-restricted environment. The transcription factor hypoxia-inducible factor (HIF)-1 regulates genes important for cell survival and repair, including the cell adhesion protein β1-integrin. Integrins function as αβ-dimers, and α-integrin-matrix binding is critical for cell migration. We hypothesized that HIF-1 stabilization accelerates epithelial migration through integrin-dependent pathways. We aimed to examine functional and posttranslational activity of α-integrins during HIF-1-mediated intestinal epithelial healing. Wound healing was assessed in T84 monolayers over 24 h with/without prolyl-hydroxylase inhibitor (PHDi) (GB-004), which stabilizes HIF-1. Gene and protein expression were measured by RT-PCR and immunoblot, and α-integrin localization was assessed by immunofluorescence. α-integrin function was assessed by antibody-mediated blockade, and integrin α6 regulation was determined by HIF-1α chromatin immunoprecipitation. Models of mucosal wounding and 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis were used to examine integrin expression and localization in vivo. PHDi treatment accelerated wound closure and migration within 12 h, associated with increased integrin α2 and α6 protein, but not α3. Functional blockade of integrins α2 and α6 inhibited PHDi-mediated accelerated wound closure. HIF-1 bound directly to the integrin α6 promoter. PHDi treatment accelerated mucosal healing, which was associated with increased α6 immunohistochemical staining in wound-associated epithelium and wound-adjacent tissue. PHDi treatment increased α6 protein levels in colonocytes of TNBS mice and induced α6 staining in regenerating crypts and reepithelialized inflammatory lesions. Together, these data demonstrate a role for HIF-1 in regulating both integrin α2 and α6 responses during intestinal epithelial healing. HIF-1 plays an important role in epithelial restitution, selectively inducing integrins α6 and α2 to promote migration and proliferation, respectively. HIF-stabilizing prolyl-hydroxylase inhibitors accelerate intestinal mucosal healing by inducing epithelial integrin expression.
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http://dx.doi.org/10.1152/ajpgi.00192.2020DOI Listing
April 2021

Effectiveness of spiritual care training for rehabilitation professionals: An exploratory controlled trial.

NeuroRehabilitation 2020 ;47(4):393-403

Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.

Background: Spirituality may play an important role in neurorehabilitation, however research findings indicate that rehabilitation professionals do not feel well equipped to deliver spiritual care.

Objective: To evaluate a spiritual care training program for rehabilitation professionals.

Methods: An exploratory controlled trial was conducted. Participants enrolled in a two-module spiritual care training program. Spiritual care competency was measured with the Spiritual Care Competency Scale. Confidence and comfort levels were measured using the Spiritual Care Competency Scale domains. The Spirituality and Spiritual Care Rating Scale assessed participant attitudes and knowledge. Measures were administered three times: pre-program, post-program and six weeks follow-up.

Results: The training (n = 41) and control (n = 32) groups comprised rehabilitation professionals working in spinal cord or traumatic brain injury units. No between-group differences were observed on the study variables at the pre-program time point. Multilevel models found that levels of spiritual care competency, confidence, comfort, and ratings on existential spirituality increased significantly for the training group (versus control) post-program (p < 0.05) and these significant differences were maintained at follow-up.

Conclusions: A brief spiritual care training program can be effective in increasing levels of self-reported competency, confidence and comfort in delivery of spiritual care for rehabilitation professionals.
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http://dx.doi.org/10.3233/NRE-203221DOI Listing
March 2021

Maternal nutrient restriction alters endocrine pancreas development in fetal heifers.

Domest Anim Endocrinol 2021 Jan 10;74:106580. Epub 2020 Oct 10.

Department of Animal Science, Texas A&M University, 2471 TAMUS, College Station, TX 77843, USA. Electronic address:

Maternal nutrient restriction during pregnancy alters fetal programming, which modifies the growth and health of the offspring in postnatal life. In cattle, nutrient restriction during pregnancy can be a result of environmental or economic factors, but little is known about how it alters the physiology of the fetus and affects future reproductive or growth efficiency. This study used female monozygotic twins, produced through in vitro fertilization and embryo splitting, to determine the effect of moderate maternal nutrient restriction on fetal development. Recipient Angus cross heifers pregnant with one twin were fed a diet meeting 100% National Research Council (NRC) total energy requirements (n = 4; control), whereas recipient heifers pregnant with the second twin were fed at 70% of NRC total energy requirements (n = 4; restricted) from gestational day (GD) 158 to GD 265 in Calan gate feeders. Recipient heifers were killed at GD 265. Change in maternal metabolic body weight was greater from zero in restricted heifers than controls (P < 0.05); restricted heifers lost weight during the nutrient restriction period. There was no difference in last rib back fat or rib eye area between groups (P > 0.10). There was no difference in fetal weight, uterine weight, or total placentome weight between groups (P > 0.10). The pancreas weight was reduced in restricted fetuses compared with control fetuses (P < 0.01), but there were no other differences in fetal organ weights (P > 0.10). Plasma insulin concentrations were reduced in restricted fetuses compared with controls (P < 0.01), but there was no effect of maternal diet on plasma glucose or glucagon concentrations in the fetus (P > 0.10). Histological analyses of the fetal pancreas revealed no differences in endocrine cell number or localization. Results indicate that a modest late gestation nutritional restriction impairs development of the fetal pancreas in the cow. Additional research will be needed to determine if these developmental changes lead to altered glucose and insulin homeostasis in the adult.
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http://dx.doi.org/10.1016/j.domaniend.2020.106580DOI Listing
January 2021

Enhancing sensitivity of lateral flow assay with application to SARS-CoV-2.

Appl Phys Lett 2020 Sep;117(12):120601

Texas A&M University, College Station, Texas 77843, USA.

Lateral flow assay (LFA) has long been used as a biomarker detection technique. It has advantages such as low cost, rapid readout, portability, and ease of use. However, its qualitative readout process and lack of sensitivity are limiting factors. We report a photon-counting approach to accurately quantify LFAs while enhancing sensitivity. In particular, we demonstrate that the density of SARS-CoV-2 antibodies can be quantified and measured with an enhanced sensitivity using this simple laser optical analysis.
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http://dx.doi.org/10.1063/5.0021842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518548PMC
September 2020

"Spirituality is everybody's business": an exploration of the impact of spiritual care training upon the perceptions and practice of rehabilitation professionals.

Disabil Rehabil 2020 Sep 25:1-10. Epub 2020 Sep 25.

School of Human Services and Social Work, Griffith University, Brisbane, Australia.

Purpose: This study explored the impact of a brief spiritual care training program upon the perceptions and self-reported practice of rehabilitation professionals working in traumatic injury.

Methodology And Methods: A qualitative study. Semi-structured interviews were held with staff from a rehabilitation hospital in Sydney, Australia, between six and eight weeks after participation in spiritual care training. A thematic analysis was conducted.

Results: Of the 41 rehabilitation professionals who attended the training (1 h online, 1.5 h face to face), 16 agreed to be interviewed. The majority worked in spinal cord injury and were female. Half reported holding a Christian affiliation. One overarching theme and six sub-themes were identified from the qualitative data. The overarching theme was "spirituality is everybody's business". The six sub-themes were: (i) increased awareness of the nature of spirituality, (ii) realisation of the importance of spirituality to clients, (iii) a desire to keep spirituality on the radar, (iv) identifying barriers to providing spiritual care (v) incorporating spirituality into practice, and, (vi) recognising spirituality as personally meaningful.

Conclusions: A brief spiritual care training program can impact positively upon perceptions and practice of rehabilitation professionals. Ongoing training is needed to ensure that staff retain what was learnt. IMPLICATIONS FOR REHABILITATION Brief spiritual care training can impact positively upon rehabilitation professionals' perceptions of spirituality and lead to practice change in the delivery of spiritual care across many clinical disciplines. The stories of patients and family members are powerful staff education tools in spiritual care training. Client spirituality is an under recognised resource that staff can draw upon in supporting and enhancing the rehabilitation process.
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http://dx.doi.org/10.1080/09638288.2020.1820586DOI Listing
September 2020

Structural snapshots of human DNA polymerase μ engaged on a DNA double-strand break.

Nat Commun 2020 09 22;11(1):4784. Epub 2020 Sep 22.

Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Dr., Bldg. 101/Rm F338, Research Triangle Park, NC, 27709, USA.

Genomic integrity is threatened by cytotoxic DNA double-strand breaks (DSBs), which must be resolved efficiently to prevent sequence loss, chromosomal rearrangements/translocations, or cell death. Polymerase μ (Polμ) participates in DSB repair via the nonhomologous end-joining (NHEJ) pathway, by filling small sequence gaps in broken ends to create substrates ultimately ligatable by DNA Ligase IV. Here we present structures of human Polμ engaging a DSB substrate. Synapsis is mediated solely by Polμ, facilitated by single-nucleotide homology at the break site, wherein both ends of the discontinuous template strand are stabilized by a hydrogen bonding network. The active site in the quaternary Pol μ complex is poised for catalysis and nucleotide incoporation proceeds in crystallo. These structures demonstrate that Polμ may address complementary DSB substrates during NHEJ in a manner indistinguishable from single-strand breaks.
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http://dx.doi.org/10.1038/s41467-020-18506-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508851PMC
September 2020

Verification Testing to Confirm V˙O2max in a Hot Environment.

Med Sci Sports Exerc 2021 04;53(4):763-769

Department of Health and Human Performance, Concordia University, Chicago, IL.

Purpose: This study aimed to evaluate the validity and reliability of a verification test to confirm GXT V˙O2max in a hot environment.

Methods: Twelve recreationally trained cyclists completed a two-test protocol that included a GXT progressing 20 W·min-1 followed by a biphasic supramaximal-load verification test (1 min at 60% increasing to 110% maximal GXT wattage until failure) in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a thermoneutral room and was anchored to the duration required for gastrointestinal temperature to return to baseline.

Results: Mean verification test V˙O2max (51.3 ± 8.8 mL·kg-1·min-1) was lower than GXT (55.9 ± 7.6 mL·kg-1·min-1, P = 0.02). Verification tests confirmed GXT V˙O2max in 92% of participants using individual analysis thresholds. Bland-Altman analysis revealed a sizable mean bias (-4.6 ± 4.9 mL·kg-1·min-1) with wide 95% limits of agreement (-14.0 to 5.0 mL·kg-1·min-1) across a range of V˙O2max values. The high coefficient of variation (9.6%) and typical error (±3.48 mL·kg-1·min-1) indicate potential issues of test-retest reliability in the heat.

Conclusions: Verification testing in a hot condition confirmed GXT V˙O2max in virtually all participants, indicating robust utility. To enhance test-retest reliability in this environment, protocol recommendations for work rate and recovery between tests are provided.
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http://dx.doi.org/10.1249/MSS.0000000000002520DOI Listing
April 2021

Enabling one-pot Golden Gate assemblies of unprecedented complexity using data-optimized assembly design.

PLoS One 2020 2;15(9):e0238592. Epub 2020 Sep 2.

Research Department, New England Biolabs, Ipswich, Massachusetts, United States of America.

DNA assembly is an integral part of modern synthetic biology, as intricate genetic engineering projects require robust molecular cloning workflows. Golden Gate assembly is a frequently employed DNA assembly methodology that utilizes a Type IIS restriction enzyme and a DNA ligase to generate recombinant DNA constructs from smaller DNA fragments. However, the utility of this methodology has been limited by a lack of resources to guide experimental design. For example, selection of the DNA sequences at fusion sites between fragments is based on broad assembly guidelines or pre-vetted sets of junctions, rather than being customized for a particular application or cloning project. To facilitate the design of robust assembly reactions, we developed a high-throughput DNA sequencing assay to examine reaction outcomes of Golden Gate assembly with T4 DNA ligase and the most commonly used Type IIS restriction enzymes that generate three-base and four-base overhangs. Next, we incorporated these findings into a suite of webtools that design assembly reactions using the experimental data. These webtools can be used to create customized assemblies from a target DNA sequence or a desired number of fragments. Lastly, we demonstrate how using these tools expands the limits of current assembly systems by carrying out one-pot assemblies of up to 35 DNA fragments. Full implementation of the tools developed here enables direct expansion of existing assembly standards for modular cloning systems (e.g. MoClo) as well as the formation of robust new high-fidelity standards.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238592PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467295PMC
October 2020

Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders.

Curr Gastroenterol Rep 2020 Aug 14;22(10):51. Epub 2020 Aug 14.

School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, University of Newcastle, Newcastle, NSW, Australia.

Purpose Of Review: Functional dyspepsia (FD) is a chronic functional gastrointestinal disorder characterised by upper gastrointestinal symptoms. Here, we aimed to examine the evidence for immune responses to food in FD and overlap with food hypersensitivity conditions.

Recent Findings: A feature of FD in a subset of patients is an increase in mucosal eosinophils, mast cells, intraepithelial cytotoxic T cells and systemic gut-homing T cells in the duodenum, suggesting that immune dysfunction is characteristic of this disease. Rates of self-reported non-celiac wheat/gluten sensitivity (NCW/GS) are higher in FD patients. FD patients commonly report worsening symptoms following consumption of wheat, fermentable oligosaccharides, disaccharides, monosaccharides, or polyols (FODMAPs), high-fat foods and spicy foods containing capsaicin. Particularly, wheat proteins and fructan in wheat may drive symptoms. Immune mechanisms that drive responses to food in FD are still poorly characterised but share key effector cells to common food hypersensitivities including non-IgE-mediated food allergy and eosinophilic oesophagitis.
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http://dx.doi.org/10.1007/s11894-020-00789-9DOI Listing
August 2020

An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation.

J Adv Nurs 2020 Oct 4;76(10):2586-2596. Epub 2020 Aug 4.

Royal Rehab, Ryde, NSW, Australia.

Aim: To describe the nature of readmission to acute care and identify patient characteristics associated with avoidable readmission to acute care from inpatient brain injury rehabilitation.

Design: A retrospective cohort design.

Methods: Data prospectively documented between 1 January 2012 -31 December 2018 in local clinical and administrative database were used. Patient medical records were accessed when missing data were identified. Descriptive statistics were used to describe the nature of readmission episodes and univariate and multivariable logistic regression were used to identify patient characteristics associated with readmission to acute care.

Results: Of the 383 patients admitted for rehabilitation, 83 (22%) experienced readmission to acute care for a total of 171 episodes. Thirty-seven percent of readmission episodes were due to hospital acquired complications and therefore potentially avoidable. Infection accounted for 63% of hospital acquired complications. Patients with an avoidable readmission episode (N = 38) were more likely to have a significantly lower Functional Independence Measure score, be incontinent, have a tracheostomy, require a mobility aid, and be prescribed a dysphagia diet on rehabilitation admission. Patients with a tracheostomy on rehabilitation admission had a 56% probability for an avoidable readmission to acute care.

Conclusion: Brain injury rehabilitation patients with an avoidable readmission to acute care were more likely to have a higher burden of care on rehabilitation admission and infection was the leading cause of avoidable readmission episodes.

Impact: Research into readmission to acute care in the mixed brain injury inpatient rehabilitation population is limited. In this patient population, readmission to acute care is a contemporary issue that can occur at any time during a patient's rehabilitation admission. This study provides valuable information informing practice change for preventing avoidable readmission episodes. Locally developed policy aimed at preventing readmission episodes should include proactive prevention, early recognition of complications and discrete escalation care pathways.
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http://dx.doi.org/10.1111/jan.14475DOI Listing
October 2020

Division of the genus Observation of discontinuities in amino acid identity values, a possible consequence of major extinction events, guides transfer of nine species to the genus , eleven species to the genus , and three species to the genus gen. nov., with description of sp. nov. and sp. nov. derived from clinical specimens.

Int J Syst Evol Microbiol 2020 Aug 2;70(8):4432-4450. Epub 2020 Jan 2.

Special Bacteriology Reference Laboratory, Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

The genus in the family is known to be polyphyletic. Amino acid identity (AAI) values were calculated from whole-genome sequences of species of the genus and their distribution was found to be multi-modal. These naturally-occurring non-continuities were leveraged to standardise genus assignment of these species. We speculate that this multi-modal distribution is a consequence of loss of biodiversity during major extinction events, leading to the concept that a bacterial genus corresponds to a set of species that diversified since the Permian extinction. Transfer of nine species (, , and ) to the genus and eleven (, , , , , , , , and ) to the genus is proposed. Two novel species are described: sp. nov. and sp. nov. Evidence is presented to support the assignment of to a genus apart from to which comb nov. also belongs. The novel genus is proposed, to contain the type species comb. nov., along with comb. nov., and comb. nov.
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http://dx.doi.org/10.1099/ijsem.0.003935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660247PMC
August 2020

Association of CARD8 Activating Polymorphism With Bone Erosion in Cholesteatoma Patients.

Laryngoscope 2021 02 12;131(2):E605-E611. Epub 2020 May 12.

Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Objectives: We compared the incidence of polymorphisms activating the NLRP3 inflammasome between controls and patients with cholesteatoma and its potential association with bone erosion in patients with cholesteatoma.

Methods: This is a case-control study assessing the mutation rates in genes of interest in patients with and without cholesteatoma. A total of 133 saliva samples from control (n = 65) and cholesteatoma (n = 68) patients were collected for DNA extraction. Caspase recruitment domain family member 8 (CARD8) (AA: homozygous wild type, AT: heterozygous, TT: homozygous mutant polymorphism) and NLRP3 (CC: homozygous wild type, CA: heterozygous, AA: homozygous mutant) polymorphisms were analyzed with TaqMan single-nucleotide polymorphism (SNP) quantitative polymerase chain reaction (ThermoFisher Scientific, Waltham, MA). Mutation status was correlated with a novel bone erosion scoring model developed as a part of this study. Summary statistics, including frequencies (%) and median (Q1, Q3) were used to describe the sample.

Results: The presence of CARD8 and NLRP3 homozygous wild-type polymorphisms were generally similar for the control and cholesteatoma patient groups. CARD8 homozygous TT polymorphisms were an exception, occurring more frequently in patients who developed a cholesteatoma compared to the control group (29% vs. 10%, P = .009). Those patients with CARD8 homozygous TT polymorphism had higher median scores of bone erosion as compared to subjects with nonhomozygous mutant genotypes (median [interquartile range]: 4.0 [3.0, 5.5] vs. 2.5 [1.0, 3.5], P = .0142).

Conclusion: Cholesteatoma patients have a significant, twofold higher incidence of CARD8 homozygous TT polymorphism. Furthermore, cholesteatoma patients with this homozygous polymorphism had greater bone erosion rates than controls. These findings suggest that genetic mutations may increase host susceptibility to cholesteatomas. Specifically, the CARD8 TT polymorphism may influence the severity of cholesteatoma-induced bone erosion.

Level Of Evidence: 3B.
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http://dx.doi.org/10.1002/lary.28741DOI Listing
February 2021

CHANGES IN INFRASPINATUS AND LOWER TRAPEZIUS ACTIVATION IN VOLLEYBALL PLAYERS FOLLOWING REPETITIVE SERVES.

Int J Sports Phys Ther 2020 Apr;15(2):196-202

Department of Physical Therapy, California State University, Fresno, CA, USA.

Background: Prolonged and repetitive overhead use of the arm, such as during the volleyball serve, has been linked to overuse injuries.

Purpose: To examine changes in activation of the infraspinatus and lower trapezius following performance of repetitive jump-float serves.

Study Design: Descriptive Cohort study.

Methods: Six asymptomatic female Division I college volleyball players (age = 19.2 ± 1.1 years, height = 182.9 ± 2.5 cm, weight = 82.1 ± 12.2 kg) performed 87 jump-float serves in 13 intervals of seven serves each on an NCAA regulated indoor volleyball court. Electromyography (EMG) electrodes were connected to TeleMyo DTS wireless sensor with the DTS EMG lead sampling at 1000 Hz. Dependent variables included Median Power Frequency (MPF) of the infraspinatus (IF) and lower trapezius (LT), as well as rating of perceived exertion (RPE), perceptual fatigue measured using the Borg scale, and heart rate (HR). Paired t-tests were performed to examine differences in variables between interval 1 (serves 1-3) and interval 13 (serves 85-87). Pearson's r Correlation Coefficients were calculated to examine relationships between the dependent variables across all 13 intervals.

Results: IF MPF demonstrated a significant and clinically meaningful decrease from interval 1 to interval 13, indicating muscular fatigue. The decrease in LT MPF from interval 1 to interval 13 was not statistically significant, though it met criteria for clinical meaningfulness and was underpowered. RPE and perceptual fatigue were strongly correlated (r = 0.889.  < 0.01) as were RPE and HR (r = 0.679,  < 0.01) and HR and fatigue (r = 0.631,  < 0.01). IF MPF was weakly related to LT MPF (r = 0.227,  < 0.05). LT MPF was weakly related to RPE (r = 0.352,  < 0.01), perceptual fatigue (r = 0.313,  < 0.01), and HR (r = 0.322,  < 0.01).

Conclusions: Repeated overhead jump-float serves, common in volleyball players, required high effort and induced clinically meaningful muscular fatigue that was not perceived by the participant. Significant changes were observed in IF MPF and percent change and effect size suggest that a meaningful change occurred in LT MPF related to jump-float serving.

Level Of Evidence: 2.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134349PMC
April 2020

Movement Technique During Jump-Landing Differs Between Sex Among Athletic Playing Surfaces.

J Strength Cond Res 2020 Feb 27. Epub 2020 Feb 27.

Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York.

Pryor, JL, Burbulys, ER, Root, HJ, and Pryor, RR. Movement technique during jump-landing differs between sex among athletic playing surfaces. J Strength Cond Res XX(X): 000-000, 2020-Whether athletic surface type affects movement technique, a causal factor for lower extremity injury, is unclear. This study evaluated the influence of 4 common athletic surfaces on movement technique using the Landing Error Scoring System (LESS). Secondarily, we aimed to evaluate differences in movement technique between men and women among surfaces. Recreationally active men and women (n = 38) completed jump-landing tests on 4 common athletic surfaces in a quasi-randomized crossover fashion. Vertical jump height, perceptual fatigue, and muscle soreness were evaluated before jump-landing movement analyses and were similar across testing sessions (p > 0.05). Men achieved higher LESS scores on hardwood and artificial pellet turf compared with women (p ≤ 0.037). Women exhibited lower LESS scores on grass and artificial turf vs. concrete (p ≤ 0.048). Data indicate differential lower extremity movement technique and therefore injury risk across athletic surface types and sex, challenging the generalizability of the LESS construct. Athletic playing surface should be considered during movement technique assessment and implementation of injury prevention programs.
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http://dx.doi.org/10.1519/JSC.0000000000003520DOI Listing
February 2020

Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation.

Int J Environ Res Public Health 2020 02 19;17(4). Epub 2020 Feb 19.

Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.

The combination of hyperthermia, dehydration, and strenuous exercise can result in severe reductions in kidney function, potentially leading to acute kidney injury (AKI). We sought to determine whether six days of heat acclimation (HA) mitigates the rise in clinical biomarkers of AKI during strenuous exercise in the heat. Twenty men completed two consecutive 2 h bouts of high-intensity exercise in either hot ( = 12, 40 °C, 40% relative humidity) or mild ( = 8, 24 °C, 21% relative humidity) environments before (PreHA) and after (PostHA) 4 days of 90-120 min of exercise per day in a hot or mild environment. Increased clinical biomarkers of AKI (CLINICAL) was defined as a serum creatinine increase ≥0.3 mg·dL or estimated glomerular filtration rate (eGFR) reduction >25%. Creatinine similarly increased in the hot environment PreHA (0.35 ± 0.23 mg·dL) and PostHA (0.39 ± 0.20 mg·dL), with greater increases than the mild environment at both time points (0.11 ± 0.07 mg·dL, 0.08 ± 0.06 mg·dL, ≤ 0.001), respectively. CLINICAL occurred in the hot environment PreHA ( = 9, 75%), with fewer participants with CLINICAL PostHA ( = 7, 58%, = 0.007), and no participants in the mild environment with CLINICAL at either time point. Percent change in plasma volume was predictive of changes in serum creatinine PostHA and percent changes in eGFR both PreHA and PostHA. HA did not mitigate reductions in eGFR nor increases in serum creatinine during high-intensity exercise in the heat, although the number of participants with CLINICAL was reduced PostHA.
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http://dx.doi.org/10.3390/ijerph17041325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068478PMC
February 2020

Rehabilitation health professionals' perceptions of spirituality and spiritual care: The results of an online survey.

NeuroRehabilitation 2020 ;46(1):17-30

Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.

Background: Spirituality has been positively associated with key adjustment indicators for individuals affected by traumatic brain injury or spinal cord injury.

Objective: To explore the perceptions of health professionals working in rehabilitation in relation to spirituality and spiritual care practice.

Methods: An observational study. An adapted version of the Royal College of Nursing Spirituality Survey was emailed to specialty networks of rehabilitation health professionals across Australia.

Results: The majority of the 125 participants were female (92.8%), from a nursing (67.2%) background, and selected 'Christian' as their religious affiliation (68.8%). A range of spiritual needs for rehabilitation clients were identified, including a source of hope and strength. Although 84% agreed that spirituality was a fundamental aspect of healthcare, 85% agreed that staff did not receive enough education or training. Thematic analysis identified three key ways participants felt their workplaces could better address spirituality: increasing staff knowledge and skills in providing spiritual care, incorporating spirituality into rehabilitation processes, and providing patients with access to spiritual resources.

Conclusions: Spirituality is considered to play an important role after traumatic injury, but most staff do not feel well equipped to provide spiritual care. Training in spiritual care for rehabilitation professionals is warranted.
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http://dx.doi.org/10.3233/NRE-192857DOI Listing
July 2020

Immune Activation in Functional Gastrointestinal Disorders.

Gastroenterol Hepatol (N Y) 2019 Oct;15(10):539-548

Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student.

There is growing appreciation that functional gastrointestinal disorders (FGIDs) such as functional dyspepsia and irritable bowel syndrome are heterogeneous conditions linked by subtle inflammation within the gastrointestinal (GI) tract. The literature suggests that while the symptoms of these diseases may manifest with similar clinical presentations, there are significant differences in triggers and disease severity among patients classified into the same subtype. It is hypothesized that the subtle inflammation observed in these patients is related to an imbalance in GI homeostasis. Disruption of the delicate homeostatic balance within the GI tract can result from any number or combination of factors, including dysbiosis, loss of barrier integrity, genetic predisposition, or immune responses to dietary or luminal antigens. This article discusses the interplay between the immune system, microbiota, and luminal environment in FGIDs. In addition, the article proposes emerging immune pathways, including those involving T-helper type 17 response and innate lymphoid cells, as potential regulators of the subtle inflammation characteristic of FGIDs that warrant investigation in future studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883739PMC
October 2019

Predictors of unplanned readmission to acute care from inpatient brain injury rehabilitation.

J Clin Nurs 2020 Feb 10;29(3-4):593-601. Epub 2019 Dec 10.

Brain Injury Unit, Royal Rehab, Sydney, NSW, Australia.

Aims And Objectives: To identify the predictors of unplanned readmission to acute care (RTAC) from inpatient brain injury rehabilitation and to develop a risk prediction model.

Background: RTAC from inpatient rehabilitation is not uncommon. Individual rehabilitation patient populations require their own body of evidence regarding predictors of RTAC.

Design: Retrospective cohort study.

Methods: Adult patients with new onset acquired brain injury admitted to a stand-alone rehabilitation facility between 1 January 2012-31 December 2018 were included in the study. The main measures were RTAC, sensitivity, specificity, the C-statistic and Youden's index. This paper is reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Results: Of 383 patients admitted for rehabilitation, 83 (22%) experienced a RTAC; 69 (18%) patients had at least one unplanned RTAC episode. Patients requiring unplanned RTAC were more likely to have lower Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) scores on rehabilitation admission, a higher burden of care on rehabilitation discharge and be discharged to a nonhome residence. Rehabilitation admission GCS and motor FIM were identified as the independent RTAC predictors in multivariate regression modelling. The combined C-statistic was 0.86. A GCS cut-off score of ≤14 and motor FIM cut-off score of ≤40 were identified as optimal, yielding a combined Youden's index of 0.56 (sensitivity = 0.72; specificity = 0.83).

Conclusion: Patients requiring an unplanned RTAC had a lower functional status on rehabilitation admission. A prediction model for unplanned RTAC has been developed using validated and readily available clinical measures.

Relevance To Clinical Practice: The developed RTAC risk prediction model is the first step in preventing unplanned RTAC from inpatient brain injury rehabilitation. Future research should focus on discrete interventions for preventing unplanned RTAC from inpatient brain injury rehabilitation.
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http://dx.doi.org/10.1111/jocn.15118DOI Listing
February 2020

Sulfonamide desensitization in solid organ transplant recipients: A protocol-driven approach during the index transplant hospitalization.

Transpl Infect Dis 2019 Dec 15;21(6):e13191. Epub 2019 Nov 15.

Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA.

Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for Pneumocystis jiroveci pneumonia (PJP) prophylaxis for solid organ transplant (SOT) recipients because of its efficacy for this indication, extended antimicrobial coverage, and favorable cost. Reported sulfonamide allergy is not uncommon and often results in TMP-SMX avoidance. Desensitization offers an efficacious and cost-effective alternative to TMP-SMX avoidance. Herein, we reviewed our experience with desensitization during the index transplant hospitalization among 52 SOT recipients with history of a non-anaphylactic sulfonamide allergy. Of those enrolled in the desensitization protocol, 92% (48/52) completed the protocol, with nearly 80% (41/52) still on TMP-SMX at 3 months without adverse reaction. Eleven patients discontinued TMP-SMX (7 for allergic reactions and 4 for non-allergic reasons) and switched to pentamidine. A cost savings of $575 per desensitization was calculated based on annual wholesale drug prices, for a total savings of $23 575. Additionally, the protocol did not delay discharge in any patient nor was it associated with any severe allergic reactions. These findings suggest TMP-SMX desensitization is safe and effective in SOT recipients with a history of non-anaphylactic, non-life-threatening sulfonamide hypersensitivity.
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http://dx.doi.org/10.1111/tid.13191DOI Listing
December 2019

Dietary management of neurogenic bowel in adults with spinal cord injury: an integrative review of literature.

Disabil Rehabil 2019 Aug 15:1-12. Epub 2019 Aug 15.

Nutrition and Dietetics, University of Sydney , Sydney , Australia.

To examine the literature for current evidence on the dietary management of neurogenic bowel in adults with spinal cord injuries (SCIs). Neurogenic bowel dysfunction presenting as faecal incontinence or constipation is a common occurrence in individuals with SCI. It poses numerous challenges for the management of bowel function and has a significant impact on quality of life following SCI. Dietary management is a common, early treatment strategy as a conservative approach for neurogenic bowel; however, current recommendations rely on expert opinion only. An integrative review of the literature using a systematic search was conducted using Medline, Embase, CINAHL, Proquest, and Google Scholar. The selected articles were critically appraised using Critical Appraisal Skills Programme checklists by two independent reviewers. The risk of bias of studies and the quality of evidence for outcomes were assessed using the risk of bias tool and the grading of recommendations, assessment, development, and evaluation system in the . Thirteen studies that met the inclusion criteria were identified exploring a variety of diet-related factors: foods, dietary behaviours, and multiple interventions including a diet plan. However, the dietary management strategies used varied significantly between studies, posing challenges to ascertain its efficacy. Given the low level of evidence and paucity of data on dietary management of neurogenic bowel, the efficacy of dietary strategies (alone or in combination with others) in managing neurogenic bowel cannot be substantiated from the studies identified. Therefore, more robust studies are warranted to bridge this gap. IMPLICATIONS FOR REHABILITATION Consumption of ∼15 g dietary fibre is shown to be beneficial in managing neurogenic bowel in SCI. Further research is required to strengthen evidence for fibre recommendations and investigating the potential benefits of traditional and non-traditional dietary approaches.
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http://dx.doi.org/10.1080/09638288.2019.1652702DOI Listing
August 2019

Exacerbated heat strain during consecutive days of repeated exercise sessions in heat.

J Sci Med Sport 2019 Oct 18;22(10):1084-1089. Epub 2019 Jun 18.

Korey Stringer Institute, Department of Kinesiology, University of Connecticut, United States.

Objectives: An exercise session in a hot environment may increase thermal strain during subsequent exercise sessions on the same and consecutive days. Therefore, this study was conducted to determine lasting physiological strain from moderate-high intensity, intermittent exercise in heat on subsequent exercise.

Design: Repeated measures laboratory study.

Methods: Seventeen healthy, recreationally active men (age: 22±3 y, maximal oxygen consumption: 54.6±5.3mLkgmin) underwent two intermittent moderate-high intensity aerobic exercise sessions separated by 2h of rest one day, followed by one session 24h later in a 40°C, 40% relative humidity environment. Heart rate, rectal temperature, heat stress perception, and environmental symptoms were assessed.

Results: 100%, 35%, and 71% of participants completed the full exercise protocol during the first exercise session, second exercise session, and the following day, respectively. Exercising heart rate and rectal temperature were greater during the second exercise session (189±11bpm, 38.80±0.47°C) than the first identical exercise session (180±17bpm, p=0.004; 38.41±0.52°C, p=0.001), respectively. Immediate post-exercise heart rate, rectal temperature, thirst, thermal sensation, fatigue, and perceived exertion were similar among exercise sessions despite a shorter exercise duration during the second exercise session (93±27min, p=0.001) and the following day (113±12min, p=0.032) than the first exercise session (120±0min).

Conclusions: Moderate-high-intensity intermittent exercise in the heat resulted in greater heat strain during a second exercise session the same day, and exercise the subsequent day.
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http://dx.doi.org/10.1016/j.jsams.2019.06.003DOI Listing
October 2019

Metabolic Demands of Yoga at Varying Tempos and Compared With Walking.

J Phys Act Health 2019 06;16(7):575-580

Background: Yoga is a popular alternative to walking, but the tempo at which asanas must be performed to elicit comparable metabolic and cardiorespiratory demands is unknown. Therefore, the authors aim to compare the metabolic demands of moderate-intensity walking to Surya Namaskar yoga performed at varying tempos.

Methods: Inactive obese adults with limited prior yoga experience (n = 10) completed 10 minutes of treadmill walking at a self-selected pace (rating of perceived exertion = 12-13) and three, 10-minute bouts of yoga at a low (6 s/pose; LSUN), medium (4 s/pose; MSUN), and high (3 s/pose; HSUN) tempo with 10-minutes rest between exercise bouts.

Results: Mean metabolic equivalents observed in MSUN (3.64 [0.607]), HSUN (4.22 [0.459]), and treadmill (5.29 [1.147]) were greater than 3.0 (P ≤ .01), but not LSUN (3.28 [0.529], P = .13). Treadmill elicited greater caloric and kilocaloric expenditure (1.36 [0.23] L·min-1; 64 [11] kcal) than LSUN (0.87 [0.24] L·min-1; 39 [11] kcal) and MSUN (1.00 [0.29] L·min-1; 45 [13] kcal) (P ≤ .01). Absolute V˙O2 between yoga tempos were not different, but relative V˙O2 was higher in HSUN (14.89 [1.74] mL·min-1·kg) versus LSUN (11.39 [1.83] mL·min-1·kg) (P = .02).

Conclusions: Yoga can meet (LSUN) or exceed (MSUN and HSUN) moderate-intensity exercise recommendations. For unfit or obese populations, varying tempos of yoga practice may serve as a lower-impact option for beginning an exercise program.
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http://dx.doi.org/10.1123/jpah.2018-0283DOI Listing
June 2019

Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review.

PM R 2019 12 3;11(12):1335-1345. Epub 2019 Jul 3.

Royal Rehab, Sydney, Australia.

Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC. LEVEL OF EVIDENCE: IV.
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http://dx.doi.org/10.1002/pmrj.12179DOI Listing
December 2019

Application of evidence-based recommendations for heat acclimation: Individual and team sport perspectives.

Temperature (Austin) 2019 13;6(1):37-49. Epub 2018 Oct 13.

Department of Kinesiology, California State University, Fresno, CA, USA.

Heat acclimation or acclimatization (HA) occurs with repeated exposure to heat inducing adaptations that enhance thermoregulatory mechanisms and heat tolerance leading to improved exercise performance in warm-to-hot conditions. HA is an essential heat safety and performance enhancement strategy in preparation for competitions in warm-to-hot conditions for both individual and team sports. Yet, some data indicate HA is an underutilized pre-competition intervention in athletes despite the well-known benefits; possibly due to a lack of practical information provided to athletes and coaches. Therefore, the aim of this review is to provide actionable evidence-based implementation strategies and protocols to induce and sustain HA. We propose the following suggestions to circumvent potential implementation barriers: 1) incorporate multiple induction methods during the initial acclimation period, 2) complete HA 1-3 weeks before competition in the heat to avoid training and logistical conflicts during the taper period, and 3) minimize adaptation decay through intermittent exercise-heat exposure or re-acclimating immediately prior to competition with 2-4 consecutive days of exercise-heat training. Use of these strategies may be desirable or necessary to optimize HA induction and retention around existing training or logistical requirements.
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http://dx.doi.org/10.1080/23328940.2018.1516537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422510PMC
October 2018