Πέμπτη 11 Απριλίου 2019

Medicine & Science in Sports & Exercise

Estimating Energy Expenditure during Level, Uphill, and Downhill Walking

Looney, David P.; Santee, William R.; Hansen, Eric O.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 09, 2019

Abstract:

Introduction

The Load Carriage Decision Aid (LCDA) walking equation was developed from literature-aggregated group mean data to calculate standing and level walking energy expenditures in healthy, military-age adults. The LCDA walking equation has not been validated for use in individuals or graded walking.

Purpose

We aimed to validate the LCDA walking equation as a predictor of standing and level walking energy expenditure in individuals and expand to a new graded walking equation for uphill and downhill walking.

Methods

We compiled standing, level walking, and graded walking energy expenditures measured in 95 participants from eleven studies. Walking speeds reached up to 1.96 m·s -1 with grades ranging between -40% and 45%. The LCDA walking equation was validated against the aggregated standing and level walking data. The new LCDA graded walking equation was developed and cross-validated on the graded walking trials. We compared each equation against four reference predictive equations with the standard error of estimation (SEE) as the primary criterion.

Results

The LCDA walking equation accurately estimated standing and level walking energy expenditure (Bias, -0.02 ± 0.20 W·kg -1 ; SEE, 0.20 W·kg -1 ). Addition of the novel grade term resulted in precise estimates of uphill and downhill walking energy expenditure (Bias, 0.09 ± 0.40 W·kg -1 ; SEE, 0.42 W·kg -1 ).

Conclusions

The LCDA walking equation is a valid predictor of standing and walking energy expenditure in healthy, military-age individuals. We developed a novel grade term for estimating both uphill and downhill walking energy expenditure with a single equation. Practitioners can use the new LCDA graded walking equation to calculate energy expenditure during standing as well as walking on level, uphill, and downhill slopes.

Kinetics of Left Ventricular Mechanics during Transition from Rest to Exercise

Omar, IZEM; Claire, MAUFRAIS; Philippe, OBERT; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 09, 2019

Abstract:
PURPOSE

At the onset of physical exercise, oxygen (O 2 ) transport adapts to meet the working muscle O 2demands. Cardiac output abruptly increases through the concomitant changes of heart rate and stroke volume (SV), which is conditioned by the left ventricular (LV) function. The purpose of this study was to investigate the contribution of many LV diastolic and systolic function parameters, including twist-untwist mechanics, to SV adaptation during the first minutes after exercise onset.

METHODS

Diastolic and systolic myocardial strains and twist were monitored by two-dimensional (2D) speckle-tracking echocardiography with high temporal resolution in 28 young men (mean age: 23 ± 4 years) who performed five similar constant work-load exercises on a cycloergometer (target heart rate: 125 bpm). 2D cine-loops were recorded every 15 seconds during the first minute of exercise, and then every 30 seconds for the next 3 minutes.

RESULTS

During the first 60 seconds of exercise, SV (from 104 ± 15 to 126 ± 21 mL, p<0.001) increased concomitantly with LV strain and strain rates. Early filling was the main SV determinant during this phase, probably linked to the increase of venous return (at the very beginning of exercise), LV relaxation (from 1.5 ± 0.3 to 2.5 ± 0.4 s -1 , p<0.001) and untwisting (from -78 ± 34 to -165 ± 61 deg.s -1 , p<0.001). After the first minute, SV remained constant, while LV untwisting continued to increase (from -165 ± 61 to -187 ± 60 deg.s -1 , p<0.001) and the other systolic and diastolic parameters reached a plateau.

CONCLUSION

This study gives new mechanical insights into LV kinetics to address the challenge of SV response at the onset of exercise.

Transfer Learning Effects of Biofeedback Running Retraining in Untrained Conditions

Zhang, Janet Hanwen; Chan, Zoe Yau-Shan; Au, Ivan Pui-Hung; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 09, 2019

Abstract:
Purpose

Running gait retraining via peak tibial shock biofeedback has been previously shown to reduce impact loading and mitigate running-related symptoms. In previous research, peak tibal shock is typically measured and trained for one limb at a single constant training speed during all training sessions. The goal of this study was to determine how runners transfer learning in the trained limb to the untrained limb at different unconstrained speeds.

Methods

Thirteen runners (3 females, age = 41.1 ± 6.9 years, running experience = 6.8 ± 4.4 years, weekly running distance = 30.7 ± 22.2 km) underwent running gait biofeedback retraining via continuous tibial acceleration measured at the right distal tibia. Before and after the training, participants were asked to run at their self-selected constrained training speeds (2.8 ± 0.2 m·s -1 ) and at 110% and 90% of the training speed. Pre- and post-training peak tibial shock values for each limb were compared.

Results

Participants reduced peak tibial shock in the trained limb by 35-37% ( p <0.05, Cohen's d = 0.78-0.85), and in the untrained limb by 20-23% ( p <0.05, Cohen's d = 0.51-0.71) across the three testing speeds. The reduction was not significantly different between the trained and untrained limbs ( p = 0.31-0.79, Cohen's d = 0.18-0.45). Similarly, there was no difference in peak tibial shock reduction among the three running speeds ( p = 0.48-0.61, Cohen's d = 0.06-0.45).

Conclusion

Participants demonstrated transfer learning effects evidenced by concomitant reduced peak tibial shock in the untrained limb, and the learning effects were retrained when running at a 10% variance of the training speed.

Effect of Shoe and Surface Stiffness on Lower Limb Tendon Strain in Jumping

Firminger, Colin R.; Bruce, Olivia L.; Wannop, John William; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 08, 2019

Abstract:
Background

Tendinopathies are painful overuse injuries observed in athletes participating in jumping sports. These injuries are heavily dependent on the resulting strain from the applied mechanical load. Therefore, mechanisms to reduce tendon strain may represent a primary prevention strategy to reduce the incidence of tendinopathy.

Purpose

The purpose of this study was to examine the effect of shoe and surface stiffness on Achilles and patellar tendon strains during jumping. We hypothesized that less stiff shoes and surfaces would reduce Achilles and patellar tendon strains during jumping.

Methods

Thirty healthy male basketball players performed countermovement jumps in three shoes and on three surfaces with different stiffness while motion capture, force platform, and jump height data were collected. Magnetic resonance imaging was used to obtain participant-specific tendon morphology, and a combined dynamometry/ultrasound/electromyography session was used to obtain tendon material properties. Finally, a musculoskeletal model was used to estimate tendon strains in each surface and shoe combination.

Results

Achilles tendon strains during landing were reduced by 5.3% in the least stiff shoe compared to the stiffest shoe ( p = 0.021) due to differences in bending stiffness altering the center of pressure location. Furthermore, Achilles tendon strains during landing were 5.7% and 8.1% lower on the stiffest surface compared to the least stiff and middle stiffness surfaces, respectively ( p ≤ 0.047), due to changes in ground reaction force magnitude and center of pressure location. No effects of shoe stiffness or surface construction were observed for jump height ( p > 0.243) or peak patellar tendon strains ( p > 0.259).

Conclusions

Changes to shoe stiffness and surface construction can alter Achilles tendon strains without affecting jump performance in athletes.

Key Terms

Achilles tendon; patellar tendon; musculoskeletal modeling; tendinopathy; injury prevention.

Resistance Training Induces Antiatherogenic Effects on Metabolomic Pathways

Sarin, Heikki V.; Ahtiainen, Juha P.; Hulmi, Juha J.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 08, 2019

Abstract:
Introduction

Arising evidence suggests that resistance training has the potential to induce beneficial modulation of biomarker profile. To date, however, only immediate responses to resistance training have been investigated using high-throughput metabolomics whereas the effects of chronic resistance training on biomarker profile have not been studied in detail.

Methods

A total of 86 recreationally active healthy men without previous systematic resistance training background were allocated into i) a resistance training (RT) group (n=68, age 33 ± 7 years, body mass index (BMI) 28 ± 3 kg/m2) and ii) a non-RT group (n=18, age 31 ± 4 years, BMI 27 ± 3 kg/m2). Blood samples were collected at baseline (PRE), after 4 weeks (POST-4wk), and after 16 weeks of resistance training intervention (POST-16wk), as well as baseline and after the non-RT period (20–24 weeks). Nuclear magnetic resonance (NMR) -metabolome platform was used to determine metabolomic responses to chronic resistance training.

Results

Overall, the resistance training intervention resulted in favorable alterations (P < 0.05) in body composition with increased levels of lean mass (~2.8 %), decreased levels of android (~9.6 %), and total fat mass (~7.5 %). These changes in body composition were accompanied by anti-atherogenic alterations in serum metabolome profile (FDR < 0.05) as reductions in non-HDL cholesterol (e.g., free cholesterol, remnant cholesterol, IDL cholesterols, LDL cholesterols) and related apolipoprotein B, and increments in conjugated linoleic fatty acids levels were observed. Individuals with the poorest baseline status (i.e. body composition, metabolome profile) benefitted the most from the resistance training intervention.

Conclusions

In conclusion, resistance training improves cardiometabolic risk factors and serum metabolome even in previously healthy young men. Thus, suggesting attenuated risk for future cardiovascular disease.

Diverse Exercises Similarly Reduce Older Adults' Mobility Limitations

Tollár, József; Nagy, Ferenc; Moizs, Mariann; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 08, 2019

Abstract:
Inroduction/purpose

Little is known about the comparative effectiveness of exercise programs, especially when delivered at a high intensity, in mobility-limited older adults. We compared the effects of 25 sessions of high-intensity agility exergaming (EXE) and stationary cycling (CYC) at the same cardiovascular load on measured and perceived mobility limitations, balance, and health-related quality of life (QoL) in mobility-limited older adults.

Methods

Randomized to EXE (n=28) and CYC (n=27), mobility-impaired older adults (age 70) exercised 5x/week for 5 weeks at 80% of age-predicted maximal heart rate. Wait-listed controls did not exercise (n=28).

Results

Groups did not differ at baseline in any outcomes (p>0.05). The primary outcomes (SF-36: EXE: 6.9%, effect size:2.2; CYC: 5.5%, 1.94; WOMAC: EXE:-27.2%, -3.83; CYC:-17.2, -2.90) improved similarly (p>0.05). Secondary outcomes, including body mass (-3.7%), depression (-18%), and walking capacity (13.5%) also improved (p<0.05) similarly after the two interventions. Activities of daily living, Berg Balance Score, BestTest scores, and dynamic gait index improved more (p<0.05) after EXE than CYC. COP of standing sway path improved in 1 of 6 tests only after EXE (p<0.05). Post-exercise cardiovascular response improved in EXE (p=0.019). CON did not change in any outcomes (p>0.05).

Conclusions

When matched for cardiovascular and perceived effort, two diverse high-intensity exercise programs improved health-related QoL, perceived mobility limitation, and walking capacity similarly and balance outcomes more in mobility-limited older adults, expanding these older adults' evidence-based exercise options to reduce mobility limitations.

Serum Endocannabinoid and Mood Changes after Exercise in Major Depressive Disorder

Meyer, Jacob D.; Crombie, Kevin M.; Cook, Dane B.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 08, 2019

Abstract:

The endocannabinoid (eCB) system is implicated in the pathophysiology of depression and is responsive to acute exercise in healthy adults.

Purpose

We aimed to describe acute changes in serum eCBs across a prescribed moderate (MOD) and a self-selected/preferred (PREF) intensity exercise session in women with major depressive disorder (MDD) and determine relationships between changes in eCBs and mood states.

Methods

Women with MDD (n=17) exercised in separate sessions for 20 min on a cycle ergometer at both MOD or PREF in a within-subjects design. Blood was drawn before and within 10 min after exercise. Serum concentrations of eCBs (anandamide [AEA]; 2-arachidonoylglycerol [2-AG]) and related lipids (palmitoylethanolamine [PEA]; oleoylethanolamine [OEA]; 2-oleoylglycerol [2-OG]) were quantified using stable isotope-dilution, liquid chromatography/mass spectrometry/mass spectrometry. The profile of mood states and state-trait anxiety inventory (state only) were completed prior to, 10 min and 30 min post-exercise.

Results

Significant elevations in AEA (p=0.013) and OEA (p=0.024) occurred for MOD (moderate effect sizes: Cohen's d=0.58 and 0.41, respectively). Significant (p<0.05) moderate negative associations existed between changes in AEA and mood states for MOD at 10 min (depression, confusion, fatigue, total mood disturbance [TMD] & state anxiety) and 30 min post-exercise (confusion, TMD & state anxiety). Significant (p<0.05) moderate negative associations existed between 2-AG and mood states at 10 min (depression & confusion) and 30 min post-exercise (confusion & TMD). Changes in eCBs or related lipids or eCB-mood relationships were not found for PREF.

Conclusion

Given the broad, moderate-strength relationships between improvements in mood states and eCB increases following MOD, it is plausible that the eCB system contributes to the mood-enhancing effects of prescribed acute exercise in MDD. Alternative mechanisms are likely involved in the positive mood state effects of preferred exercise.

Trends in Step-determined Physical Activity among Japanese Adults from 1995 to 2016

Takamiya, Tomoko; Inoue, Shigeru

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 30, 2019

Abstract:
Purpose

We tried to clarify the trends in step-determined physical activity (PA) among Japanese adults from 1995 to 2016.

Methods

Raw data from the National Health and Nutrition Surveys Japan (NHNS-J) performed between 1995 and 2016 was used, in compliance with the Statistics Act of Japan. NHNS-J was conducted annually by the Japanese government (the Ministry of Health, Labour, and Welfare) using a representative Japanese sample, with the same sampling method every year except in 2012 and 2016. A 1-day pedometer survey was conducted each year as a part of the NHNS-J, on a weekday in November specified by each individual. Because of the difference in age distribution of the samples, age-adjusted mean steps per day were calculated from 1995 to 2016 by sex. The time trends of step-determined PA levels among Japanese adults were described, and examined using Joinpoint regression.

Results

The highest age-adjusted mean number of steps for men was 8,235 steps per day in 2000, whereas it was 7,667 steps per day in 2015. The highest age-adjusted mean number of steps for women was 7,474 steps per day in 1998, and 6,691 steps per day in 2015. The age-adjusted step-determined PA trend showed significantly decreasing trend from 1997 to 2008 in men (Annual Percentage Change (APC) =-0.74, p < 0.001), and from 1998 to 2008 (APC = -1.30, p < 0.001) in women, by Joinpoint regression.

Conclusion

The age-adjusted step-determined PA among Japanese adults between 1995 and 2016 decreased from around 1997-1998 until around 2008, but since then the decreasing trend became unclear both in men and women. Continuous monitoring of PA trends is essential to assess the effectiveness of policies.

Match Play–induced Changes in Landing Biomechanics with Special Focus on Fatigability

Smeets, Smeets Annemie; Vanrenterghem, Jos; Staes, Filip; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 30, 2019

Abstract:
Introduction

Growing evidence exists that match-related fatigue induces biomechanical alterations that might increase lower extremity injury risk. Fatigue studies often use match simulation protocols that expose all subjects to a standardized demand (e.g. a fixed distance/time). In those studies, the induced level of fatigue depends then on subjects' fatigability. If between-subjects variability in fatigability is high, this might confound overall fatigue effects. Therefore the first aim was to investigate whether a fatigue protocol with fixed demand causes alterations in landing patterns. Secondly, we assessed the relationship between fatigability and landing patterns as we hypothesized that athletes with high fatigability would show movement patterns that involve greater injury risk.

Methods

Eighteen athletes performed three different unilateral landing tasks before and after a match simulation protocol while muscle activation (vastus medialis, vastus lateralis, hamstrings medialis, hamstrings lateralis, gastrocnemius medialis, gastrocnemius lateralis, gluteus medius) and landing kinematics and kinetics of the hip, knee and ankle joint were recorded. Furthermore ratings of perceived exertion (RPE) were administered to measure fatigability. ANOVA analyses were conducted to investigate fatigue effects on landing patterns. Correlation analyses assessed the relationship between fatigability (post-fatigue RPE) and landing patterns.

Results

The ANOVA analyses did not show any overall post-fatigue alterations in landing patterns. However, correlation analyses showed an association between fatigability and landing patterns. Athletes who had higher RPE scores showed smaller post-fatigue knee flexion angles and smaller pre- and post-fatigue knee abduction angles across different landing tasks.

Conclusion

The fixed demand protocol did not cause overall alterations in landing patterns. When fatigability was taken into account, high fatigability was related with less optimal landing patterns.

High-Frequency Stimulation on Skeletal Muscle Maintenance in Female Cachectic Mice

Sato, Shuichi; Gao, Song; Puppa, Melissa J.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 30, 2019

Abstract:

Cancer cachexia, unintentional body weight loss due to cancer, affects patients' survival, quality of life, and the response to chemotherapy. While exercise training is a promising intervention to prevent and treat cancer cachexia, our mechanistic understanding of cachexia's effect on contraction-induced muscle adaptation has been limited to the examination of male mice. Since sex can impact muscle regeneration and the response to contraction in humans and mice, the impact of cachexia on the female response to eccentric contraction warrants further investigation.

Purpose

The purpose of this study was to determine if high frequency electric stimulation (HFES) could attenuate muscle mass loss during the progression of cancer cachexia in female tumor bearing mice.

Methods

16~18-week female wild-type (WT) and ApcMin/+ (Min) mice performed either repeated bouts or a single bout of HFES (10 sets of 6 repetitions, ~ 22 minutes), which eccentrically contracts the Tibialis Anterior (TA) muscle. TA myofiber size, oxidative capacity, anabolic signaling and catabolic signaling were examined.

Results

Min had reduced TA muscle mass and IIa and IIb fiber size compared to WT. HFES increased muscle weight and the mean cross-sectional area of type IIa and IIb fibers in WT and Min mice. HFES increased mTOR signaling, myofibrillar protein synthesis, and attenuated cachexia-induced AMPK activity. HFES attenuated the cachexia-associated decrease in skeletal muscle oxidative capacity.

Conclusion

HFES in female mice can activate muscle protein synthesis through mTOR signaling and repeated bouts of contraction can attenuate cancer-induced muscle mass loss.

Obesity Prevalence and Musculoskeletal Injury History in Probation Officers

Mota, Jacob A.; Kerr, Zachary Y.; Gerstner, Gena R.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 28, 2019

Abstract:
PURPOSE

The purpose of the present investigation was to identify 1) the prevalence of overweight and obesity and 2) factors associated with previous work-related musculoskeletal injury, and physical activity levels in North Carolina probation officers.

METHODS

North Carolina probation officers (n=1,866) were sent a questionnaire on demographics, work history, injury history, and physical activity. A multivariable logistic regression model estimated the odds of reporting work-related musculoskeletal injury history within the past year, and multivariable ordinal logistic regression estimated the odds of reporting lower physical activity levels in the previous month. Odds ratios (OR) with 95% confidence intervals (CI) excluding 1.00 were deemed significant.

RESULTS

Complete data were available for 1,323 probation officers (70.9% completion rate; 46.5% female; mean±SD age=39.9±10.0 years). 80.8% of officers were classified as overweight and obese (body mass index [BMI]≥25kg/m 2 ), with 49.9% and 9.5% categorized as obese (BMI≥30kg/m 2 ) and severely obese (BMI≥40kg/m 2 ), respectively. Being older (1-year increase; OR=1.06; 95% CI=1.04-1.09) and severely obese (compared to normally weighted; OR=2.56; 95% CI=1.19–5.51) was associated with a greater odds of sustaining a work-related musculoskeletal injury in the past year. A higher number of years of employment (one-year increase; OR=1.03; 95% CI=1.01–1.04), being overweight or obese (compared to normal weight; OR=1.57–3.22) and being female (compared to male; OR=0.38; 95% CI=0.31–0.47) was associated with greater odds of lower physical activity levels in the previous month.

CONCLUSION

The prevalence of obesity is alarmingly high in probation officers, and is associated with a greater likelihood of sustaining previous work-related musculoskeletal injury and engaging in lower amounts of PA. Public safety administrators may consider worksite exercise/diet interventions and annual physical employment standards to combat obesity.

Cardiopulmonary Profile of Individuals with Intellectual Disability

Boonman, Anne J. N.; Schroeder, Elizabeth C.; Hopman, Maria T. E.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 28, 2019

Abstract:
Introduction

Individuals with intellectual disabilities (ID) are often sedentary and have low fitness levels. Current knowledge supports the existence of physiological barriers resulting in low fitness and exercise intolerance in individuals with Down syndrome (DS), which might be applicable to other ID etiologies. If physiological barriers exist in ID, this would require adaptation of the physical activity guidelines.

Purpose

The aim of this study was to assess differences in cardiopulmonary profiles, including maximal oxygen uptake, during a cardiopulmonary exercise test (CPET) in individuals with ID without DS and healthy controls.

Methods

Participants performed an incremental CPET on a treadmill until exhaustion. Outcomes were HRpeak, absolute VO 2 peak, relative VO 2 peak, VEpeak, VCO 2 peak, OUES, VE/VCO 2 slope, absolute O 2pulse, relative O 2 pulse, difference from predicted HRpeak, heart rate reserve, RERpeak, ventilatory threshold (VT) and VT as percentage of VO 2 peak. Differences between groups were analyzed with Student's T-tests and multiple linear regression after adjusting for potential confounders (sex, age, BMI, activity level).

Results

Individuals with ID had worse outcomes on all of the cardiopulmonary outcomes, except for VT expressed as percentage of VO 2 peak and VE/VCO 2 slope (p<0.05). Having ID was an independent predictor of reduced physiologic function during exercise (p<0.05).

Conclusion

These results demonstrate that individuals with ID present exercise intolerance potentially related to lower peak heart rates, impairments in ventilatory function and these results also suggest the possibility of peripheral muscle hypoperfusion. Existing physical activity guidelines likely underestimate the actual intensity of activity performed by individuals with ID and need to be adapted.

Physiological Responses of Male and Female Race Car Drivers during Competition

Ferguson, David P.; Barthel, Samuel C.; Pruett, Montana L.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: April 04, 2019

Abstract:

Automobile racing is one of the largest spectator sports in the world with male and female drivers competing together. Popular media has speculated on the relative capabilities of males and females in automobile racing, yet there are no scientific investigations examining physiological responses to racing among males and females.

PURPOSE

(1) To evaluate the physiological responses of male and female drivers in open and closed cockpit race cars; (2) to examine the moderating influence of menstrual cycle phase on physiological responses to racing among female drivers.

METHODS

Heart rate, breathing rate, skin temperature, core temperature and physiological strain index (PSI) were measured using the Equivital Life Monitor in male (n=6) and female (n=6) drivers at three races in open or closed cockpit cars. Among females, menstrual cycle phase for each race was recorded.

RESULTS

During racing conditions there was no difference (P>0.05) between male and female drivers for heart rate, skin temperature, core temperature, or PSI. The female drivers had a higher (P<0.001) breathing rate compared to the male drivers. Compared to the follicular phase, the luteal phase had an increased (P<0.001) heart rate, breathing rate, skin temperature, core temperature, and PSI. The closed cockpit cars elicited (P<0.001) a higher skin temperature, core temperature and physiological strain index as compared to the open cockpit cars.

CONCLUSIONS

There was no differences in the physiological responses to automobile racing between male and female drivers. The luteal phase elicited higher physiological responses than the follicular phase, but was not different from the male drivers. Thereby, practitioners should focus on reducing stresses induced by a closed cockpit race car as opposed to the menstrual cycle.

Physiological Evaluation for Endurance Exercise Prescription in Sickle Cell Disease

Messonnier, Laurent A.; Gellen, Barnabas; Lacroix, Roxane; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 25, 2019

Abstract:
Purpose

While strenuous exercise may expose sickle cell disease (SCD) patients to risks of vaso-occlusive crisis (VOC), evidence suggests that regular endurance exercise may be beneficial. To test i) the safety and usefulness of a submaximal incremental exercise in evaluating physical ability of SCD patients and identify a marker for the management of endurance exercise, and ii) the feasibility of endurance exercise sessions in SCD patients.

Methods

Twenty adults with sickle cell disease (12 men and 8 women) performed a submaximal incremental exercise stopped as soon as blood lactate concentration ([lactate] b ) reached ≥ 4 mmol . L -1 and used to determine the first lactate threshold (LT1). Fifteen of those patients (8 men and 7 women) also performed three 30-min endurance exercise sessions at ~2.5 mmol . L -1 of [lactate] b on separate occasions.

Results

LT1 occurred at 47 ± 3 and 33 ± 3 W for men and women, respectively, demonstrating the extreme deconditioning and thus low physical ability of adult SCD patients. Most of the physiological parameters associated with LT1 correlated with hemoglobin concentration. During endurance exercise, peripheral oxygen saturation and [lactate] b most often remained stable and within acceptable ranges.

Conclusions

The proposed strategy of submaximal incremental exercise allowed safe determination of LT1, an important parameter of patients' physical ability. The study also demonstrated the feasibility and safety of individually-tailored endurance exercises at ~2.5 mmol . L -1 of [lactate] b . These latter results suggest that endurance training programs may be considered for adult SCD patients and that the method proposed here may be helpful in that regard.

Impact of Eccentric or Concentric Training on Body Composition and Energy Expenditure

Touron, Julianne; Perrault, Hélène; Julian, Valérie; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 25, 2019

Abstract:
Purpose

To compare the effects of 8-week eccentric (ECC) versus concentric (CON) training using downhill and uphill running in rats on whole body composition, bone mineral density (BMD), and energy expenditure (EE).

Methods

Animals were randomly assigned to one of the following groups: 1) control (CTRL), 2) +15% uphill-running slope (CON), 3) –15% downhill-running slope (ECC15) and 4) –30% downhill-running slope (ECC30). Those programs enabled to achieve conditions of iso-power output for CON and ECC15 and of iso-oxygen uptake (VO 2 ) for CON and ECC30. Trained rats ran 45min at 15 m⋅min -1 five times per week. Total (TBM), fat (FBM) and lean (LBM) body mass measured through EchoMRI™, and 24-hour EE including basal metabolic rate (BMR) assessed using PhenoMaster/LabMaster™ cage system were obtained before and after training. At sacrifice, the right femur was collected for bone parameters analysis.

Results

While TBM increased in all groups over the 8-week period, almost no change occurred for FBM in exercised groups (CON: -4.8±6.18 g; ECC15: 0.6±3.32 g; ECC30: 2.6±6.01 g). The gain in LBM was mainly seen for ECC15 (88.9±6.85 g) and ECC30 (101.6±11.07 g). ECC was also seen to positively affect BMD. An increase in BMR from baseline was seen in exercise groups (CON: 13.9±4.13 kJ·day -1 ; ECC15: 11.6±5.10 kJ·day -1 ; ECC30: 18.3±4.33 kJ·day -1 ) but not in CTRL one. This difference disappeared when BMR was normalized for LBM.

Conclusions

Results indicate that for iso-VO 2 training, the impact on LBM and BMD is enhanced with ECC as compared to CON, and that for iso-power but lower VO 2 ECC, an important stimulus for adaptation is still observed. This provides further insights for the use of ECC in populations with cardiorespiratory exercise limitations.

Weight Training and Risk of 10 Common Types of Cancer

Mazzilli, Kaitlyn M.; Matthews, Charles E.; Salerno, Elizabeth A.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 25, 2019

Abstract:
Introduction

Ample data support that leisure time aerobic moderate to vigorous physical activity (MVPA) is associated with lower risk of at least seven types of cancer. However, the link between muscle-strengthening activities and cancer etiology is not well-understood. Our objective was to determine the association of weight lifting with incidence of 10 common cancer types.

Methods

We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for association of weight lifting with incidence of 10 cancer types in the NIH-AARP Diet and Health Study follow-up. Weight lifting was modeled continuously and categorically. Dose-response relationships were evaluated using cubic restricted spline models. We explored whether associations varied by subgroups defined by sex, age, and body mass index (BMI) using the Wald test for homogeneity. We examined joint categories of MVPA and weight lifting in relation to cancer risk for significant associations.

Results

After adjusting for all covariates including MVPA, we observed a statistically significant lower risk of colon cancer (P trend =0.003) in individuals who weight lifted; the HR and 95% CI associated with low and high weight lifting as compared with no weight lifting were 0.75(CI:0.66,0.87) and 0.78(CI:0.61,0.98) respectively. This relationship differed between men and women (HR men =0.91 ;CI:0.84, 0.98; HR women=1.00; CI:0.93, 1.08) (P interaction =0.008). A lower risk of kidney cancer among weight lifters was observed but became non-significant after adjusting for MVPA (P trend =0.06); resulting in a HR of 0.94 (CI:0.78,1.12) for low weight lifting and 0.80 (CI:0.59,1.11) for high weight lifting.

Conclusion

Participants who engaged in weight lifting had a significantly lower risk of colon cancer and a trend towards a lower risk of kidney cancer than participants who did not weight lift. Keywords

Resistance, strengthening, epidemiology, physical activity, colon

Blood Flow–restricted Exercise Does Not Induce a Cross-transfer of Effect: An RCT

Ampomah, Kwasi; Amano, Shinichi; Wages, Nathan P.; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 19, 2019

Abstract:
Purpose

The goal of this trial was to determine whether low-load blood flow restricted (BFR) exercise of appendicular muscles induces a cross-transfer of effect to the trunk extensor (TE) muscles, such that low-load TE exercise would enhance TE size and function to a greater extent than standard low-load exercise in people with recurrent low back pain (LBP). We also investigated the direct effects of BFR exercise in the appendicular muscles.

Methods

32 adults with recurrent, non-specific LBP were randomized into two groups: Appendicular BFR Exercise (BFR Exercise) or Control Exercise (CON Exercise). All participants trained (2x/week) for 10-weeks, with a 12-week follow-up. Participants performed three sets of leg extension (LE), plantar flexion (PF), and elbow flexion (EF) exercises followed by low-load TE exercise without BFR. Outcome measures included MRI-derived muscle size (quadriceps and TE), strength (LE, PF, EF, and TE), and endurance (LE and TE).

Results

There was no evidence for a cross-transfer of effect to the trunk extensors. There was also no statistically significant enhancement of limb skeletal muscle size or function of BFR relative to CON Exercise at any time point; though, moderate effect sizes for BFR exercise were observed for enhanced muscle size and strength in the leg extensors.

Conclusions

Low-load BFR exercise of the appendicular muscles did not result in a cross-transfer of effect to the TE musculature. There was also no significant benefit of low-load BFR exercise on the appendicular muscle size and function, suggesting no benefit from low-load BFR exercise in adults with recurrent, non-specific LBP.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Beep Test Performance Is Influenced by 30 Minutes of Cognitive Work

MacMahon, Clare; Hawkins, Zackary; Schücker, Linda

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 19, 2019

Abstract:
Purpose

This study explored conflicting findings in the literature on the influence of perceived cognitive fatigue on physical performance by testing the effect of the Stroop task (high cognitive load) on an intermittent running test (beep test).

Methods

In a within-subjects repeated measures experiment, 13 active athletes performed the beep test on two occasions, in a randomized, counterbalanced order. In each session a preceding cognitive task was completed for 30 minutes, with the incongruent Stroop task in the high load condition, and the congruent Stroop task in the low load condition. Perceived cognitive fatigue was measured before testing (baseline) and at 10, 20, and 30 minutes of the cognitive load manipulation. Perceived effort on the cognitive task and general motivation for the physical task (beep test) were measured prior to the beep test, and motivation-related perception of the beep test and ratings of perceived exertion were measured after completion of the test. Heart rate and beep test performance (completion stage and time) were also recorded.

Results

The incongruent Stroop task was perceived as more fatiguing and effortful. Participants also withdrew from the beep test significantly earlier in the high load condition ( M = 8:48 min, SD = 2:32 min) compared to the low load condition ( M = 9:20 min, SD = 2:28 min), F (1,11) = 21.76, p < .01, ŋ 2 = .67. There were no differences in heart rate or general motivation between the two conditions.

Conclusions

Whereas previous research shows that active athletes can maintain performance on the beep test after 10 minutes of the incongruent Stroop task, this study shows that performance is impaired after thirty minutes. Variables in need of exploration in future investigations include experience with both the physical and cognitive task.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Effect of Creatine Supplementation on the Airways of Youth Elite Soccer Players

Simpson, Andrew J.; Horne, Sara; Sharp, Peter; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 19, 2019

Abstract:

Introduction

Owing to its well-established ergogenic potential, creatine is a highly popular food supplement in sports. As an oral supplement, creatine is considered safe and ethical. However, no data exist on the safety of creatine on lung function in athletes. The aim of this project was to evaluate the effects of a standard course of creatine on the airways of youth elite athletes.

Methods

Nineteen elite soccer players, aged 16-21yr, completed a stratified, randomized, double-blind, placebo-controlled, parallel-group trial. The creatine group ( n =9) ingested 0.3 g/kg/d of creatine monohydrate (CM) for 1wk (loading phase) and 5 g/d for 7wk (maintenance phase), and the placebo group ( n =10) received the same dosages of maltodextrin. Airway inflammation (assessed by exhaled nitric oxide, F ENO) and airway responsiveness (to dry air hyperpnoea) were measured pre- and post-supplementation.

Results

Mild, unfavorable changes in F E NO were noticed by trend over the supplementation period in the CM group only ( P =0.056 for interaction, η 2 =0.199), with a mean group change of 9 ± 13 ppb in the CM group versus -5 ± 16 ppb in the placebo group ( P =0.056, d =0.695). Further, the maximum fall in forced expiratory volume in 1 sec (FEV 1 ) after dry air hyperpnoea was larger by trend post-supplementation in the CM group compared to the placebo group: 9.7 ± 7.5% versus 4.4 ± 1.4%, respectively ( P =0.070, d =0.975). These adverse effects were more pronounced when atopic players only ( n =15) were considered.

Conclusion

Based on the observed trends and medium-to-large effect sizes, we cannot exclude that creatine supplementation has an adverse effect on the airways of elite athletes, particularly in those with allergic sensitization. Further safety profiling of the ergogenic food supplement is warranted.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Microparticle Responses to Aerobic Exercise and Meal Consumption in Healthy Men

Highton, Patrick J.; Goltz, Fernanda R.; Martin, Naomi; More

Medicine & Science in Sports & Exercise. ., Post Acceptance: March 19, 2019

Abstract:
Purpose

Microparticles (MPs) are shed extracellular vesicles that express the pro-thrombotic tissue factor (TF). Aerobic exercise may reduce MP count and TF expression. This study investigated the impact of acute running or rest followed by standardised meal consumption on MP phenotypes and TF expression.

Methods

15 males (age: 22.9 ± 3.3 years; body mass: 81.9 ± 11.4 kg; V[Combining Dot Above]O 2 max 54.9 ± 6.5 mL·kg·min -1 ; mean ± SD) completed 1h of running (70% V[Combining Dot Above]O 2 max) or rest at 9am, and consumed a standardised meal (1170 kcal, 43% CHO, 17% PRO, 40% fat) at 10:45am. Venous blood samples were taken at 9am, 10am and 11:30am. MP concentration, diameter, phenotypes and TF-expression were assessed using nanoparticle tracking analysis (NTA) and flow cytometry.

Results

NTA identified no changes in MP concentration or diameter in response to time or trial. Flow cytometry revealed total MP count increased from 9am to 10am (1.62 ± 2.28 to 1.74 ± 2.61 x10 10 /L, p = .016, effect size (η 2 ) = .105), but was unaffected by trial. TF + platelet-derived MP % reduced from 9am to 10am (44.0 ± 21.2 to 21.5 ± 9.3%, p = .001, η 2 = .582) after exercise only (control: 36.8 ± 18.2 to 34.9 ± 11.9%, p = .972). TF + neutrophil-derived MP % reduced from 9am to 11:30am (42.3 ± 17.2 to 25.1 ± 14.9%, p = 0.048, η 2 = .801) in the exercise trial only (control: 28.5 ± 15.7 to 32.2 ± 9.6%, p = .508).

Conclusion

Running induced a significant reduction in %TF + platelet and neutrophil MP, suggesting a transient reduction in cardiovascular risk via reduced TF-stimulated thrombosis. This requires further investigation over longer time periods in cardiovascular disease populations.

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Prosthodontics

Visual analog scale in prosthodontics
N Gopi Chander

The Journal of Indian Prosthodontic Society 2019 19(2):99-100



The effect of incorporating various reinforcement materials on flexural strength and impact strength of polymethylmethacrylate: A meta-analysis
Manali Vipul Somani, Meenakshi Khandelwal, Vikas Punia, Vivek Sharma

The Journal of Indian Prosthodontic Society 2019 19(2):101-112

Polymethylmethacrylate (PMMA) is a widely used denture base material with a major drawback of inferior mechanical properties. In the existing published reports, most studies indicate the superiority of the incorporation of various reinforcement materials in PMMA in terms of the flexural strength (FS) and impact strength (IS), whereas none shows the compilation and comparison of all. The present meta-analysis aims at synthesizing all the available data. The purpose of this study was to systematically review the existing reports to compare and evaluate the effect of various reinforcement materials on FS and IS of heat-cured acrylic resin (PMMA) by combining the available evidence in a meta-analysis. A search strategy was adopted using PubMed, ScienceDirect, Ebscohost, Google Scholar, and Cochrane Central Register of Controlled Trials in February 2018 to screen research studies. These studies were screened against predetermined criteria for eligibility for meta-analysis. In the present meta-analysis, twenty articles were included. Out of 15 data available on reinforcement, 14 showed better results for IS of reinforced PMMA resin as compared to their respective control group. Out of the 25 available data, 11 showed better results for FS of reinforced PMMA resin when compared to their respective control group. The homogeneity test of meta-analysis confirmed acceptable heterogeneity among 15 reinforcement techniques of IS (i2 &#61; 95.8&#37;) and 25 reinforcement techniques of FS (i2 &#61; 96.2&#37;). A random-effects model and fixed-effects model were used for analysis. The present meta-analysis showed that reinforcement of PMMA can significantly increase FS and IS. Hence, it can be incorporated in clinical practice. 


Comparative evaluation of condylar inclination in dentulous subjects as determined by two radiographic methods: Orthopantomograph and cone-beam computed tomography – An in vivo study
Dipal Mawani, Byrasandra Channappa Muddugangadhar, Arindam Das, Arindam Mukhopadhyay

The Journal of Indian Prosthodontic Society 2019 19(2):113-119

Aim: The aim of the study was to compare two radiographic techniques, orthopantomograph (OPG), and cone-beam computed tomography (CBCT) in determining the sagittal condylar guidance (SCG) and to find out if CBCT can serve as an alternative aid to program semi-adjustable and fully adjustable articulators. Materials and Methods: Following the inclusion and exclusion criteria, 40 individuals (20 males and 20 females) aged between 20 and 40 years were selected. An OPG and a CBCT radiograph were obtained for each individual. Using appropriate software, the SCG was measured for both the sides, for both the radiographic methods. The values for each individual were obtained by two investigators for both the methods using the respective software and the average value was taken. After performing the Shapiro&#8211;Wilk test, paired t-test was used to compare the mean difference pairwise (for both right and left side) while t-test was used to compare the mean difference between two groups. Results: Results showed that the right and left SCG values obtained from both, OPG and CBCT methods were comparable and there were no significant differences. Statistically significant difference was not found between the left and ride side condylar inclination values for both the sex obtained from both the methods. With increasing age, condylar inclination values obtained from both the radiographic methods tend to decrease. The values for SCG obtained from both the methods (CBCT and OPG) are thus comparable and correlated. Conclusion: The values for SCG obtained from both the methods (CBCT and OPG) are comparable and correlated. Thus, CBCT being a better radiographic technique can be used for obtaining the condylar inclination for programming the semi-adjustable and fully adjustable dental articulators. 


The role of the combination of Moringa oleifera leaf extract and demineralized freeze-dried bovine bone xenograft (xenograft) as tooth extraction socket preservation materials on osteocalcin and transforming growth factor-beta 1 expressions in alveolar bone of Cavia cobaya
Utari Kresnoadi, Primanda Nur Rahmania, Hera Utami Caesar, Eha Djulaeha, Bambang Agustono, Muhammad Dimas Aditya Ari

The Journal of Indian Prosthodontic Society 2019 19(2):120-125

Aim: Alveolar bone resorption, often occurring after tooth extraction, can be minimized through socket preservation. This process uses a combination of Moringa leaf extract and demineralized freeze-dried bovine bone xenograft (DFDBBX) that is expected to generate both transforming growth factor-beta 1 (TGF-&#946;1) expressions as a transcription factor associated with osteoblast differentiation and osteocalcin accelerating alveolar bone formation. This research aimed to analyze the role of the combination of Moringa leaf extract and DFDBBX induced in socket preservation when generating TGF-&#946;1 and osteocalcin expressions. Materials and Methods: The left mandibular incisors of 56 Cavia cobaya were extracted and divided into four groups subjected to different socket preservation treatments. The first group treated with polyethylene glycol, the second group with DFDBBX, the third group with Moringa leaf extract, and the fourth group with a combination of DFDBBX and Moringa leaf extract. The C. cobaya were examined on days 7 and 30, after which the specimens were sacrificed and examined using an immunohistochemical technique. The resulting data were then analyzed using one-way ANOVA and Tukey&#39;s honestly significant difference tests. Results: There was a significant difference in TGF-&#946;1 and osteocalcin expressions between the groups (P &#60; 0.05). The highest mean amount of TGF-&#946;1 and osteocalcin was found in the fourth group on both days 7 and 30. Conclusions: The combination of Moringa leaf extract and DFDBBX can effectively generate TGF-&#946;1 and osteocalcin expressions during the preservation of tooth extraction sockets. 


Evaluation of the effect of silicone residue after different surface treatments on shear bond strength of glass ionomer cement to the dentin surface
R Anusha, M C Suresh Sajjan, A V Rama Raju, D Bheemalingeswararao, Nukalamarri Om Brahma Prasad Chary

The Journal of Indian Prosthodontic Society 2019 19(2):126-133

Aim: Use of silicone fit-checking material during cementation of fixed restoration has shown to leave residual silicone film after peeling off of fit checker (FC). This residual film reduced bond strength of cement to the inner surface of restoration. Silicone residue effect on tooth surface needs to be studied. The aim of this study was to evaluate the effect of residual silicone film on shear bond strength (SBS) of glass ionomer cement (GIC) to dentin surface and the efficacy of different surface treatments (STs) on dentin in the removal of silicone residue. Materials and Methods: Fifty freshly extracted human molars were individually mounted on acrylic blocks and occlusal surfaces were ground flat until dentine surface was exposed. Specimens were divided into five groups as follows: Group I: without application of FC (n &#61; 10) as control group; Group II: without any ST after peeling off FC (n &#61; 10); Group III: ST using wet pumice after peeling off FC (n &#61; 10); Group IV: ST with 37&#37; phosphoric acid after peeling off FC (n &#61; 10); and Group V: ST with 10&#37; polyacrylic acid after peeling off FC (n &#61; 10). GIC was placed on the dentinal surface using polyvinyl mold and subjected to SBS test using universal testing machine. The debonded specimens were observed under stereomicroscope for the mode of failure. Selected debonded dentinal surfaces from each group were examined under scanning electron microscope. One-way analysis of variance and Tukey&#39;s test. Results: Group II (1.083 MPa) showed significantly lower SBS. Among the STs, Group III (2.047 MPa) was comparable to the control group whereas Group IV (1.376 MPa) and Group V (1.63 MPa) were significantly lower. There was no significant association between failures and groups at P &#61; 0.257. Conclusion: The residue of silicone was demonstrable on dentin surface after peeling off FC and caused a significant reduction in SBS between GIC and dentin. ST with wet pumice is found to be beneficial in removing silicone residue and improving SBS, followed by phosphoric acid and polyacrylic acid. 


The effect of a zirconia primer on the shear bond strength of Y-TZP ceramic to three different core materials by using a self-adhesive resin cement
Rashin Giti, Reza Zarkari

The Journal of Indian Prosthodontic Society 2019 19(2):134-140

Aim: Considering the importance of bond strength of zirconia ceramic to different core materials, this study aimed to evaluate the effect of a new zirconia primer, a mixture of organophosphate and carboxylic acid monomers, on the bond strength of zirconia to three core materials cemented with a self-adhesive resin cement. Materials and Methods: The study was done on 36 disk-shaped zirconia specimens in the case (receiving new zirconia primer) and control groups (n &#61; 18) and three core material subgroups (n &#61; 6) (amalgam, nickel&#8211;chromium [Ni-Cr], and composite resin). A self-adhesive resin-based luting agent bonded the two parts together. The shear bond strength was tested and the facture modes were determined. Two-way ANOVA and Tukey&#39;s honestly significant difference tests were used for data analyses (&#945; &#61; 0.05). Results: Zirconia primer could not significantly increase the bond strength of zirconia ceramic to different core materials (P &#61; 0.754). Composite resin and amalgam cores showed significantly higher bond strength than Ni-Cr core (P &#61; 0.001). On using zirconia primer, 100&#37; of failures of composite resin cores were cohesive inside the core material, 75&#37; in amalgam core and 100&#37; in Ni-Cr core were adhesive. Conclusions: The use of new zirconia primer based on organophosphate/carboxylic acid monomers could not enhance the bond strength of zirconia ceramic to different core materials. The bond strength of zirconia to amalgam and composite resin cores was higher than that to Ni-Cr core material. 


Evaluation of the effect of dentin surface treatment by air abrasion and Er:YAG laser on the retention of metal crowns luted with glass ionomer cement in teeth with reduced crown height: An in vitro study
Sameer Chauhan, Neerja Mahajan, Rajesh Sethuraman, YG Naveen

The Journal of Indian Prosthodontic Society 2019 19(2):141-148

Aim and Objectives: The purpose of this study was to investigate the effect of dentin surface treatment with aluminum oxide air abrasion and Er:YAG laser on tensile bond strength of metal crowns. Metal crowns were luted with conventional glass ionomer cement (GIC) in the teeth with reduced crown height, where preparation geometry did not provide optimal retention form. Materials and Methods: Forty-eight human premolars were prepared to receive metal crowns and were randomly divided into four groups for tensile bond strength testing. Group A: Untreated dentin luted with self-adhesive composite resin cement as positive control; Group B: Untreated dentin luted with GIC as negative control; Group C: Surface treatment with 50 &#956;m aluminum oxide air abrasion and luted with GIC; Group D: Surface treatment with Er:YAG laser (&#955; &#61;2.94 mm) with a total energy 84.88 J/cm2 of (60 mJ/pulse, 10 Hz, 60 pulses, and 100 &#956;s pulse width) and luted with GIC. The cemented specimens were thermocycled and later subjected to axial load in a universal testing machine at 0.5 mm/min cross-head speed for tensile testing. Scanning electron microscopic evaluation of dentin surface treatment and cement&#8211;dentin interface was also done in representative specimens. Results: One-way analysis of variance showed statistically significant difference among/within the groups (P &#60; 0.001). Tukey&#39;s post hoc test presented significant increased tensile bond strength of Er:YAG laser group. Air abrasion group showed no significant increase in tensile bond strength values (P &#61; 0.033). Conclusion: Dentin surface treatment with Er:YAG laser significantly improved the tensile bond strength of luting GIC compared to air-abraded and untreated dentin. 


Evaluation of the effect of implant angulations and impression techniques on implant cast accuracy – An in vitro study
Aman Arora, Viram Upadhyaya, Kirti R Parashar, Divya Malik

The Journal of Indian Prosthodontic Society 2019 19(2):149-158

Aim: The purpose of this study was to evaluate the accuracy of implant casts generated with splinted and nonsplinted impression techniques with multiple parallel and nonparallel implants. Materials and Methods: In this experimental study, two edentulous maxillary stainless steel models with seven implant analogs in the central incisor, canine, premolar, and first molar region simulating clinical condition were used (control groups). In one master model, implant analogs were placed parallel to each other, whereas in another model, analogs were placed with a tilt-to-longitudinal axis. Forty stone casts were made from each model using splined and nonsplinted technique using polyether with open-tray technique. Then, the difference in the distance between the master cast and experimental cast in three dimensions was measured by coordinate-measuring machine. One-way ANOVA, post hoc Bonferroni test, and unpaired t-test were used for data analysis. Results: Statistical comparisons were made using ANOVA test, post hoc test, and unpaired t-test. Splinted technique with parallel implants generated interimplant distance values closest to the master model, followed by nonsplinted technique with parallel implants, splinted technique with angulated implants, and nonsplinted technique with angulated implants. Conclusions: Splinted impression technique exhibited higher accuracy than the other technique studies in both parallel and angulated implants. 


Validity and reliability of intraoral conventional tracer and intraoral digital tracer in different positions for recording horizontal jaw relation in edentulous patients
Nikhil Bharat Abbad, Rajeev Srivastava, Vivek Choukse, Vandana Sharma

The Journal of Indian Prosthodontic Society 2019 19(2):159-165

Aim: The purpose of the study is to evaluate and compare the horizontal mandibular positions recorded between intraoral conventional tracer and intraoral digital tracer in upright and supine position. Materials and Methods: Twenty-four edentulous patients with well-formed ridge and adequate interarch distance space were selected. MATLAB software was assimilated with intraoral digital tracer and was utilized in the study for recording the horizontal movements of the mandible, i.e., gothic arch tracing by intraoral digital tracer and was observed on a laptop with the help of MATLAB Software. For each subject, multiple mandibular readings were recorded and analyzed through software, and similar readings were recorded with conventional intraoral tracers. The comparison between intraoral conventional tracer and intraoral digital tracer was done to assess the reliability. Moreover, the consistency of recording horizontal mandibular position was also compared between upright and supine position. Results: The data were procured and utilized in comparison for different positions revealed statistically significant difference by using Student&#39;s Paired t-test. The test resulted in supine position better compared to upright position (P &#61; 0.0001). The association between supine position with upright position was calculated using Fischer&#39;s exact test, and it was also found to be statistically significant (P &#61; 0.002). The Pearson&#39;s Correlation analysis was performed to check the agreement between upright and supine position and very weak downhill correlation (r2&#61; &#8722;0.130) was observed between the two variables. Conclusion: On evaluation and comparison of horizontal mandibular position, it was found that the intraoral digital tracing technique is more valid compared to conventional intraoral tracer technique. It was also observed that the consistency of reproducibility in recording horizontal mandibular position in supine position is significantly higher than upright position. 


An in vitro study to compare the influence of newer luting cements on retention of cement-retained implant-supported prosthesis
Hasan Sarfaraz, Arifa Hassan, K Kamalakanth Shenoy, Mallika Shetty

The Journal of Indian Prosthodontic Society 2019 19(2):166-172

Purpose: The study was conducted to evaluate the retentiveness of specifically formulated implant cements and compare its retentiveness with a commonly used noneugenol zinc oxide luting cement and also to assess the influence of abutment height on the retentiveness of these cements. Materials and Methods: A master stainless steel mold was used to mount snappy abutment-implant analog complex in acrylic resin. A total of six snappy abutments (Nobel Biocare&#174;) of 4 mm and 5.5 mm height with their analogs were used. A total of 66 ceramill&#174; Sintron metal copings fabricated using computer-aided design/computer-aided manufacturing system and divided into six groups (n &#61; 11) according to the height (three 4 mm abutment and three 5.5 mm abutment). The cements that were compared were a Noneugenol zinc oxide provisional cement (Temp-BondTM NE), a Noneugenol temporary resin cement (Premier&#174; Implant Cement) and a resin based acrylic urethane cement (Implalute&#174; Implant Cement). After cementation samples were immersed in artificial saliva for 7 days and subjected to a pull-out test using a universal testing machine at a crosshead speed of 1 mm/min. The load required to de-cement each coping was recorded and analyzed using one-way ANOVA, post hoc multiple comparison, and independent t-test. Results: Noneugenol temporary resin cement had the highest tensile strength followed by noneugenol zinc oxide cement and the least retentive strength was observed in resin-based acrylic urethane cement. Conclusion: The results suggest that noneugenol temporary resin cement may be considered as a better choice for cementation of implant prosthesis, as it has shown to have better mechanical properties. 


Clinical Practice

Do genetic polymorphisms affect susceptibility to periodontal disease? A literature review
VE Toy, MO Uslu

Nigerian Journal of Clinical Practice 2019 22(4):445-453

The pathogenesis of periodontal disease is not solely based on microbial dental plaque but is the result of the multifactorial and complex interaction between infection and host response. Many studies in the literature have demonstrated the differences between individuals in terms of host immune response and the presence of genetic components in numerous pathological conditions. Therefore, periodontitis may be defined as a complex genetic disorder with a phenotype formed by the genetic structure and environmental factors in the affected individual. So, determination of the genetic susceptibility profile associated with periodontitis might be very precious for developing novel diagnostic techniques and individual treatment strategies. To clarify the possible role of genetic polymorphisms in periodontal diseases, we searched PubMed for studies published on the subject since 1997 up to June 2018 and obtained data from original studies, meta analyzes, and systematic reviews. We included only case&#8211;control studies with large study populations. 


Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia
BU Eze, TU Mbaeri, KC Oranusi, JA Abiahu, AM Nwofor, JC Orakwe, OO Mbonu

Nigerian Journal of Clinical Practice 2019 22(4):454-459

Background: Intravesical prostatic protrusion (IPP) is a noninvasive test that can predict bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). Objective: The objective of this study was to determinethe correlation between IPP and International Prostate Symptom Score (IPSS) in patients with BPH. Patients and Methods: A cross-sectional prospective study of new patients with symptomatic BPH who presented to the urology clinics of NAUTH, Nnewi. Ethical approval and informed consent were obtained. Participants had abdominal ultrasonography measurements of IPP from midline sagittal image of the prostate (at bladder volume &#8805;100 mL) using Prosound SSD3500 with abdominal probe frequency of 3.5 MHz. IPP was divided into three grades (grade I: 0&#8211;4.9mm, grade II: 5.0&#8211;9.9 mm, and grade III: &#8805;10.0 mm). Data were analyzed using SPSS version 20. The data were subjected to analysis of variance, and Pearson&#39;s correlation was used to assess correlation where necessary. P value &#60; 0.05 was considered significant. Results: In all, 101 men with a mean age of 67.09 &#177; 10.93 years were included in the study. The average IPSS, storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and IPP were 17.05 &#177; 7.62, 7.81 &#177; 5.17, 9.24 &#177; 3.16, 4.75 &#177; 1.59, and 13.50 &#177; 7.47 mm, respectively. There were significant differences between the mean IPSS (P &#61; 0.000), mean IPSS-S (P &#61; 0.000), and mean IPSS-V (P &#61; 0.002) among the three grades of IPP. There were significant positive correlations between IPP and IPSS (P &#61; 0.000), IPSS-S (P &#61; 0.000), IPSS-V (P &#61; 0.000), and IPSS QoL index (P &#61; 0.000). Conclusion: There were significant positive correlations between IPP and IPSS, IPSS-S, IPSS-V, and IPSS QoL index. 


Relationship between self-efficacy and pain control in Iranian women with advanced knee osteoarthritis
N Mirmaroofi, A Ghahramanian, M Behshid, F Jabbarzadeh, TC Onyeka, M Asghari-Jafarabadi, J Ganjpour-Sales

Nigerian Journal of Clinical Practice 2019 22(4):460-468

Objectives: This study aimed to determine the relationship between pain of osteoarthritis (OA) and body mass index (BMI), age, pain control strategy, self-efficacy for pain control, exercise, and functional activities in a cohort of Iranian women. Subjects and Methods: In total, 150 women with advanced knee OA, candidates for arthroplasty in Tabriz, in the Northwest of Iran were enrolled into the study. A convenience sampling method was used, and data was collected using demographic form, short-form McGill pain questionnaire, pain self-efficacy questionnaire, self-efficacy for exercise, and functional activities scales. Results: The present pain intensity of 74.7&#37; of women was described as excruciating with mean (&#177;SD) score 9.58 (&#177;0.77) in the visual analogue scale. The majority of the women had a low self-efficacy for pain, exercise, and functional activities with means of 31.8, 17.28, and 57.63 respectively. There was a significant inverse relationship between sensory and affective components of pain and self-efficacy for pain control and functional activities (P &#60; 0.001). The sensory and affective components of pain was related to age (P &#60; 0.05), pain control self-efficacy (P &#60; 0.01), and BMI (P &#60; 0.05). A great majority of the women (79.33&#37;) used complementary medicine (CM) for pain management. Those who used CM reported lower pain and higher self-efficacy (P &#60; 0.01). Conclusion: The findings of this study suggest that life style modification and pain management education of women with OA and nurses on non-pharmacological interventions as well as integration of these into nursing care is essential. 


Investigation of the reliability of light-curing units in Sivas City, Turkey
D Eren, F Tutkan

Nigerian Journal of Clinical Practice 2019 22(4):469-477

Background: The number of studies investigating the physical properties of light-curing units used in city centers in terms of the light intensity, presence of residues fractures at the tips, how long they have been used, and hardness measurements of the composite resins polymerized by these is limited. There is no such study in Turkey and Sivas province. The objective of this study is to examine the light-curing units used in Sivas city center and determine the reliability of light-curing units by measuring the surface hardness of composite samples polymerized with these devices. Materials and Methods: The power of the light-curing units that used in all private clinics in Sivas city center was measured. Then, the Vickers surface hardness measurements of the composite resin samples polymerized with these devices were made, and they were statistically evaluated. Results: The light intensity was found to be below from the acceptable value of 400 mW/cm2 in 10.7&#37; of the devices. It was observed that with increasing years of usage, the light intensity of light-curing units decreased (P &#60; 0.05). Conclusion: It was observed that as the power of light-curing units increased, the hardness values of the bottom and top surfaces increased significantly. 


Postoperative analgesia after total abdominal hysterectomy: Is the transversus abdominis plane block effective?
ZC Suner, D Kalayci, O Sen, M Kaya, S Unver, G Oguz

Nigerian Journal of Clinical Practice 2019 22(4):478-484

Background: Analgesic protocol is needed following gynecologic surgery to ensure early mobilization, decrease the duration in the post-anesthetic care unit and hospitalization, and provide patient comfort. Transversus abdominis plane (TAP) blocks are used in the treatment of acute postoperative pain after lower abdominal surgery. TAP block may be a better choice of postoperative pain control. In the present study, the efficacy of ultrasound-guided TAP block on pain control and postoperative opioid consumption was evaluated in patients undergoing a total abdominal hysterectomy. Methods: Fifty patients undergoing total abdominal hysterectomy were included in this study. Patients were divided into TAP block (n &#61; 25) and control groups (n &#61; 25). Both groups postoperative patient-controlled analgesia (PCA) was planned during 24 h postoperatively. Patients were assessed 1, 2, 4, 6, 12, 18, and 24 h postoperatively using the Visual Analog Scale (VAS), Ramsey Sedation Score, PCA demand, morphine consumption, first analgesic requirement time, and adverse reactions. Results: When compared with the control group, the time to first analgesic requirement in the TAP block group was significantly lower (P &#60; 0.05). The amount of additional analgesia also differed significantly (P &#60; 0.001). In the TAP group, the VAS was significantly lower at 2, 4, 6, 12, 18, and 24 h postoperatively compared to the control group (P &#60; 0.05). There was no statistically significant difference in adverse reactions. Conclusion: TAP block can effectively treat postoperative pain as part of multimodal analgesia in patients undergoing total abdominal hysterectomy. 


Locked intramedullary nailing using the sign nailing device
IC Nwagbara

Nigerian Journal of Clinical Practice 2019 22(4):485-491

Objective: Locked intramedullary nailing is the treatment of choice not only in diaphyseal fractures of long bone but also in most metaphyseal and periarticular fractures. In this study, we set out to present our experience with the Surgical Implant Generation Network (SIGN)] technique of locked intramedullary nailing in long bones that do not require the use of image intensifier, fracture table, and power reamers. Patients and Methods: This was a hospital-based prospective descriptive study involving 54 consecutive patients seen over a 2-year period. All closed fractures of the femur and tibia/fibula seen within the period under review were included in the study. The patients were followed up for a minimum of 12 months. Fracture union was recorded when there was absence of pain at fracture site and X-ray shows presence of bridging callus in two orthogonal views. Results: Fifty seven fractures in 54 patients were managed in the period of the study. There were 46 [81&#37;] femoral and 11 [19&#37;] tibia/fibula fractures recorded in 47 [87&#37;] males and 7 [13&#37;] females with a male to female ratio of 6.7:1. Majority of the patients were within the 31--40 years age bracket (n &#61; 25, 46&#37;). All the fractures were as a result of motor vehicle accident. Thirty six (78&#37;) of the femoral fractures were operated through the antegrade approach, whereas the rest (22&#37;) were through the retrograde approach. Both proximal and distal locking were achieved in all cases. Fracture union was recorded in all but one case [98&#37;]. Complications were observed in 8 cases, which included 5 cases of superficial infection, one case each of osteomyelitis, delayed union and nonunion. Conclusion: Locked intramedullary nailing using external jigs for screw placement as in the SIGN technique gives a good result and is recommended for use in the developing countries where image intensifiers are not readily available. 


Tibial fractures following participation in recreational football: Incidence and outcome
C Nwosu

Nigerian Journal of Clinical Practice 2019 22(4):492-495

Background: Football is responsible for 3.5&#37;&#8211;10&#37; of all injuries treated in hospital, but this may reflect the popularity of the sport rather than its dangers. Young people are particularly at risk of sports injury because of high levels of exposure at a time of major physiological change. Soccer players are susceptible to a variety of injuries due to contact, aggressive tackle, and high-speed collisions. Aims: The aim of this study was to determine the pattern of presentation, treatment, and outcome of tibial fractures following participation in recreational football activity; with the hope that knowledge gained from this study will help in preventing or reducing its occurrence. Patients and Methods: This is a retrospective study of all cases of tibial fractures following participation in recreational football presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, north western Nigeria; from January 2012 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients&#39; case folders on biodata, diagnosis, mechanism of injury, associated injuries, type of surgical procedure, site of surgery, date of surgery, and postoperative complications. Data collected were analyzed using the Statistical Package for Social Sciences for Windows version 22. Results were presented with descriptive statistics. Results: In total, 37 patients were included in the study. All of them were males. The age range is from 14 to 33 years with mean age of 23.6. 17 (45.9&#37;) of the patients are in the 21- to 30-year age group. The right tibia was affected in 34 (91.9&#37;) patients. None of the patients used shin guard. The mechanism of injury in all the cases was direct contact. About 31 (83.8&#37;) of the fractures were closed. Seven (18.9&#37;) of these patients were discharged against medical advice. Nineteen (51.3&#37;) patients were managed nonoperatively with plaster of Paris casts. Ten (27.1&#37;) of these patients had internal fixation with locked intramedullary nail. Conclusion: Tibial fractures following football occur mostly in males especially adolescents and youths. The right tibia was commonly affected and most of the injuries are closed. The most common mechanism of injury was direct contact. 


The effect of microwave glazing on the surface properties of various porcelain materials
FA Sanal, M Kurt

Nigerian Journal of Clinical Practice 2019 22(4):496-502

Aim: The aim of this research was to investigate the effect of microwave glazing, conventional oven glazing, and polishing on surface roughness and wettability of porcelains. Materials and Methods: The initial surface roughness values (Ra0) of the prepared specimens for four different porcelains (Vita VM 9, VitaVM 13, Vita VMK 95, IPS e.maxCeram) were determined by profilometry. Then, the specimens were divided randomly into three groups as polishing, conventional oven glazing, and microwave glazing. Final surface roughness values were evaluated by profilometry (Ra1) and scanning electron microscopy. Wettability of glazed specimens were evaluated by contact angle goniometer. Results: Although microwave-glazed specimens had lower Ra1 values compared with the conventional oven-glazed ones for IPS e.maxCeram (P &#60; 0.05), there were not any statistically significant differences between these two procedures in terms of Ra1 values for the other porcelains (P &#62; 0.05). Microwave-glazed specimens had lower wettability values than conventional oven-glazed ones for Vita VM 9. Conclusions: Microwave glazing procedure may be considered as an alternative method because of the advantages of providing volumetric heating, time, and energy saving. 


The effect of pregabalin and ibuprofen combination for pain after third molar surgery
A Degirmenci, E Yalcin

Nigerian Journal of Clinical Practice 2019 22(4):503-510

Aim: The objective of this study was to compare the efficacy of different doses of pregabalin and intravenous ibuprofen with regard to pain management and analgesic consumption after third molar surgery. Materials and Methods: Ninety patients who had been scheduled for third molar surgery were assigned to four different treatment groups. The inclusion criteria consisted of the presence of fully or partially bony retentive asymptomatic mandibular third molars. These groups are included the following: (Group 1) premedicated with oral placebo and intravenous (IV) placebo, (Group 2) premedicated with oral placebo and 400-mg IV Ibuprofen, (Group 3) premedicated with 75-mg oral pregabalin and 400-mg IV ibuprofen, and (Group 4) premedicated with 150-mg oral pregabalin and 400 mg IV ibuprofen. Postoperative pain was assessed with visual analog scale (VAS) every hour for the first 12 hs following the surgery. Pain was then assessed at different time intervals during 7 days following the surgery. Kruskal&#8211;Wallis tests were used to compare the four groups in terms of VAS pain scores, analgesic consumption, and first rescue analgesic request time after the surgery. Results: At the end of the study, the results of 80 patients (20 patients per group) were analyzed. The group 4 had lower pain intensity compared with other groups at various time intervals. This difference is statistically significant in between the first 3&#8211;10 h (first day) and single-time intervals in second, third, fifth, and sixth postoperative days. Postoperative analgesic consumption was not statistically different between the groups. The first rescue analgesic request time after surgery was different between the pregabalin combination groups and group 2. No significant difference in the side effects was observed. Conclusion: These findings suggest that preoperative coadministration of 150-mg pregabalin and IV ibuprofen may be useful in improving pain control after third molar surgery. 


Prognostic value of neutrophil-to-lymphocyte ratio in castration resistant prostate cancer: Single-centre study of Nigerian men
JO Bello, OO Olanipekun, AL Babata

Nigerian Journal of Clinical Practice 2019 22(4):511-515

Background: Elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be a useful prognosticator of overall survival (OS) in several cancers including castration resistant prostate cancer. However, its utility in black populations known to have benign ethnic neutropenia is unknown. We evaluated the prognostic value of NLR in Nigerian men with CRPC in terms of OS. Materials and Methods: We retrospectively analysed 58 patients with castration resistant prostate cancer who received androgen deprivation therapy (ADT) and docetaxel chemotherapy at our institution. Baseline NLR was calculated from available complete blood counts. NLR cut-off point value was determined based on receiver operator characteristic (ROC) curves for mortality. A multivariate analysis was performed to investigate the association between NLR and OS. Results: Based on the ROC curves, the NLR (AUC 0.85, 95&#37; CI 0.74-0.97, P &#61; 0.0001) cut-off point was determined to be 1.8. This cut-off point has a sensitivity of 92&#37; and specificity of 70&#37;. Median OS was 20 months (95&#37; CI 14-27 months); the median OS in patients with NLR &#60;1.8 and those with NLR of &#8805;1.8 was 40 months and 12 months respectively. Kaplan-Meier plots showed that a higher NLR of &#8805;1.8 correlated significantly with an increased risk of mortality, Log rank P &#61; 0.001. Multivariate Cox regression analyses confirmed NLR as an independent prognostic biomarker for OS (HR &#61; 1.49, 95&#37; CI: 1.18-1.87). Conclusions: This study demonstrated that NLR is a useful prognostic biomarker in Nigerian men with CRPC and that elevated baseline NLR &#8805;1.8 is associated with poorer OS. 


Philosophy & Technology

Branching Is Not a Bug; It's a Feature: Personal Identity and Legal (and Moral) Responsibility

Abstract

Prospective developments in computer and nanotechnology suggest that there is some possibility—perhaps as early as this century—that we will have the technological means to attempt to duplicate people. For example, it has been speculated that the psychology of individuals might be emulated on a computer platform to create a personality duplicate—an "upload." Physical duplicates might be created by advanced nanobots tasked with creating molecule-for-molecule copies of individuals. Such possibilities are discussed in the philosophical literature as (putative) cases of "fission": one person "splitting" into two. Many philosophers, perhaps most, reject the idea of fission, appealing to some form of a "no-branching" condition to rule out such possibilities. I argue, to the contrary, that there are good moral reasons to think that any account of personal identity that does not permit fission is deeply problematic, especially in connection with theorizing about criminal punishment. I discuss and reject David Lewis' famous account of personal identity that invokes "multiple occupancy" to allow for branching. In contrast, I offer an account of personal identity that permits branching using the type/token distinction to help with such puzzling cases.



Dark Data as the New Challenge for Big Data Science and the Introduction of the Scientific Data Officer

Abstract

Many studies in big data focus on the uses of data available to researchers, leaving without treatment data that is on the servers but of which researchers are unaware. We call this dark data, and in this article, we present and discuss it in the context of high-performance computing (HPC) facilities. To this end, we provide statistics of a major HPC facility in Europe, the High-Performance Computing Center Stuttgart (HLRS). We also propose a new position tailor-made for coping with dark data and general data management. We call it the scientific data officer (SDO) and we distinguish it from other standard positions in HPC facilities such as chief data officers, system administrators, and security officers. In order to understand the role of the SDO in HPC facilities, we discuss two kinds of responsibilities, namely, technical responsibilities and ethical responsibilities. While the former are intended to characterize the position, the latter raise concerns—and proposes solutions—to the control and authority that the SDO would acquire.



The Ethics of Biomedical 'Big Data' Analytics


The Digital Phenotype: a Philosophical and Ethical Exploration

Abstract

The concept of the digital phenotype has been used to refer to digital data prognostic or diagnostic of disease conditions. Medical conditions may be inferred from the time pattern in an insomniac's tweets, the Facebook posts of a depressed individual, or the web searches of a hypochondriac. This paper conceptualizes digital data as an extended phenotype of humans, that is as digital information produced by humans and affecting human behavior and culture. It argues that there are ethical obligations to persons affected by generalizable knowledge of a digital phenotype, not only those who are personally identifiable or involved in data generation. This claim is illustrated by considering the health-related digital phenotypes of precision medicine and digital epidemiology.



What the Near Future of Artificial Intelligence Could Be


The Challenge of the Digital and the Future Archive: Through the Lens of The National Archives UK

Abstract

On the 7th of June 2018, The National Archives UK held its inaugural digital lecture, delivered by Professor Luciano Floridi entitled "Semantic Capital: What it is and how to protect it". The lecture was followed by a poster exhibition, showcasing nine cutting-edge digital research projects at The National Archives (You can listen to the lecture's podcast and see the posters at: https://media.nationalarchives.gov.uk/index.php/digital-lecture-semantic-capital/ Accessed on 12 July 2018). This paper aims at giving a distinct overview of The National Archives' digital research priorities, drawing on examples from the active and recently completed research projects, which were displayed at the exhibition on the 7th of June 2018. The focus of this paper is to discuss the research challenges that we are facing as we seek to become a second-generation digital archive, that is digital by instinct and design. By placing a particular emphasis on the conceptual and epistemological challenges relating to trust and openness, the paper suggests that research is the key for us as a rapidly evolving digital archive; enabling us not only to inform but also innovate around the forthcoming digital challenges, and helping us to define future directions and lead the shaping of the future archive.



Accessing Online Data for Youth Mental Health Research: Meeting the Ethical Challenges

Abstract

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. This paper firstly highlights the relevance of a process-based approach to ethics (Markham and Buchanan 2012) when accessing highly sensitive data and then discusses the ethical considerations and potential challenges regarding the accessing of public data from Digital Mental Health (DMH) services. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users' expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research that includes vulnerable young people as research participants in an ethical manner. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users' control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and 'read more' options (Bergin and Harding 2016).



Between Minimal and Greater Than Minimal Risk: How Research Participants and Oncologists Assess Data-Sharing and the Risk of Re-identification in Genomic Research

Abstract

Data-sharing among genomic researchers is promoted for its potential to accelerate our understanding of the molecular basis of cancer. However, with genomic data sharing the risks of re-identifying study participants, revealing personal genomic information and data misuse might increase. This study aims at exploring perceptions of patients and physicians in Oncology regarding their assessment of the informational risks resulting from participating in whole genomic research studies in order to improve the informed consent process. For this purpose, we conducted a qualitative focus group study at the National Center for Tumor Diseases (NCT). Patients and oncologists assessed the informational risks either as minimal or as greater than minimal, depending on the context factors of occupational status, age, and patients' prognosis. Interestingly, even patients who assumed a greater risk did not refrain from participating in genomic research, provided that certain informational and institutional safeguards are implemented. Moreover, they expected comprehensive disclosure of the risks resulting from genomic data sharing. These results suggest (1) comprehensive disclosure of the risks of genomic research to potential study participants in genomic research to facilitate risk assessment and sound decision making, (2) establishing independent governance entities in order to minimize the informational risks of genomic research, and (3) implementing data sharing policies which offer guidance for physicians and researchers involved in genomic research.



Trust and Justice in Big Data Analytics: Bringing the Philosophical Literature on Trust to Bear on the Ethics of Consent

Abstract

Much bioethical literature and policy guidances for big data analytics in biomedical research emphasize the importance of trust. It is essential that potential participants trust so they will allow their data to be used to further research. However, comparatively, little guidance is offered as to what trustworthy oversight mechanisms are, or how policy should support them, as data are collected, shared, and used. Generally, "trust" is not characterized well enough, or meaningfully enough, for the term to be systematically applied in policy development. Yet points made in the philosophical literature on trust can help. They allow us, not only to better distinguish the different ways the term "trust" may be interpreted, but also to better determine how different approaches to trust can align with policy and governance—in what ways they may relate to key bioethical concepts and related laws, and in what ways they can help to balance individual and group interests in data sharing. This article draws from the philosophical literature on trust to identify a relationship among consent, trust, and justice. Specifically, parallels are drawn between "character-trustworthiness" and "natural justice," a set of widely held legal safeguards intended to ensure decision-makers follow a pattern of procedural fairness which protects the rights of the individual and thereby maintains public confidence in the decision-making process. Relevance to traditional bioethical principles, established laws, and consent procedures are addressed throughout. In conclusion, policy actions are suggested.



Social Justice, Equality and Primary Care: (How) Can 'Big Data' Help?

Abstract

A growing body of research emphasises the role of 'social determinants of health' in generating inequalities in health outcomes. How, if at all, should primary care providers respond? In this paper, I want to shed light on this issue by focusing on the role that 'big data' might play in allowing primary care providers to respond to the social determinants that affect individual patients' health. The general idea has been proposed and endorsed by the Institute of Medicine, and the idea has been developed in more detail by Bazemore et al. (2016). In Bazemore et al.'s proposal, patients' addresses are used to generate information about the patients' neighbourhood; this information is then included in patients' health care records and made available to providers. This allows primary care providers to take this information into account when interacting with, and providing care to, patients. I explore three issues arising from this proposal. First, while questions of privacy have been central to discussions about big data, Bazemore et al.'s proposal also allows us to see that there might be costs to not making certain information available. Second, I consider some of the questions arising for primary care from the influence of social factors on health outcomes: given that we know these factors to be significant contributors to social inequalities in health, what precisely should be done about this in the primary care context? Finally, I address problems arising from the use of population level data when dealing with individuals.