From Total Volume to Sequence Maps—Sophisticated Accelerometer Data Analysis

Purpose To date, epidemiological studies have focused on the potential health effects of total volume of physical activity (PA) or sedentary behaviour (SB). However, two persons may have the same volume of PA or SB but accumulated in a completely different sequence. The pattern of accumulating PA and SB might be more important for health effects than the total volume. Therefore the aim was to develop a sophisticated algorithm translating accelerometer data into detailed sequence maps considering how PA and SB are accumulated throughout the day. Methods We developed a novel algorithm to convert accelerometer counts into a sequence map based on behaviour states defined by a combination of intensity (SB, light, moderate, and vigorous intensity) and duration (sporadic accumulation or in bouts of different duration). Additionally, hierarchical cluster analysis was applied to identify clusters of children with similar behavioural sequence maps. Results Clustering resulted in seven clusters of children with similar PA and SB sequence maps: an average cluster (33% of children); a cluster with relatively more SB, light and moderate PA in bouts (SB and PA bouters, 31%); a cluster characterized by more sporadic SB and light PA (light activity breakers, 26%); and four smaller clusters with 7% of the children or less. Conclusion This novel algorithm is a next step in more sophisticated analyses of accelerometer data considering how PA and SB are accumulated throughout the day. The next step is identifying whether specific patterns of accumulating PA and SB are associated with improved health outcomes. *Mai Chinapaw and Xinhui Wang contributed equally to the paper. Corresponding author: M.J.M. Chinapaw, PhD, Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands, ph: +31 20 444 8203, f: +31 20 444 8387, m.chinapaw@vumc.nl The contributions of Chinapaw, Wang, and Altenburg were funded by the Netherlands Organization for Health Research and Development (ZonMw projectnr 91211057). The CHAMPS-study was funded by: The TRYG Foundation, University College Lillebaelt, University of Southern Denmark, The Nordea Foundation, The IMK foundation, The Region of Southern Denmark, The Egmont Foundation, The A.J. Andersen Foundation, The Danish Rheumatism Association, Østifternes Foundation, Brd. Hartmann's Foundation, TEAM Denmark, The Danish Chiropractor Foundation, The Nordic Institute of Chiropractic and Clinical Biomechanics. Conflict of interest: The authors have no relevant conflicts of interest to disclose, the results of the present study do not constitute endorsement by ACSM and the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 14 November 2018. © 2018 American College of Sports Medicine

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Grounded Running Reduces Musculoskeletal Loading

Purpose Recent observations demonstrate that a sizeable proportion of the recreational running population runs at rather slow speeds and does not always show a clear flight phase. This study determined the key biomechanical and physiological characteristics of this running pattern, i.e. grounded running (GR), and compared these characteristics with slow aerial running (SAR) and reference data on walking at the same slow running speed. Methods Thirty male subjects performed instructed GR and SAR at 2.10 m·s-1 on a treadmill. Ground reaction forces, tibial accelerations and metabolic rate were measured to estimate general musculoskeletal loading (external power and maximal vertical ground reaction force), impact intensity (vertical instantaneous loading rate and tibial acceleration) and energy expenditure. More explicit measures of muscular loading (muscle stresses and peak eccentric power) were calculated based on a representative subsample, in which detailed kinematics and kinetics were recorded. We hypothesized that all measures would be lower for the GR condition. Results Subjects successfully altered their running pattern upon a simple instruction towards a GR pattern by increasing their duty factor from 41.5% to 51.2%. As hypothesized, impact intensity, general measures for musculoskeletal and the more explicit measures for muscular loading decreased by up to 35.0%, 20.3% and 34.0% respectively compared to SAR. Contrary to our hypothesis, metabolic rate showed an increase of 4.8%. Conclusion Changing running style from SAR to GR reduces musculoskeletal loading without lowering the metabolic energy requirements. As such, GR might be beneficial for most runners as it has the potential to reduce the risk of running related injuries while remaining a moderate-to-vigorous form of physical activity, contributing to fulfillment of the recommendations concerning physical activity and public health. Corresponding author: Dirk De Clercq; Watersportlaan 2, 9000 Gent, Belgium; +32 9 264 63 22; dirk.declercq@UGent.be Mizuno Corporation provided financial and product support for this study. All authors declare no conflict of interest. The results of the study are presented clearly, honestly and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 18 October 2018. © 2018 American College of Sports Medicine

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Quantifying Brain White Matter Microstructure of People with Lateral Ankle Sprain

Purpose This study aimed to quantify differences in white matter microstructure and static postural control in individuals with and without a previous history of a lateral ankle sprain. Methods Ten participants with a history of a lateral ankle sprain and 10 controls performed 3, 20-second trials of single-leg static balance on a force platform under an eyes-open condition. Resultant sample entropy (SampEn) was used to assess static postural control performance. To assess white matter microstructure, fractional anisotropy (FA) of the superior cerebellar peduncles and corticospinal tracts was quantified using diffusion tensor imaging (DTI). In the case of statistically significant differences in FA, component diffusivities were evaluated, including mean diffusivity, radial diffusivity (RD), and axial diffusivity (AD). Results Significant differences between participants with and without a history of lateral ankle sprains were observed in superior cerebellar peduncle FA and RD. Participants with a history of lateral ankle sprains had significantly lower FA in the superior cerebellar peduncle compared to controls. Participants with a history of lateral ankle sprains also demonstrated higher RD values in the superior peduncle compared to control. Finally, participants with a history of lateral ankle sprains had lower resultant SampEn values compared to controls. Conclusion Findings suggest that microstructural changes in white matter tracts governing postural control, may be biomarkers of central nervous system dysfunction in individuals with a lateral ankle sprain history. Correspondence: Masafumi Terada, College of Sport and Health Science, Ritsumeikan University, Shiga, Japan. mterada@fc.ritsumei.ac.jp No funding was received for this current study. The results of the current study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. CONFLICT OF INTEREST: All authors declare that they have no conflict of interest. Accepted for publication November 2018. © 2018 American College of Sports Medicine

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Sedation and neurodevelopmental outcomes in PICU: identification of study groups

Abstract

Background/Aims

As little as 30 minutes of exposure to anesthetic and sedative agents may adversely affect the developing brain. Safe, humane management of critically ill infants requires the use of sedative agents, often for prolonged periods. We sought to identify two comparable groups of critical care patients who did or did not receive sedatives, with the aim of designing a long‐term neuro‐development follow‐up study. This feasibility study aimed to determine if two comparable groups could be found.

Methods

Infants with respiratory diagnoses having non‐invasive ventilation without sedation (Group C) or intubation and ventilation with sedation (Group S) were identified by chart review. Charts of patients fulfilling the above inclusion criteria were searched for exclusion criteria including neurological disease, extreme prematurity, congenital cardiac disease, genetic anomalies. Data was extracted to score pediatric severity of illness scores (PRISM and PELOD) for each patient. These scores were then compared using the absolute scores and by risk strata.

Results

Group S included 33 patients and Group C had 39. The absolute PRISM and PELOD scores were different between groups, Comparing the groups in 3 risk strata (PRISM greater or less than 5 or 10) there were no significant differences between groups

Conclusions

It is not possible to randomise infants to sedation or no sedation to investigate neurodevelopmental outcomes. This phase of the project aimed to determine the comparability of 2 groups of PICU patients.

These findings indicate that these groups could be enrolled as exposed and control subjects in an outcomes study.

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Physico‐chemical stability of Plasma‐Lyte 148 ® and Plasma‐Lyte 148 ® + 5% Glucose with eight common intravenous medications

Abstract

Background

Plasma‐Lyte 148 ^® is a balanced, crystalloid intravenous (IV) fluid which is both calcium‐free and isotonic. It prevents the hyperchloraemic metabolic acidosis and iatrogenic hyponatraemia seen with use of 0.9% sodium chloride and hypotonic solutions respectively. However, data on compatibility with commonly used drugs is lacking.

Aim

To investigate the stability of Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^® + 5% Glucose with eight commonly used therapeutic agents when compared with 5% Glucose and 0.9% Sodium Chloride as diluents. We aimed to provide vital data which may facilitate the introduction of what appears to be a safer and more economic fluid.

Method

Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^® + 5% Glucose were mixed with morphine, midazolam, fentanyl, ketamine, clonidine, aminophylline, salbutamol and furosemide at set concentrations. Comparisons were made to 0.9% Sodium Chloride and 5% Glucose fluid controls. Six repeats of each IV fluid and drug admixture were analysed through high performance liquid chromatography (HPLC), at three time points: 0, 2 and 24 hours. A concentration change of < 5% was defined as chemically stable. Physical stability was assessed by observation of precipitate formation or colour change. pH changes were measured using a Fisherbrand Hydrus 300 pH meter.

Results

Relative to starting concentration, all drugs except midazolam were stable to +/‐ 3%. All examined therapeutic agents were chemically stable at 2 and 24 hours relative to control solutions. No precipitate formed in any of the samples. All Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^® + 5% Glucose drug admixtures remained in a safe, peripheral administration pH range of 5‐9 and were closer to the pH of blood than standard fluid‐drug admixtures.

Conclusion

Morphine, fentanyl, ketamine, salbutamol, aminophylline, and clonidine are stable for 24 hours when mixed with Plasma‐Lyte 148 ^® and Plasma‐Lyte 148 ^®+5% Glucose for administration at concentrations equivalent to those found at a typical Y site with maintenance fluid. Furosemide is stable at lower concentrations than those seen at a Y‐site, but midazolam displayed instability.

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Sips for little lips‐ letter to the editor

Abstract

We write to you in relation to your recent important publication of the consensus statement on clear fluid fasting for elective paediatric general anaesthesia, that emphasises improving fasting times from two hours to one hour prior to surgery^[1].

In order to determine the volume of clear fluid to be given, one of the practical interventions advised by the author was to use an age‐based banded calculator. This eliminates the need to weigh the child prior to fluid administration.

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A Follow‐up Survey of Total Intravenous Anesthesia Usage in Children in the U.K. and Ireland

Abstract

Background

Total intravenous anesthesia usage in children remains relatively unpopular in the UK and Ireland. A postal survey by Hill et al in 2008 indicated that only 26% of Consultants used a propofol infusion at least once a month.

Aim

Following an increase in teaching and training opportunities in pediatric total intravenous anesthesia in the UK, we repeated the survey amongst Consultant members of Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia, to see if this had affected total intravenous anesthesia usage in children and how practice may have changed.

Methods

We used an anonymous online survey sent to APAGBI and SIVA members.

Results

A total of 291 responses were analysed. Total intravenous anesthesia was the default method of anesthesia in 8% of respondents and a further 46% used total intravenous anesthesia at least monthly. Overall total intravenous anesthesia usage had increased in the past year in 53%. The main indications were malignant hyperthermia susceptibility, and postoperative nausea and vomiting. ENT Surgery was the most popular surgical specialty. The main reasons for not using total intravenous anesthesia were that it was too 'fiddly' and lack of confidence in the user. Most respondents used propofol in combination with remifentanil. Over 80% used propofol target‐controlled infusion. The potential for propofol‐related infusion syndrome concerned many, with 74% limiting infusion duration as a result. Bispectral Index was not used routinely by the majority of anesthetists. Even though most anesthetists did not use total intravenous anesthesia routinely, 98% felt they would be confident to anesthetize an MH positive patient using the technique.

Conclusion

This survey has shown that although total intravenous anesthesia is not the default anesthetic technique for most anesthetists, overall usage in children has more than doubled in the past 10 years, with many happy to use it in a wide variety of patients and procedures.

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