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Rowing performance depends on the design and building materials used for competition. Recently, attempting to improve rowing performance, the Randall foil has been attached to the top edge of a rowing Big blade, making it spoon shaped. The current study aimed to analyse the differences between Big blades with and without Randall foils in force-related variables. Nineteen rowers performed two bouts of 90 s at maximal effort tethered rowing and differences were found in cycle average peak force (4.33 ± 1.46 vs. 5.26 ± 1.57 N/kg), propulsive cycle average time (1.79 ± 0.38 vs. 1.52 ± 0.24 N/kg.s) and rate of force development (8.79 ± 4.75 vs. 12.07 ± 4.60 N/kg/s) for Big blades with and without foils (respectively). Differences were also observed between the middle (4.79 ± 1.21 vs. 4.08 ± 1.48 N/kg) and final phases (4.86 ± 1.45 vs. 4.04 ± 1.47 N/kg) of the rowing effort for the cycle average peak force of Big blades with and without Randall foils. Data suggest a positive effect of these foils on the force-time curve profile. Future studies should focus on testing its influence on free on-water rowing.

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Empirical observations support that the addition of a plastic strip - also known as Randall foils - on the top edge of a rowing blade improves rowing efficiency during the cycle propulsive phase. The aim of the current study was to analyze the effect of using big blades with and without Randall foils on rowing performance. Twenty experienced rowers performed two 90 s tethered rowing bouts (with and without Randall foils) to assess their impact on force production and physiologic variables. All tests were randomized and a repeated measure design was used to compare experimental conditions. Higher values of peak and mean peak forces (479.4±134.7 vs. 423.2±153.0, d=0.83 and 376.5±101.4 vs. 337.1±113.3 N, d=0.68), peak oxygen uptake (47.9±7.5 vs. 45.3±7.3 mL∙kg-1∙min-1, d=0.19), peak blood lactate concentration (7.9±1.6 vs. 6.9±1.7 mmol∙L-1, d=0.16), blood lactate increasing speed (0.08±0.01 vs. 0.07±0.06 [(mmol·L-1)·s-1], d=0.27) and lactic anaerobic energy (27.4±7.9 vs. 23.4±8.1 kJ, d=0.23) were found for big blades with vs. without Randall foils, p<0.05. The current data suggest that the Randall foils can positively affect rowing performance.

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High performance sport for females is an area which is gaining more and more relevance today, but which hasn't received the same research interest as sport for males. The aim of the present study was to analyse the motivational climate perceived by high performance female athletes and the implications on perceived motor competence and autonomous behaviour and check the differences according category, sport experience and training hours in performance and master climate. The participants were 615 female athletes who practice top level team sports, with ages comprised of 16 to 38 (M = 22,10; SD = 4,91). The sample consisted of two different categories: junior (n = 242) and senior (n = 373). These players participated in different team sports, specifically football, handball, basketball and volleyball, training between 6 and 24 hours a week (M = 8,34; DT = 4,33). The variables measured were: perceived motivational climate in sport, autonomous behaviour and perceived motor competence. A cluster analysis was carried out using, as a variable, the perceived motivational climate, and showing the existence of two profiles, one related to ego and the other to task. The multivariate analysis showed that the profile orientated towards the task had significant differences compared to the autonomous behaviour (M = 4.66 vs M = 3.41). At the same time an analysis was carried out looking at different social demographic variables, revealing how there were differences in the sports experience (those participants with more than ten years' experience were more orientated towards ego, compared to those with less than ten years' experience) and the category (junior athletes were more orientated towards the task, compared to senior athletes). It was concluded that a greater orientation towards the task can lead to an improvement in the perception of motor competence, with the youngest and least experienced athletes being the most prominent in this category.

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Water polo is a team sport that has been suffering rule changes aiming for a more attractive game. Our goal was to unveil whether different offensive playing styles or methods were adopted by elite national teams from Eastern Europe and from other world countries after the new rules framework was applied at the 2019 FINA World Championship. Additionally, we questioned whether those rules induced a more dynamic game. A total of 648 offensive sequences from games contested by the top-six ranked national squads were analysed. Descriptive statistics, parametric and nonparametric tests were computed, and the effect size was used. The eastern Europeans were the tallest (t (76) = −4.081; p < 0.001, d = 0.42) and the Hungarians were higher than Italians (p = 0.005, dz = −0.41). Offensive time length differed between teams (H (5) = 30.50, p < 0.001) with Serbia being the fastest (Mdn = 22 s). In successful attacks without extra time, Italy was quicker than Spain (17.5 vs. 25.0 s; p = 0.031, dz = −0.36) scoring 30% of their total goals under 20 s, while Australia up to 24% and Croatia, Hungary and Spain ≤ 16.0%. When power-play occurred, the teams' pass action was different (H (5) = 15.99, p < 0.007), with Italy performing more passes than counterparts, especially Serbia (Mdn = 13 vs. 9, respectively; p= 0.003, dz = 0.20) and with the exception of Hungary. Through fast play sequences, Italy, Serbia and Australia scored up to 33% of their goals, while Spain, Croatia, and Hungary scored ≤ 15%. The power-play contributed to ≥50% of teams' goals, except for Spain and Australia (48 and 45%, respectively). Playing styles commonly attributed to Eastern vs. non-Eastern Europeans and other worldwide national teams such as Australia were not confirmed. However, offensive trends were perceived and described for the first time, and some base guidelines were suggested to distinguish the static or positional vs. a more dynamic playing model. Rule changes did not seem to induce the expected effects on game dynamics.

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INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.

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Survival outcomes increase significantly when cardiopulmonary resuscitation (CPR) is provided correctly, but rescuers' fatigue can compromise its delivery. We investigated the effect of two exercise modes on CPR effectiveness and physiological outputs. After 4 min baseline conditions, 30 lifeguards randomly performed a 100 m run and a combined water rescue before 4 min CPR (using an adult manikin and a 30:2 compression-ventilation ratio). Physiological variables were continuously measured during baseline and CPR using a portable gas analyzer (K4b2, Cosmed, Rome, Italy) and CPR effectiveness was analyzed using two HD video cameras. Higher oxygen uptake (23.0 ± 9.9 and 20.6 ± 9.1 vs. 13.5 ± 6.2 mL·kg·min-1) and heart rate (137 ± 19 and 133 ± 15 vs. 114 ± 15 bpm), and lower compression efficacy (63.3 ± 29.5 and 62.2 ± 28.3 vs. 69.2 ± 28.0%), were found for CPRrun and CPRswim compared to CPRbase. In addition, ventilation efficacy was higher in the rescues preceded by intense exercise than in CPRbase (49.5 ± 42.3 and 51.9 ± 41.0 vs. 33.5 ± 38.3%), but no differences were detected between CPRrun and CPRswim. In conclusion, CPRrun and CPRswim protocols induced a relevant physiological stress over each min and in the overall CPR compared with CPRbase. The CPRun protocol reduces the compression rate but has a higher effectiveness percentage than the CPRswim protocol, in which there is a considerably higher compression rate but with less efficacy.

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This study aimed to compare three swimming conditions in a swimming flume with water at 26 ℃ (using swimsuit) and 18 ℃ (randomly with swimsuit and wetsuit). Seventeen swimmers (32.4±14.7 years old, 175.6±0.06 cm height, and 70.4±9.8 kg body mass) performed three bouts until exhaustion at a 400-m front crawl pace (24 h intervals). ANOVA repeated measures compared the experimental conditions. Swimming at 26 ℃ with swimsuit evidenced a higher metabolic demand (total energy expenditure; (E)), comparing to 18 ℃ swimsuit (p=0.05) and with 18 ℃ wetsuit (p=0.04). The 26 ℃ swimsuit condition presented higher peak oxygen uptake (VO2peak), blood lactate concentrations ([La-]peak), rate of perceived exertion (RPE), maximal heart rate (HRmax), anaerobic lactic energy (AnL), E, energy cost (C), V̇O2 amplitude (Ap), and stroke rate (SR), but lower stroke length (SL) and stroke index (SI) than 18 ℃ wetsuit. The 18 ℃ swimsuit condition (comparing to wetsuit) lead to higher V̇O2peak, [La-]peak, HRmax, E, C, Ap, and SR but lower SL and SI. Swimming at aerobic power intensity with swim and wetsuit at 18 ℃ does not induce physiologic and biomechanical disadvantages compared to 26 ℃. The results suggested that the use of wetsuit might increase performance at 18 ℃ water temperature for competitive master swimmers. Its use is thus recommended in open water swimming competitions when the water temperature is 18-20 ℃.

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This study aimed to analyze the effects of a swimming training mesocycle in master swimmers' performance and active drag. Twenty-two 39.87 ± 6.10 year-old master swimmers performed a 25 m front crawl at maximal intensity before and after a typical four-week training mesocycle. Maximum, mean and minimum speeds, speed decrease and hip horizontal intra-cyclic velocity variation were assessed using an electromechanical speedometer, and the active drag and power to overcome drag were determined using the measuring active drag system. Maximum, mean and minimum front crawl speeds improved from pre- to post-training (mean ± 95% CI: 3.1 ± 2.8%, p = 0.04; 2.9 ± 1.6%, p = 0.01; and 4.6 ± 3.1%, p = 0.01; respectively) and the speed decrease along the 25 m test lowered after the training period (82.5 ± 76.3%, p = 0.01). The training mesocycle caused a reduction in the active drag at speeds corresponding to 70% (5.0 ± 3.9%), 80% (5.6 ± 4.0%), and 90% (5.9 ± 4.0%), but not at 100% (5.9 ± 6.7%), of the swimmers' maximal exertions in the 25 m test. These results showed that four weeks of predominantly aerobic training could improve master swimmers' performance and reduce their hydrodynamic drag while swimming mainly at submaximal speeds.

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We compared the hydrodynamic characteristics and pull-out strategies of four backstroke-to-breaststroke turning techniques in young swimmers. Eighteen 11 and 12-year-old swimmers participated in a 4 week intervention program including 16 contextual interference sessions. The hydrodynamic variables were assessed through inverse dynamics, and the pull-out strategy kinematics were assessed with tracking markers followed by 12 land cameras and 11 underwater cameras. Swimmers randomly completed sixteen 30 m maximal backstroke-to breaststroke-open, somersault, bucket and crossover turns (four in each technique) with a 3 min rest. The data showed higher drag force, cross-sectional area and drag coefficient values for the first (compared with the second) gliding position. The crossover turn revealed the highest push-off velocity (2.17 ± 0.05 m·s-1), and the somersault turn demonstrated the lowest foot plant index (0.68 ± 0.03; 68%), which could have affected the first gliding, transition and second gliding depths (0.73 ± 0.13, 0.86 ± 0.17 and 0.76 ± 0.17 m). The data revealed the consistency of the time spent (4.86 ± 0.98 s) and breakout distance (6.04 ± 0.94 m) among the four turning techniques, and no differences were observed between them regarding time and average velocity up to 7.5 m. The hydrodynamic characteristics and pull-out strategy of the backstroke-to-breaststroke turns performed by the age group swimmers were independent of the selected technique.

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Survival outcomes increase significantly when cardiopulmonary resuscitation (CPR) is provided correctly, but rescuer's fatigue can compromise CPR delivery. We investigated the effect of a 100-m maximal run on CPR and physiological variables in 14 emergency medical technicians (age 29.2 ± 5.8 years, height 171.2 ± 1.1 cm and weight 73.4 ± 13.1 kg). Using an adult manikin and a compression-ventilation ratio of 30:2, participants performed 4-min CPR after 4-min baseline conditions (CPR) and 4-min CPR after a 100-m maximal run carrying emergency material (CPR-run). Physiological variables were continuously measured during baseline and CPR conditions using a portable gas analyzer (K4b2, Cosmed, Rome, Italy) and analyzed using two HD video cameras (Sony, HDR PJ30VE, Japan). Higher VO2 (14.4 ± 2.1 and 22.0 ± 2.5 mL·kg-1·min-1) and heart rate (123 ± 17 and 148 ± 17 bpm) were found for CPR-run. However, the compression rate was also higher during the CPR-run (373 ± 51 vs. 340 ± 49) and between every three complete cycles (81 ± 9 vs. 74 ± 14, 99 ± 14 vs. 90 ± 10, 99 ± 10 vs. 90 ± 10, and, 101 ± 15 vs. 94 ± 11, for cycle 3, 6, 9 and 12, respectively). Fatigue induced by the 100-m maximal run had a strong impact on physiological variables, but a mild impact on CPR emergency medical technicians' performance.

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Physiological responses related to 400-m front crawl performance were examined in a 11-week training macrocycle in children 11.6 ± 1.2 years old. Fourteen girls and twenty-nine boys completed a maximum intensity 400-m test, at the beginning (Τ1) and at the end of four weeks of general preparation (Τ2), four weeks of specific preparation (Τ3), and three weeks of the competitive period (Τ4). Blood lactate (La), blood glucose (Glu) and heart rate were measured post effort. Stroke rate (SR), stroke length (SL) and stroke index (SI) were measured during the test. The 400-m time was decreased at T2, T3, and T4 compared to T1 by 4.2 ± 4.9, 7.5 ± 7.0, and 8.6 ± 7.3% (p < 0.05) and at T3 and T4 compared to T2 by 3.1 ± 4.3 and 4.2 ± 4.6%, respectively (p < 0.05). La was not different between tests (p > 0.05) and Glu was decreased at T3 compared to other testing moments (p < 0.05). SR, SL, and SI were higher at T3 and T4 compared to T1 (p < 0.05). SL and SI were also increased at T4 compared to T2 (p < 0.05). Performance changes from T1 to T2 were related to SL and SI changes (r = 0.45 and 0.83, p < 0.05), and subsequent changes between T2 to T3 were related to SR, SI, La, and Glu changes (r = 0.48, 0.68, 0.34, and 0.42, p < 0.05). Performance change from T3 to T4 was related to SL, SI, and La modifications (r = 0.34, 0.70, and 0.53, p < 0.05). Performance gains may be related to various biomechanical or physiological changes according to training macrocycle structure.

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BACKGROUND: It has been suggested that beta-blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta-blockers discontinuation or reinitiation has not been examined. AIMS: To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta-blockers discontinuation and reinitiation. METHODS: Sub-analysis of NACSELD (North American consortium for the study of end-stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites. Data on BB discontinuation and reinitiation were collected by chart review. RESULTS: Seven hundred and sixteen patients, 307 (43%) on beta-blockers at admission and 366 (51%) with refractory ascites, were followed to death or hospital discharge. Beta-blocker use was associated with a lower white blood cell count at admission. Beta-blocker use in hospitalised patients with ascites was not associated with a higher mortality, even in those with refractory ascites. No significant changes in mean arterial pressure (MAP) were observed between groups. Discontinuation of beta-blockers (49%) was driven by low MAP, infection and acute kidney injury at time of discontinuation but was not associated with a higher mortality. Beta-blocker reinitiation occurred in 40% prior to discharge and was mainly driven by an increase in MAP. CONCLUSIONS: Beta-blocker use is safe in patients with cirrhosis and ascites (including those with refractory ascites) provided beta-blockers are discontinued in the presence of a low MAP and reinitiated once MAP reincreases. A potentially beneficial anti-inflammatory effect of beta-blockers is suggested.

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The purpose of the study is to examine the effects of the motivational climate created by the coach and perceived by a group of young handball players on their goal orientations, their beliefs regarding reasons for success and their self-satisfaction. The study participants were 159 young handball players. Players were administered a battery composed of tests to measure the above-mentioned motivational constructs. Results showed that a perceived mastery-oriented motivational climate was positively related to a task-centered goal orientation, enjoyment, and a belief that success may be achieved through effort. In contrast, a perceived performance-orientated training climate was linked to an ego-centered goal orientation, boredom, or lack of enthusiasm, and a belief that the routes of success in this sport are the abilities and the use of deception techniques. On the whole, this study underlines the educational role of the coach in young handball players. Specifically, the coach's socializing role influences both handball player's commitment and positive motivational profile as well as sport performance.

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OBJECTIVE: Cardiopulmonary resuscitation (CPR) after a drowning episode is performed under fatigue conditions. However, the characterization of CPR in this context is still unknown. Our purpose was to investigate the effect of a 100-m simulated in-water rescue on CPR and physiological parameters in trained certified lifeguards. METHODS: Thirty trained certified lifeguards (age 24.6 ± 3.8 yrs; height 178.2 ± 7.4 cm and weight 76.9 ± 10.6 kg) completed two protocols using an adult manikin: (i) 4-min CPR after 4-min baseline conditions (CPR), and (ii) 4-min CPR after a 100-m simulated in-water rescue in the sea (CPR Rescue), both with a compression-ventilation ratio of 30:2. Physiological parameters of the subjects were continuously measured (breath-by-breath) during baseline and CPR conditions, using a telemetric portable gas analyzer (K4b 2 , Cosmed, Rome, Italy) and CPR techniques analyzed using two HD video cameras (Sony, HDR PJ30VE, Japan). RESULTS: The 100-m simulated in-water rescue induced higher values of physiological related parameters all over the 4-min CPR exercise (e.g. Tidal Volume: 1.5 ± 0.4 and 2.4 ± 0.5 L; VO2: 15.9 ± 3.9 and 22.8 ± 3.2 ml.kg-1.min-1; R: 0.9 ± 0.1 and 1.2 ± 0.1, for CPR and CPR Rescue, respectively). However, the compression rate was higher in CPR Rescue compared to the CPR in the first (cycle 3: 85 ± 12 vs. 78 ± 9 s) and last three complete cycles (cycle 12: 100 ± 12 and 85 ± 12 s), and, in both conditions, it increased from the first to the last CPR complete cycle. CONCLUSIONS: Fatigue induced by the 100-m simulated in-water rescue had a strong physiological expression but a minimal impact on CPR performance. Key words: CPR; fatigue; lifeguards; VO2.

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BACKGROUND: Cholangitis-associated septic shock carries significant mortality. There is uncertainty regarding the most appropriate time to achieve biliary decompression. AIM: To determine whether the timing of biliary decompression and anti-microbial therapy affect the survival in cholangitis patients with septic shock. METHODS: Nested retrospective cohort study of all cholangitis-associated septic shock patients (hypotension requiring vasopressors) from an international, multi-centre database between 1996 and 2011. RESULTS: Among 260 patients (mean age 69 years, 57% male), overall mortality was 37%. Compared to nonsurvivors (n = 96), survivors (n = 164) had lower mean admission Acute Physiology And Chronic Health Evaluation (APACHE) II (22 vs. 28, P < 0.001) and lower median serum lactate on admission (3.4 vs. 4.6 mmol/L, P < 0.001). Survivors were more likely to receive appropriate anti-microbial therapy earlier (median 2.6 vs. 6.8 h from shock, P < 0.001). Survivors were also more likely to undergo successful biliary decompression earlier (median 8.8 vs. 22 h, P < 0.001). After adjusting for co-variates, APACHE II (odds ratio, OR 1.21 per increment (1.11-1.32), time delay to appropriate anti-microbial therapy [OR 1.15 per hour (1.07-1.25)] and delayed biliary decompression >12 h [OR 3.40 (1.12-10.31)] were all significantly associated with increased mortality (P < 0.04 for all; c-statistic 0.896). CONCLUSIONS: Patients with septic shock secondary to acute cholangitis have significant mortality. Endoscopic biliary decompression >12 h after the onset of shock and delayed receipt of appropriate anti-microbial therapy were both significantly associated with adverse hospital outcome. This might suggest that early initiation of anti-microbial therapy and urgent biliary decompression (within 12 h) could potentially improve outcomes in this high-risk patient population.

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Foot and hand set-up position effects were analysed on backstroke start performance. Ten swimmers randomly completed 27 starts grouped in trials (n = 3) of each variation, changing foot (totally immersed, partially and totally emerged) and hand (lowest, highest horizontal and vertical) positioning. Fifteen cameras recorded kinematics, and four force plates collected hands and feet kinetics. Standardised mean difference and 95% confidence intervals were used. Variations with feet immersed have shown lower vertical centre of mass (CM) set-up position (0.16 m), vertical impulse exerted at the hands, horizontal and vertical impulse exerted at the feet (0.28, 0.41, 0.16 N/BW.s, respectively) than feet emerged with hands horizontal and vertically positioned. Most variations with feet partially emerged exhibited higher and lesser vertical impulse exerted at hands than feet immersed and emerged (e.g. vertical handgrip, 0.13, 0.15 N/BW.s, respectively). Variation with feet emerged and hands on the lowest horizontal handgrip depicted shorter horizontal (0.23, 0.26 m) and vertical CM positioning at flight (0.16, 0.15 m) than the highest horizontal and vertical handgrip, respectively. Start variations have not affected 15-m time. Variations with feet partially or totally emerged depicted advantages, but focusing on the entry and underwater biomechanics is relevant for a shorter start time.

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The aim was to examine behavioural variability within and between individuals, especially in a swimming task, to explore how swimmers with various specialty (competitive short distance swimming vs. triathlon) adapt to repetitive events of sub-maximal intensity, controlled in speed but of various distances. Five swimmers and five triathletes randomly performed three variants (with steps of 200, 300 and 400m distances) of a front crawl incremental step test until exhaustion. Multi-camera system was used to collect and analyse eight kinematical and swimming efficiency parameters. Analysis of variance showed significant differences between swimmers and triathletes, with significant individual effect. Cluster analysis put these parameters together to investigate whether each individual used the same pattern(s) and one or several patterns to achieve the task goal. Results exhibited ten patterns for the whole population, with only two behavioural patterns shared between swimmers and triathletes. Swimmers tended to use higher hand velocity and index of coordination than triathletes. Mono-stability occurred in swimmers whatever the task constraint showing high stability, while triathletes revealed bi-stability because they switched to another pattern at mid-distance of the task. Finally, our analysis helped to explain and understand effect of specialty and more broadly individual adaptation to task constraint.

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We aimed to analyse the handgrip positioning and the wedge effects on the backstroke start performance and technique. Ten swimmers completed randomly eight 15 m backstroke starts (four with hands on highest horizontal and four on vertical handgrip) performed with and without wedge. One surface and one underwater camera recorded kinematic data. Standardised mean difference (SMD) and 95% confidence intervals (CI) were used. Handgrip positioning did not affect kinematics with and without wedge use. Handgrips horizontally positioned and feet over wedge displayed greater knee angular velocity than without it (SMD = -0.82; 95% CI: -1.56, -0.08). Hands vertically positioned and feet over wedge presented greater take-off angle (SMD = -0.81; 95% CI: -1.55, -0.07), centre of mass (CM) vertical positioning at first water contact (SMD = -0.97; 95% CI: -1.87, -0.07) and CM vertical velocity at CM immersion (SMD = 1.03; 95% CI: 0.08, 1.98) when comparing without wedge use. Swimmers extended the hip previous to the knee and ankle joints, except for the variant with hands vertically positioned without wedge (SMD = 0.75; 95% CI: -0.03, 1.53). Swimmers should preserve biomechanical advantages achieved during flight with variant with hands vertically positioned and wedge throughout entry and underwater phase.

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