Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)

AimsConstipation in patients on Clozapine is the biggest cause of mortality. We have no set protocol in LPT for how to manage and monitor Constipation in Clozapine initiation in the inpatient setting. Internationally protocols, (such as the Porirua protocol) exist but have not been widely used locally.We wanted to assess local compliance with monitoring constipation in patients admitted to hospital and started on Clozapine. We also wanted to assess whether patients are prescribed PRN or regular laxatives, before considering implementing a local protocol.MethodIn LPT we use the ZTAS system for prescribing Clozapine. They provided us with a list of patient IDs who had recently started on Clozapine.We captured data on patients started on Clozapine. 1.What date was this started?2.What date was either PRN or regular laxatives started?3.Was a bowel chart recorded?4.Any evidence of constipation or significant bowel issues relating to Clozapine?ResultWe initially analysed 30 patients, (20 of whom were initiated on Clozapine as inpatients, and 10 as outpatients). A bowel chart was started in only 1 inpatient. Laxatives were started in 50% (15, only 3 of whom were outpatients). 14 were regular and 1 was a PRN prescription. 12 inpatients had constipation, and 1 outpatient suffered with constipation. 2 patients suffered with diarrhoea but there were no other significant issues with bowel problems.ConclusionFrom our initial data we can see that there are many inconsistencies in practice.Existing patients on Clozapine attend a local clinic, (Clozapine clinic) where ongoing monitoring of constipation, (and other parameters, e.g. ECGs etc are completed).We have written a new protocol which we will share, that the trust has implemented, that identifies when PRN and regular laxatives should be prescribed. We have also expanded the protocol to agree for initiation of Olanzapine bowel charts and PRN laxatives should be used.

Connected Skiing: Motion Quality Quantification in Alpine Skiing

Recent developments in sensing technology have made wearable computing smaller and cheaper. While many wearable technologies aim to quantify motion, there are few which aim to qualify motion. (2) To develop a wearable system to quantify motion quality during alpine skiing, IMUs were affixed to the ski boots of nineteen expert alpine skiers while they completed a set protocol of skiing styles, included carving and drifting in long, medium, and short radii. The IMU data were processed according to the previously published skiing activity recognition chain algorithms for turn segmentation, enrichment, and turn style classification Principal component models were learned on the time series variables edge angle, symmetry, radial force, and speed to identify the sources of variability in a subset of reference skiers. The remaining data were scored by comparing the PC score distributions of variables to the reference dataset. (3) The algorithm was able to differentiate between an expert and beginner skier, but not between an expert and a ski instructor, or a ski instructor and a beginner. (4) The scoring algorithm is a novel concept to quantify motion quality but is limited by the accuracy and relevance of the input data.

Detraining Effects on Muscle Quality in Older Men with Osteosarcopenia. Follow-Up of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)

The present study aimed to determine the effect of detraining on muscle quality (MQ) in older men with osteosarcopenia. Forty-three community-dwelling older men (78 ± 4 years) were randomly allocated to a consistently supervised high-intensity resistance exercise training (HIRT) group (n = 21) or a control group (CG, n = 22). The HIRT scheduled a periodized single set protocol twice weekly. After the intervention, the men were subjected to six months of detraining. Muscle quality (MQ), defined as maximum isokinetic hip/leg extensor strength per unit of mid-thigh intra-fascia volume, was determined by magnetic resonance imaging (MRI) or per unit of thigh muscle mass assessed by dual-energy X-ray absorptiometry (DXA). Intention-to-treat analysis with multiple imputations was applied. We observed significant exercise effects for MQ (p = 0.001). During detraining, the HIRT group lost about one-third of the intervention-induced gain and displayed significantly (p = 0.001) higher MQ reductions compared to the CG. Nevertheless, after training and detraining, the overall intervention effect on MQ remained significant (p ≤ 0.004). In summary, six months of absence from HIRT induce a significant deleterious effect on MQ in older osteosarcopenic men. We conclude that intermitted training programs with training breaks of six months and longer should be replaced by largely continuous exercise programs, at least when addressing MQ parameters.

The Nymph Architect of the Cicada Guyalna chlorogena: Behaviours and Ecosystem

At the beginning of the last year of its larval life, the nymph of Guyalna chlorogena builds, from a vertical well, which is the result of a verticalization process from a deep horizontal gallery, a clay turret 20 to 40 cm high which appears as a regulating device of the physico-chemical conditions inside the burrow. The construction of the turret is remarkable for its finish. The nymph maintains, repairs and rebuilds it if necessary. It opens and closes it under certain circumstances. Before moulting, the nymph comes out at the top, opening it according to a set protocol and time schedule, using its chitins’ forelegs. The burrow is associated in a commensal relationship with arborescent Fabaceae species (of the Tachigali genus) through its nutrition mode, the suction of the elaborated sap in fine roots, close to the meristems.

A Cluster Set Protocol in the Half Squat Exercise Reduces Mechanical Fatigue and Lactate Concentrations in Comparison with a Traditional Set Configuration

Splitting sets into clusters has been shown to maintain performance during resistance training. This study compared the acute fatigue produced by a traditional (TSC) versus a cluster (CSC) set configuration in the smith machine half squat exercise. Fifteen males performed a single bout of TSC and CSC separated by 72–96 h. In the TSC, participants performed as many repetitions as possible until reaching a 20% drop in barbell velocity (MPV), while in the CSC, they performed the same number of repetitions with 15 seconds inter-repetition rest. Effects of both protocols in MPV, countermovement jump height (CMJ), and blood lactate (BLa) were measured. Significant differences between protocols were found for MPV of the last repetition (0.4 vs 0.5 m/s TSC and CSC) and BLa (6.8 mmol/L vs 3.2 mmol/L TSC and CSC). Significant drop of velocity from the first to the last repetition of the set (19.9%), decrease in CMJ height (35.4 vs 32.6 cm), and increase in BLa (2.1 vs 6.8 mmol/L) pre–post-exercise was observed just for the TSC protocol. The results of the present study showed that CSC reduces the lactate response and mechanical fatigue produced by a single set on the half squat exercise in comparison with TSC.

Regional differences in Ca2+ entry along the proximal-middle-distal muscle axis during eccentric contractions in rat skeletal muscle

Eccentric (ECC) contraction-induced muscle damage is associated with calcium ion (Ca2+) influx from the extracellular milieu through stretch-activated channels. It remains unknown whether Ca2+ influx consequent to repetitive ECC contractions is nonuniform across different muscle regions. We tested the hypothesis that there are regional differences in Ca2+ entry along the proximal-middle-distal muscle axis. Tibialis anterior (TA) muscles of adult male Wistar rats were exposed by reflecting the overlying skin and fasciae and ECC contractions evoked by peroneal nerve stimulation paired with simultaneous ankle extension (50 times/set, 2 protocols: 1 set and 10 sets). During ECC in the proximal, middle, and distal TA, we determined 1) muscle fiber extension by high-speed camera (200 frames/s) and 2) Ca2+ accumulation by in vivo bioimaging (Ca2+-sensitive probe Fura-2-acetoxymethyl ester). Muscle fiber extension from resting was significantly different among regions (i.e., proximal, 4.0%: < middle, 11.2%: < distal, 17.0%; ECC phase length at 500th contraction). Intracellular Ca2+ accumulation after 1 set of ECC was higher in the distal (1.46 ± 0.04, P < 0.05) than the proximal (1.27 ± 0.04) or middle (1.26 ± 0.05) regions. However, this regional Ca2+ accumulation difference disappeared by 32.5 min after the 1 set protocol when the muscle was quiescent and by contraction set 5 for the 10-set protocol. The initial preferential ECC-induced Ca2+ accumulation observed distally was associated spatially with the greater muscle extension compared with that of the proximal and middle regions. Disappearance of the regional Ca2+ accumulation disparity in quiescent and ECC-contracting muscle might be explained, in part, by axial Ca2+ propagation and account for the uniformity of muscle damage across regions evident 3 days post-ECC. NEW & NOTEWORTHY After 1 set of 50 eccentric (ECC) contractions in the anterior tibialis muscle, intracellular Ca2+ ([Ca2+]i) accumulation evinces substantial regional heterogeneity that is spatially coherent with muscle length changes (i.e., distal [Ca2+]i > middle, proximal). However, irrespective of whether 50 or 500 ECC contractions are performed, this heterogeneity is subsequently abolished, at least in part, by axial intracellular Ca2+ propagation. This Ca2+ homogenization across regions is consistent with the absence of any interregional difference in muscle damage 3 days post-ECC.