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The purpose of this study was to examine the effect of manipulation of joint angle on electromyographic (EMG) fatigue curves at different sites over the quadriceps muscle group. Eight subjects performed isometric knee extensions at 0.26, 0.79, and 1.31 rad from full extension for 1 min at 50% of maximum. EMG signals were recorded with a branched electrode lead system at proximal and distal sites over the vastus lateralis and vastus medialis. The 1-min contractions were analyzed for changes in integrated EMG (IEMG) and median power frequency (MPF) over time. The results showed that the fatigue slopes for IEMG were greatest at 0.79 rad. However, the MPF data showed the greatest slopes at 0.26 rad. We hypothesize that the decline in MPF at 0.26 rad is due to activation failure while the increase in IEMG at 0.79 rad is driven by contractile failure. In addition, the EMG fatigue rates within each joint angle were similar at all sites.

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Standard medical education dictates that the vast majority of cases of an alanine aminotransferase (ALT) level >1,000 IU/l will be due to acute ischaemia, acute drug-induced liver injury (DILI) (usually paracetamol) or acute viral hepatitis. There are very few references in the literature to other potential causes of an ALT >1,000 IU/l nor to the prognosis ascribed to each aetiology. In this study, we have confi rmed that the main causes of a dramatic ALT rise are ischaemic liver injury, DILI and viral hepatitis. Common bile duct stones and hepatitis E are two causes for which there needs to be a high index of suspicion as the necessary tests may not be in the clinician's fi rst-line investigation panel. Failing to fi nd a cause and determining that the cause was ischaemic both have poor prognostic implications.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effectiveness of Comprehensive Geriatric Assessment (CGA) in community-dwelling, high-risk, frail, older adults.

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We reviewed the outcomes of our dedicated clinic for suspected scaphoid fractures. The primary outcome measure was to test the reliability of accurately diagnosing an occult scaphoid fracture with a combination of anatomical snuff box, scaphoid tubercle, longitudinal compression tenderness, ulnar deviation and the pinch test. Cost savings of the new patient pathway was our secondary outcome measure. Between December 2016 and March 2020, 922 patients were recruited at a mean of 12 days post-injury. Sixty-five per cent ( n = 602) with a low clinical suspicion were discharged and 35% ( n = 320) with a high clinical suspicion had same day MRI scan. Fifty-eight scaphoid fractures were diagnosed and treated with no nonunions reported. Anatomical snuff box tenderness was the most sensitive test (90%). A combination of five tests better excluded an occult fracture (80% accuracy). The dedicated scaphoid clinic pathway resulted in 350 fewer follow-up visits and an overall saving of £59,666. Level of evidence: III