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The purpose of this study was to determine whether caffeinated gum influenced performance in a battery of soccer-specific tests used in the assessment of performance in soccer players. In a double-blind, randomized, crossover design, 10 male university-standard soccer players (age: 19 ± 1 years, stature: 1.80 ± 0.10 m, body mass: 75.5 ± 4.8 kg) masticated a caffeinated (200 mg; caffeine) or control (0 mg; placebo) gum on two separate occasions. After a standardized warm-up, gum was chewed for 5 min and subsequently expectorated 5 min before players performed a maximal countermovement jump, a 20-m sprint test, and the Yo-Yo Intermittent Recovery Test Level 1. Performance on 20-m sprints was not different between trials (caffeine: 3.2 ± 0.3 s, placebo: 3.1 ± 0.3 s; p = .567; small effect size: d = 0.33), but caffeine did allow players to cover 2.0% more distance during Yo-Yo Intermittent Recovery Test Level 1 (caffeine: 1,754 ± 156 m, placebo: 1,719 ± 139 m; p = .016; small effect size: d = 0.24) and increase maximal countermovement jump height by 2.2% (caffeine: 47.1 ± 3.4 cm, placebo: 46.1 ± 3.2 cm; p = .008; small effect size: d = 0.30). Performance on selected physical tests (Yo-Yo Intermittent Recovery Test Level 1 and countermovement jump) was improved by the chewing of caffeinated gum in the immediate period before testing in university-standard soccer players, but the sizes of such effects were small. Such findings may have implications for the recommendations made to soccer players about to engage with subsequent exercise performance.

Sublingual feverfew/ginger appears safe and effective as a first-line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache.

Background Home monitoring of urine protein is a critical component of disease management in childhood nephrotic syndrome. We describe the development of a novel mobile application, UrApp – Nephrotic Syndrome Manager, to aid disease monitoring. Methods UrApp was iteratively developed by a panel of two pediatric nephrologists and three research engineers from May 2017 to October 2018 for Apple iPhones. App features were devised by this expert panel to support urine monitoring and other home care tasks. Each feature and user-app interface element was systematically reviewed by the panel and iteratively redesigned to remove anticipated use issues. The app prototype was then refined based on two rounds of usability testing and semi-structured user interviews with a total of 20 caregivers and adolescent patients. The analytic function of UrApp in providing a camera read of the urine test strip was compared to a standard urinalysis machine using 88 patient urine samples and three iPhones, model versions 6S and 7. Exact agreement and weighted kappa were calculated between the UrApp and urinalysis machine reads. Results The final UrApp features include: camera read of a urine test strip; analysis of urine protein trends and alerts for new disease relapse/remission; transmission of urine protein results to providers; education materials; and medication reminders. During the second round of UrApp usability testing, all users were able to perform each of the functions without error and all perceived UrApp to be helpful and indicated that they would use UrApp. UrApp camera results had 97% exact agreement and an overall weighted kappa value of 0.91 (95% CI, 0.85–0.97) compared with standard urinalysis machine interpretation. Conclusions UrApp was specifically designed to support patients and families living with nephrotic syndrome by supporting disease monitoring and home management tasks. The technically innovative feature that makes this possible is the use of a smartphone camera to read the urine test strip. This novel tool has the potential to improve disease monitoring and reduce management burden. Electronic supplementary material The online version of this article (10.1186/s12911-019-0822-z) contains supplementary material, which is available to authorized users.

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Catheter ablation has become the mainstream treatment of atrial fibrillation, but still remains a challenge in those patient with persistent and long standing persistent atrial fibrillation. In addition of isolation of the pulmonary veins, any other areas that can trigger or perpetuate atrial fibrillation need to be isolated. Current technologies may allow to effectively deliver permanently lasting lesions, and therefore improve clinical outcomes after ablation. The specialized conduction system including the Bachmann and septopulmonary bundles, are important substrate targets for the management of atrial fibrillation. The anatomical location of these fibers, and the corresponding approach for ablation are described in this case.

Then the Genoways again the second time made another leap and a fell cry, and stept forward a little, and the Englishmen removed not one foot: thirdly, again they leapt and cried, and went forth till they came within shot; then they shot À ercely with their crossbows. Then the English archers stept forth one pace and let Á y their arrows so wholly [together] and so thick, that it seemed snow. When the Genoways felt the arrows piercing through heads, arms and breasts, many of them cast down their crossbows and did cut their strings and returned discomÀ ted. When the French king saw them Á y away, he said: "Slay these rascals, for they shall let and trouble us without reason." Then ye should have seen the men of arms dash in among them and killed a great number of them: and ever still the Englishmen shot whereas they saw thickest press. 1