A case of vitamin B12 deficiency neurological syndrome in a young adult due to late-onset cobalamin C (CblC) deficiency: a diagnostic challenge

Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with ‘catatonic depression’ and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.     

Maximizing recovery time between knock-out races improves sprint cross-country skiing performance

Background:In a sprint cross-country(XC)ski competition,the difference in recovery times separating the first and the second semi-final(SF)heats from the final(F)may affect performance.The aim of the current study was to compare the effects of longer vs.shorter recovery periods prescribed between the 3 knock-out races of a simulated sprint XC ski competition involving a prologue(P),quarter-final(QF),SF,and F.Methods:Eleven well-trained XC ski athletes completed 2 simulated sprint XC ski competitions on a treadmill involving 4×883-m roller-ski bouts at a 4°incline using the gear 3 ski-skating sub-technique.The first 3 bouts were completed at a fixed speed(PFIX,QFFIX,and SFFIX)corresponding to~96%of each individual’s previously determined maximal effort.The final bout was performed as a self-paced sprint time trial(FSTT).Test conditions differed by the time durations prescribed between the QFFIX,SFFIX,and FSTT,which simulated real-world XC ski competition conditions using maximum(MAX-REC)or minimum(MIN-REC)recovery periods.Results:The FSTT was completed 5.4±5.5 s faster(p=0.009)during MAX-REC(179.2±18.1 s)compared to MIN-REC(184.6±20.0 s),and this was linked to a significantly higher power output(p=0.010)and total metabolic rate(p=0.009).The pre FSTT blood lactate(BLa)concentration was significantly lower during MAX-REC compared to MIN-REC(2.5±0.8 mmol/L vs.3.6±1.6 mmol/L,respectively;p=0.027),and the pre-to-post FSTT increase in BLa was greater(8.8±2.1 mmol/L vs.7.1±2.3 mmol/L,respectively;p=0.024).No other differences for MAX-REC vs.MIN-REC reached significance(p>0.05).Conclusion:Performance in a group of well-trained XC skiers is negatively affected when recovery times between sprint heats are minimized which,in competition conditions,would occur when selecting the last QF heat.This result is combined with a higher pre-race BLa concentration and a reduced rise in BLa concentration under shorter recovery conditions.These findings may help inform decision making when XC skiers are faced with selecting a QF heat within a sprint competition.     

‘This could be our reality in the next five to ten years’: a blogpost platform as an expectation generation device on the future of insurance markets

William James (1919) characterises hypotheses as either live or dead. A hypothesis is live when it is taken into account as a ‘real possibility’. We follow James’ suggestion to not attribute intrinsic properties to hypotheses, but rather investigate how they came into being and look at the effects they generate. Expectations of digital technologies are a topic of vivid debate in the insurance industry. Before these expectations can become ‘live’, they have, in the first place, to be generated by market devices. We investigate how the reinsurance blogpost platform Open Minds functions as an ‘expectation generation device’ on the future of insurance markets. Combining Beckert’s work on the role of fictional expectations with the pragmatist turn in sociology of markets, we propose to study ‘expectation generation devices’, provoking expectations on economic markets. In our empirical analysis, we demonstrate the explicit fictional character of the Open Minds contributions, and analyse how a contained space of openness is generated to provoke expectations. We demonstrate how Open Minds can become live through circulation to other expectation generation sites in the insurance industry and beyond. We conclude by reflecting on the importance of expectation generation devices as a particular type of market devices.     

Academic Habitus and Institutional Change: Comparing Two Generations of German Scholars

Minerva - Since the 1980s scholars have been increasingly confronted with expectations to orient themselves toward societal and economic priorities. This normative demand for societal...     

Sand training: Exercise-induced muscle damage and inflammatory responses to matched-intensity exercise

This study compared markers of muscle damage and inflammation elevated by a matched-intensity interval running session on soft sand and grass surfaces. In a counterbalanced, repeated-measures and crossover design, 10 well-trained female athletes completed 2 interval-based running sessions 1 week apart on either a grass or a sand surface. Exercise heart rate (HR) was fixed at 83–88% of HR maximum. Venous blood samples were collected pre-, post- and 24?h post-exercise, and analysed for myoglobin (Mb) and C-reactive protein (CRP). Perceptual ratings of exertion (RPE) and muscle soreness (DOMS) were recorded immediately post- and 24?h post-exercise. A significant time effect showed that Mb increased from pre- to post-exercise on grass (p?=?.008) but not on sand (p?=?.611). Furthermore, there was a greater relative increase in Mb on grass compared with that on sand (p?=?.026). No differences in CRP were reported between surfaces (p?>?.05). The HR, RPE and DOMS scores were not significantly different between conditions (p > .05). These results suggest that in response to a matched-intensity exercise bout, markers of post-exercise muscle damage may be reduced by running on softer ground surfaces. Such training strategy may be used to minimize musculoskeletal strain while still incurring an equivalent cardiovascular training stimulus.     

A novel sleep optimisation programme to improve athletes’ well-being and performance

Objectives: To improve well-being and performance indicators in a group of Australian Football League (AFL) players via a six-week sleep optimisation programme. Design: Prospective intervention study following observations suggestive of reduced sleep and excessive daytime sleepiness in an AFL group. Methods: Athletes from the Adelaide Football Club were invited to participate if they had played AFL senior-level football for 1–5 years, or if they had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >10), measured via ESS. An initial education session explained normal sleep needs, and how to achieve increased sleep duration and quality. Participants (n?=?25) received ongoing feedback on their sleep, and a mid-programme education and feedback session. Sleep duration, quality and related outcomes were measured during week one and at the conclusion of the six-week intervention period using sleep diaries, actigraphy, ESS, Pittsburgh Sleep Quality Index, Profile of Mood States, Training Distress Scale, Perceived Stress Scale and the Psychomotor Vigilance Task. Results: Sleep diaries demonstrated an increase in total sleep time of approximately 20?min (498.8?±?53.8 to 518.7?±?34.3; p?<?.05) and a 2% increase in sleep efficiency (p?<?0.05). There was a corresponding increase in vigour (p?<?0.001) and decrease in fatigue (p?<?0.05). Conclusions: Improvements in measures of sleep efficiency, fatigue and vigour indicate that a sleep optimisation programme may improve athletes’ well-being. More research is required into the effects of sleep optimisation on athletic performance.     

Effect of the look-up line on the gaze and head orientation of elite ice hockey players

Abstract

A “look-up line” (LUL) has been proposed for ice hockey, which is an orange 1?m (40′) warning line (WL) painted on the ice at the base of the boards. The LUL purports to provide an early warning to players to keep their head up prior to and as they are being checked. We determined if players looked up more on a rink with the LUL compared to a traditional Control rink. Elite offensive (O) and defensive (D) players competed 1 vs. 1, while wearing an eye tracker that recorded their quiet eye (QE) and fixation and tracking (F-T) and an electrogoniometer that measured head angle. External cameras recorded skate duration during four skate phases: P1 preparation, P2 decision-making, P3 cut to boards, P4 contact. The QE was the final fixation prior to contact between O and D as they skated towards and across the WL during P3 and P4. Skate phase durations (%) did not differ by rink or rink by position. More QE and F-T occurred on the WL on the LUL rink than on the Control. The expected increase in head angle on the LUL rink did not occur during P3 or P4. Post-hoc results also showed O and D skated further from the boards on the LUL rink, suggesting the players preferred to control the puck on white ice, rather than the orange colour of the LUL rink. More research is needed to determine if these results apply to the competitive setting.