SummaryBackgroundIntensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy.MethodsWe did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388.Findings3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p<0·0001).InterpretationAmong patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice.FundingNational Institutes of Health Research Health Technology Assessment Programme, British Heart Foundation.

Abstract:Despite the wide spread employment of Performance Analysis (PA) within the football coaching process to enhance augmented feedback, until recently little consideration has been given to the context in which PA delivery takes place at elite levels and subsequently impacts on players receiving such information. The aim of this investigation was to explore players' preferred engagement with the PA approach. Comparisons were also drawn between Senior and Academy players. Method: A two phase methodology was employed. 48 male footballers from three English Championship football clubs completed an online questionnaire. Following this 22 players were selected using an opportunistic sample to complete a semi-structured interview. Results/ Discussion: In total, the hierarchical content analysis identified 26 higher order themes and 103 lower order themes. Three key themes emerged and were explored within the discussion: (1) the level of debate and player interaction differed greatly during video feedback sessions, (2) the use of video analysis is central to player self-reflection but the level of engagement with self-reflection varied across players, (3) the majority of players preferred some delay (between 24 and 48 hours) before receiving video feedback. Chi-square statistical analysis identified no meaningful differences in the responses between Senior and Academy players and as a result only descriptive findings were reported. These factors have provided further insight into the practical contexts in which PA is used and perceived by elite players. The most eminent findings have potential implications for coach and analyst education. Further contemplation should be given to the level of interaction during PA feedback as a result of the willingness and ability of a coach to engage a player in discussion regarding their performance and PA use within the player self-reflection process. Keywords:Match analysis, Video feedback, Player perceptions, Qualitative approaches, Hierarchical content analysis. Introduction:Augmented feedback is a broad concept and its many forms have been extensively reviewed (cf Hodges and Franks 2008). Augmented feedback has also been identified as an integral part of the delivery of the performance analysis (PA thereafter) process and approaches (O'Donoghue, 2010). Despite this there seems to be a gap between the research surrounding motor learning, feedback approaches (Hodges and Franks, 2008) and how this might translate to the delivery of PA information. Therefore one would suggest that the application of PA, within the feedback process specifically, hinges upon the ability of the coach to deliver information correctly and efficiently whilst taking into account a number of contexts, interpersonal and social factors Groom et al., 2012;Booroff et al., 2015).An important question that is key to the present study is the extent to which coaches are engaging players during video sessions and the impact these sessions have on a player's learning and subsequent performance. Traditionally spo...

Energy cost of exercise, recovery of [Formula: see text]O, MAP and blood markers were ameliorated after BR. Previously-reported mechanisms explain these findings, which are more noticeable during less-efficient walking at steep gradients (15-20%). These findings have practical implications for hill-walkers.

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