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Background A widespread assumption across health systems suggests that greater clinicians’ involvement in governance and management roles would have wider benefits for the efficiency and effectiveness of healthcare organisations. However, despite growing interest around the topic, it is still poorly understood how managers with a clinical background might specifically affect healthcare performance outcomes. The purpose of this review is, therefore, to map out and critically appraise quantitatively-oriented studies investigating this phenomenon within the acute hospital sector. Methods The review has focused on scientific papers published in English in international journals and conference proceedings. The articles have been extracted through a Boolean search strategy from ISI Web of Science citation and search source. No time constraints were imposed. A manual search by keywords and citation tracking was also conducted concentrating on highly ranked public sector governance and management journals. Nineteen papers were identified as a match for the research criteria and, subsequently, were classified on the basis of six items. Finally, a thematic mapping has been carried out leading to identify three main research sub-streams on the basis of the types of performance outcomes investigated. Results and contribution The analysis of the extant literature has revealed that research focusing on clinicians’ involvement in leadership positions has explored its implications for the management of financial resources, the quality of care offered and the social performance of service providers. In general terms, the findings show a positive impact of clinical leadership on different types of outcome measures, with only a handful of studies highlighting a negative impact on financial and social performance. Therefore, this review lends support to the prevalent move across health systems towards increasing the presence of clinicians in leadership positions in healthcare organisations. Furthermore, we present an explanatory model summarising the reasons offered in the reviewed studies to justify the findings and provide suggestions for future research.

A global emergency characterized by a respiratory illness called COVID-19 has spread worldwide in early 2020. Preventive measures to reduce the risk of infection include social distancing and the closing of commercial activities to avoid social gatherings. Elite sport is also tremendously affected: ongoing championships have been suspended and the major international events have been postponed. Most elite athletes are forced to train at home, on their own and mostly unsupervised. Some elite sports clubs have provided players with home-based training programs and/or organized video conferences for online training sessions lead by their fitness trainers. Here, Impellizzeri et al discuss the potential physiological changes due to COVID-19 home confinement on athlete health protection in elite sports.

Purpose This study sought to investigate the electromyographic activity of the vastus lateralis (VL) muscle during concentric-eccentric exercise using a new concept leg press machine enabling a preset overloading in the eccentric phase. Methods Ten young males familiar with resistive exercise were recruited for this study. Tests were performed on a Leg-press Biostrength® (Technogym S.p.A., Italy). The load was set to 70% and 80% of one-repetition maximum (1-RM). The participants performed 2 sets of 6 repetitions at each relative load with (ECC +) and without (ISOW) an eccentric overload equivalent to 150% of the concentric load. A metronome was employed to maintain the selected cadence. Sets were separated by a 5-min rest. Surface electromyography (EMG) of VL was recorded and integrated (iEMG). Results Results showed a higher iEMG in ECC + with respect to ISOW at both intensities (+ 29% for 70% 1-RM, p  < 0.01 and + 31% for 80% 1-RM, p  < 0.001). No statistically significant differences were detected between concentric and eccentric phase in both ECC + conditions. Conclusions Training with a 150% eccentric overload provides a ~ 30% greater motor unit recruitment of the VL muscle in leg press exercise. Moreover, the results show that the eccentric overloading provided by the Biostrength® machine enables training at the same level of neural activation of the concentric phase. Hence, the derecruitment of motor units, normally observed during the eccentric phase when using conventional training machines, was overcome using the Biostrength® machine; this observation seems particularly important for maximizing neuromuscular responses to strength training.

ObjectivesAccording to Italian law, prevention of injuries in the workplace falls under the National Health System Service of Prevention, Health and Safety at Work (SPISAL). In a sample of about 5000 industrial firms in the Veneto region (North-Eastern Italy), the study examines the impact of SPISAL safety programmes on injuries.MethodsThe study is based on the before-and-after comparison of injury rates in 795 industrial settings that were subject to SPISAL interventions and 4186 reference firms, which were all manufacturing industries with >10 employees; construction companies were excluded. The time window (2001–2007) was chosen in order to have 8 quarters of observation before and 8 after the intervention. The National Institute for Workers’ Compensation provided data on injuries and plants, while SPISAL gave information on interventions carried out. The preintervention and postintervention rates of injuries were compared by means of interrupted time series analyses, estimating the rate ratio (RR) with a 95% CI.ResultsInspection after injury reduced by 24% (RR=0.76; 95% CI 0.65 to 0.90; p=0.001) all injuries, and by 36% (RR=0.64; 95% CI 0.50 to 0.83; p=0.001) severe injuries (fatalities, lost workdays >30, degree of permanent disability >0). These changes occurred immediately and persisted for 2 years. The effects of programmed inspections were never significant.ConclusionsIt can be presumed that, after a severe injury, the employees raised their standard of what they considered good work safety and, at the same time, the employers were pushed to improve the work environment as a result of the sudden attention from the workplace hygiene and safety authority and court authority. Inspection after injury was an effective strategy; however, confirmatory evidence is needed.

Fleischmann and Pons effect (FPE) is the production of excess power during electrochemical loading of deuterium in palladium. This effect has the following features: (1) It is a threshold effect (loading D/Pd › 0.9). (2) It is unobserved when electrochemical loading is performed with hydrogen from light water. (3) It is unexplainable as a chemical effect. (4) It occurs only if the involved materials have specific characteristics. The present article will review aspects concerning the occurrence of FPE related to materials science, a field considered to be a key to define the effect and a research approach has been conceived to find correlations with the material status. Metallurgy, crystallographic orientation and surface morphology all together are the necessary conditions to observe the phenomenon. In general, these features affect the deuterium adsorption/absorption in palladium cathodes. On the other hand, crystal orientation seems not to be crucial for PdRh alloy. A preliminary study, based on galvanostatic electrochemical impedance spectroscopy, has been carried out to investigate the status of the electrochemical interface during the effect. Results point in the direction of a significant change in the equivalent circuit at the electrode interface, as the electrode is active.

Following some recent unexpected hints of neutron production in high-voltage atmospheric discharges, we present a measurement of the neutron flux in plasma discharges in electrolytic cells. We use two different types of neutron detectors, polyallyl diglycol carbonate (PADC, aka CR-39) tracers and indium disks. At 95 % C.L. we provide an upper limit of 1.5 neutrons cm - 2  s - 1 for the thermal neutron flux at ≈ 5 cm from the center of the cell. Allowing for a higher energy neutron component, the largest allowed flux is 64 neutrons cm - 2  s - 1 . This upper limit is two orders of magnitude smaller than the signal previously claimed in an electrolytic cell plasma discharge experiment. Furthermore the behavior of the CR-39 is discussed to point out possible sources of spurious signals.

Background Ageing is accompanied by a progressive loss of skeletal muscle mass and strength, potentially determining the insurgence of sarcopenia. Evidence suggests that motoneuron and neuromuscular junction (NMJ) degeneration contribute to sarcopenia pathogenesis. Seeking for strategies able to slow down sarcopenia insurgence and progression, we investigated whether a 2‐year mixed‐model training involving aerobic, strength and balance exercises would be effective for improving or preserving motoneuronal health and NMJ stability, together with muscle mass, strength and functionality in an old, sarcopenic population. Methods Forty‐five sarcopenic elderly (34 females; 11 males) with low dual‐energy X‐ray absorptiometry (DXA) lean mass and Short Physical Performance Battery (SPPB) score <9 were randomly assigned to either a control group [Healthy Aging Lifestyle Education (HALE), n = 21] or an intervention group [MultiComponent Intervention (MCI), n = 24]. MCI trained three times per week for 2 years with a mix of aerobic, strength and balance exercises matched with nutritional advice. Before and after the intervention, ultrasound scans of the vastus lateralis (VL), SPPB and a blood sample were obtained. VL architecture [pennation angle (PA) and fascicle length (Lf)] and cross‐sectional area (CSA) were measured. As biomarkers of neuronal health and NMJ stability status, neurofilament light chain (NfL) and C‐terminal agrin fragment (CAF) concentrations were measured in serum. Differences in ultrasound parameters, NfL and CAF concentration and physical performance between baseline and follow‐up were tested with mixed ANOVA or Wilcoxon test. The relationship between changes in physical performance and NfL or CAF concentration was assessed through correlation analyses. Results At follow‐up, MCI showed preserved VL architecture (PA, Lf) despite a reduced CSA (−8.4%, P < 0.001), accompanied by maintained CAF concentration and ameliorated overall SPPB performance (P = 0.007). Conversely, HALE showed 12.7% decrease in muscle CSA (P < 0.001), together with 5.1% and 5.5% reduction in PA and Lf (P < 0.001 and P = 0.001, respectively), and a 6.2% increase in CAF (P = 0.009) but improved SPPB balance score (P = 0.007). NfL concentration did not change in either group. In the population, negative correlations between changes in CAF concentration and SPPB total score were found (P = 0.047), whereas no correlation between NfL and SPPB variations was observed. Conclusions The present findings suggest that our 2‐year mixed aerobic, strength and balance training seemed effective for preventing the age and sarcopenia‐related increases in CAF concentration, preserving NMJ stability as well as muscle structure (PA and Lf) and improving physical performance in sarcopenic older individuals.

To study static and dynamic postural balance control in elite and sub-elite male volleyball players with or without a history of musculoskeletal lower limb injuries. Cross-sectional study. Laboratory. Data were obtained from 45 male volleyball players, divided into healthy (CON, n = 28) and previously injured (INJ, n = 17) players by means of an injury self-reported questionnaire. Static postural balance parameters were recorded carrying out a monopodalic test with the dominant leg on a stabilometric platform. Dynamic postural balance was assessed with the modified Star Excursion Balance Test (mSEBT) in its version based on three directions (anterior, postero-lateral and postero-medial). No statistically significant differences were detected between CON and INJ for all the static postural balance parameters considered. Conversely, the mSEBT results underlined a statistically significant decrease of the performance in the three directions (P < .001) for INJ with respect to CON. The mSEBT should be employed in male volleyball players with a history of musculoskeletal lower limb injuries to better assess postural balance control alterations. Moreover, the decrement of the dynamic balance performance may indicate that, before returning to competitions, the rehabilitation protocol should be more focused on dynamic balance exercises. •A prior history of injury did not affect static balance in male volleyball players.•mSEBT discriminated male volleyball players with and without a history of injuries.•Balance assessment should include the modified SEBT.

Ten sanitary workers exposed to concentrations of ethylene oxide below 1 ppm were studied to determine whether effects could be observed at low exposure levels. A significant increase in the number of sister chromatid exchanges in cultured lymphocytes was found only for five subjects with relatively high exposure in the sterilization area. However, it was not possible to separate clearly the effect of smoking from that of ethylene oxide exposure. No increase in the frequencies of micronuclei in lymphocytes and buccal cells was found. The level of 2-hydroxyethyl adducts to the N-terminal valines in hemoglobin responded in a reliable fashion to chronic ethylene oxide exposure and smoking. Furthermore, measurement of levels of 2-hydroxyethyl adducts to the N-terminal valines in hemoglobin made it possible to reconstruct the dynamics of a leakage of ethylene oxide which involved three workers.

Sanitary workers exposed to concentrations of ethylene oxide below 1 ppm were studied to determine whether effects could be observed at low exposure levels. A significant increase in the number of sister chromatid exchanges in cultured lymphocytes was found only for subjects with relatively high exposure in the sterilisation area. (Abstract amended)