A test of the 2 × 2 Model of Perfectionistic Pressure in youth sport.

Perfectionistic pressure from coaches and parents is likely to contribute to the development of perfectionism in youth athletes. However, if and how perfectionistic pressure from coaches and parents interact to predict the development of perfectionism is unknown. With this in mind, the present study tested a new model - the 2 × 2 Model of Perfectionistic Pressure - that focuses on the different combinations of perfectionistic pressure youth athletes can experience. Four within-person combinations of perfectionistic pressure are identified and compared: Pure coach pressure (high coach pressure/low parental pressure), pure parental pressure (low coach pressure/high parental pressure), mixed pressure (high coach pressure/high parental pressure), and low pressure (low coach pressure/low parental pressure). To test the model, a sample of 210 youth athletes (M age = 14.68 years) completed measures of perfectionistic strivings, perfectionistic concerns, coach pressure to be perfect, and parental pressure to be perfect. Moderated hierarchical regression and simple slopes analyses revealed that mixed pressure was related to the highest levels of both perfectionistic strivings and perfectionistic concerns. The findings provide initial evidence for the new model and suggests it will be useful in studying the development of perfectionism and other outcomes in sport.

Predictive Factors of Negative Spillover From Caregiving to Employment Among Japanese Family Caregivers With Older Relatives in a Care Facility.

This cross-sectional study included 211 employed family caregivers with older relatives living in care facilities in Japan. Using multiple linear regression analysis, we examined the caregiving context after institutionalization of an older family member. Specifically, we examined predictors of negative spillover from caregiving to employment among family caregivers. The outcome was the extent of negative spillover. Primary predictors included caregiver characteristics and postinstitutionalization caregiving contexts such as caregiving tasks and dissatisfaction with institutional care services. Among all caregivers, 134 (63.5%) were female, and approximately half of all caregivers reported satisfaction with institutional care services. We found that dissatisfaction with institutional care services and being a female each had a main effect on greater negative spillover. However, they did not have any interacting effect on negative spillover after the institutionalization. Negative spillover did not terminate when older family members were institutionalized. Higher satisfaction with institutional care may reduce negative spillover.

The association of families' socioeconomic and demographic characteristics with parents' perceived barriers to returning to youth sport following the COVID-19 pandemic.

Developmentally appropriate sport contexts have the potential to positively influence young people's physiological, psychological, and social outcomes. However, little is known about how families returned to sport in the wake of COVID-19-related restrictions or how socioeconomic and demographic factors influenced parents' perceptions of barriers to returning. A nationally representative sample (N = 6183) of American youth sport parents completed a questionnaire in which they provided demographic information and answered questions related to the barriers they perceived in returning to sport, such as the risk of their child getting sick. Structural equation modeling was used to examine the relationships among a range of socioeconomic and demographic factors and these barriers to returning. Results suggest that parents from racially minoritized and urban neighborhoods held higher levels of concern over health-related and practical barriers to returning to sport. Findings highlight the importance of designing available, equitable, and appropriate youth sport contexts.

Effect of Concussion on Reaction Time and Neurocognitive Factors: Implications for Subsequent Lower Extremity Injury.

Background: Recent evidence has demonstrated that athletes are at greater risk for a lower extremity injury following a return-to-sport (RTS) after sport-related concussion (SRC). The reason for this is not completely clear, but it has been hypothesized that persistent deficits in neurocognitive factors may be a contributing factor. Hypothesis/Purpose: This study assessed simple reaction time, processing speed, attention, and concentration in a group of athletes, post-concussion upon clearance for RTS for potential deficits that may result in slower reaction time, processing speed, attention, and concentration. The researchers hypothesized that the concussion group would demonstrate worse scores on both assessments compared to a sex-, age-, and sport-matched cohort. Study Design: Case-controlled study. Methods: Twelve participants who had suffered a SRC and eight healthy individuals who were matched to the concussed group by age, sex, and sport were evaluated. Those with a concussion had been cleared for RTS by a licensed healthcare provider. Each participant underwent neurocognitive tests that included a simple reaction time test (SRT) and the King-Devick Test (K-D). Independent t-tests were performed to compare the groups with significance set a priori at p<0.05. Results: There was a significant difference (p =0.024) between groups for SRT with the concussed group demonstrating a better SRT than the control group. There were no significant differences (p =0.939) between the groups for the K-D. Conclusion: With no significant differences between groups in the K-D assessment and, surprisingly, the concussed group having a better SRT compared to the healthy group, our hypothesis was not supported. Clinical Relevance: These specific measures, compounded with extensive post-concussion time lapse until RTS clearance, may have limited capacity in revealing potential persistent deficits in relevant neurocognitive characteristics. Level of Evidence: Level of Evidence 3.

Functional limitations before and after cancer diagnosis and contributing factors: findings from the China health and retirement longitudinal study.

BACKGROUND: Although there is a general trend of functional decline with age, there lacks an understanding of how cancer diagnosis and other factors may contribute to this trend. This study aimed to examine functional limitation trajectories among adults with and without cancer, and before versus after the cancer diagnosis, and to explore potential contributing factors associated with functional trajectories among cancer survivors. METHODS: The sample were middle-aged and older Chinese adults who participated in all 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Ordinary and multiphase growth curve analyses were conducted to examine (1) differences in functional trajectories between participants with (n = 139) and without cancer (n = 7,313), (2) pre-and post-cancer diagnosis changes in functional limitations among those who reported a cancer diagnosis over the 4-year timeframe, and (3) contributing factors associated with functional trajectories among cancer survivors, guided by the Disablement Process Models, including psychological (depressive symptoms), physical (pain and falls), cognitive (self-reported memory problems), and environmental (social contact and available support) factors. RESULTS: There was a trend of increased functional limitations among all participants over time (unstandardized ß = 0.17, p < .0001). However, participants with cancer did not differ from non-cancer participants in neither the level (unstandardized ß = 0.77, p = .08) nor the rate of functional decline (unstandardized ß = -0.43, p = .07). Functional limitation trajectories were different pre- versus post-cancer diagnosis, although not in expected directions (unstandardized ß = -0.48, p < .05). Cancer survivors with greater pain had higher levels of functional limitations which were sustained over time compared to those with less pain (unstandardized ß = 0.93, p < .001). CONCLUSIONS: The study confirmed that Chinese middle-aged and older adults had overall decreased functional decline over time. A novel finding that cancer survivors experienced less rapidly functional decline after the cancer diagnosis suggested that cancer diagnosis might serve as an inflection point at which early intervention is promising to slow the functional decline. In addition, findings that within-person contributing factors, such as pain, can be influential in functional limitation trajectories suggested that more attention is needed to pay to patients with cancer-pain. These findings demonstrated the heterogeneity of functional limitation trajectories and needs for person-centered interventions among Chinese cancer survivors.

Daily Sleep and Anxious and Depressive Symptoms Among Dementia Caregivers-The Mediation of Cortisol Total Output on High- and Low-Stress Days.

OBJECTIVES: Dementia family caregivers report poor sleep and mood, typically attributed to chronic stress and managing frequent daily stressors. Although many studies use global retrospective reports of these indicators, the current study examines mechanisms linking sleep, negative affect, stress biomarkers, and high-/low-stress contexts at the daily level, from the biopsychosocial perspective of stressor exposure and reactivity. METHOD: One hundred seventy-three caregivers (Mage = 61.97, SD = 10.66) were providing care at home and used adult day services (ADS) at least 2 days a week. Caregivers reported their bedtime, wake time, sleep quality, and nighttime problems of the person with dementia (PwD) daily for eight consecutive days, concurrently reporting noncare stressors, negative affect, and providing five salivary cortisol samples per day. We conducted multilevel analysis to examine whether caregiver sleep characteristics overnight (i.e., total time in bed, quality, and PwD sleep problems) were associated with their anxious and depressive symptoms on days where ADS were utilized versus non-ADS days (i.e., low stress vs. high stress), and whether cortisol daily total output as area under the curve (AUCg) mediated the direct associations, at the within- and between-person levels. RESULTS: On high-stress (i.e., non-ADS) days when caregivers had a longer time in bed than usual the night before, they were less anxious on the following day; the direct association was statistically mediated through lower cortisol AUCg during the day. DISCUSSION: Staying longer in bed than usual before an upcoming high-stress day may help dementia family caregivers better regulate cortisol stress reactivity and anxious symptoms.

Pre-triage wait times for non-ambulance arrivals in the emergency department: A retrospective video audit.

BACKGROUND: Pre-triage emergency department (ED) waiting times can be lengthy when presentation numbers are high. Queuing is random, affecting flow management and patient care. We investigated pre-triage wait times and barriers to triage access at an Australian ED. METHODS: A reviewer conducted a retrospective audit of triage reception security video camera footage (February-March, 2020). The reviewer manually documented self-presenting patients' wait-to-be-seen times and barriers to patient flow. RESULTS: The audit identified three main topics: lengthy pre-triage wait times, pre-triage queuing and observed barriers to triage. Median pre-triage wait time was 12 min (IQR = 5-21; n = 141), with no apparent relationship between patients' wait time and time of arrival. During peak or busy periods, multiple random queues formed at the triage reception area. Triage nurses could not concurrently triage and provide queue control during busy periods. CONCLUSIONS: Unrecorded pre-triage wait times may exceed 20 min. This unseen time may extend beyond the estimated post-triage wait times suggested by the Australasian Triage Scale (ATS). There was a degree of disorder in patient queueing, reducing effective door-to-triage productivity. Larger studies could determine these findings' external replicability, with additional research addressing potential benefits of pre-triage queuing processes or a departmental concierge.

Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management.

BACKGROUND: First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seromacontaining atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS: New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS: The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of transgenic Bacillus thuringiensis cotton on insecticide use, heliothine counts, plant damage, and cotton yield: A meta-analysis, 1996-2015.

The primary management tactic for lepidopteran pests of cotton in the United States of America (USA) is the use of transgenic cotton that produces Bacillus thuringiensis Berliner (Bt) toxins. The primary target pests of this technology are Helicoverpa zea (Boddie) and Heliothis virescens (F.) in the eastern and central Cotton Belt of the USA. Concerns over the evolution of resistance in H. zea to Bt toxins and scrutiny of the necessity of Bt crops has escalated. We reviewed published and unpublished data from field trials of Bt cotton in the eastern and central Cotton Belt of the USA through 2015 to evaluate the effectiveness of Bt cotton (Bollgard, Bollgard II, WideStrike, WideStrike 3, and TwinLink). Bt cotton reduced insecticide usage, reduced heliothine pest numbers and damage, and provided a yield benefit, but Bollgard II and WideStrike efficacy declined in the Midsouth over the period evaluated. In the Southeastern region, heliothine damage remained constant through 2015, but yield benefits declined from 2010 until 2015. Resistance of H. zea to several Bt toxins is the most plausible explanation for the observed changes in Bt cotton efficacy. The introduction of new Bt toxins such as found in Widestrike 3 and Twinlink may preserve the benefits of Bt crops. However, while both Widestrike 3 and Twinlink had less damage than Widestrike, damage levels of both were similar to Bollgard II.

Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management.

BACKGROUND: First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seroma-containing atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS: New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS: The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Phosphoproteome Integration Reveals Patient-Specific Networks in Prostate Cancer.

We used clinical tissue from lethal metastatic castration-resistant prostate cancer (CRPC) patients obtained at rapid autopsy to evaluate diverse genomic, transcriptomic, and phosphoproteomic datasets for pathway analysis. Using Tied Diffusion through Interacting Events (TieDIE), we integrated differentially expressed master transcriptional regulators, functionally mutated genes, and differentially activated kinases in CRPC tissues to synthesize a robust signaling network consisting of druggable kinase pathways. Using MSigDB hallmark gene sets, six major signaling pathways with phosphorylation of several key residues were significantly enriched in CRPC tumors after incorporation of phosphoproteomic data. Individual autopsy profiles developed using these hallmarks revealed clinically relevant pathway information potentially suitable for patient stratification and targeted therapies in late stage prostate cancer. Here, we describe phosphorylation-based cancer hallmarks using integrated personalized signatures (pCHIPS) that shed light on the diversity of activated signaling pathways in metastatic CRPC while providing an integrative, pathway-based reference for drug prioritization in individual patients.

Susceptibility to insecticides and activities of glutathione S-transferase and esterase in populations of Lygus lineolaris (Hemiptera: Miridae) in Mississippi.

BACKGROUND: Lygus lineolaris (Palisot de Beauvois) is a serious pest of cotton (Gossypium hirsutum L.) in Mississippi, particularly in the Delta region. This may be due to decreased insecticide susceptibility in that region. Research has revealed populations of L. lineolaris in the Delta region with high levels of insecticide resistance; however, comparisons with populations in the remainder of the state are limited. RESULTS: Experiments were undertaken to compare the LC50 values and activities of detoxification enzymes of L. lineolaris populations. The results of these studies indicated that the LC50 values were not different between the Delta and Hills regions, but differences were significant between populations within and across regions. Results of the detoxifying enzyme activity assays revealed significantly higher esterase activity in the Delta region when compared with the Hills. Glutathione S-transferase activity was not different between regions, but differences within and across regions were significant. CONCLUSION: The results indicated that glass-vial assays to determine and compare LC50 values may be less accurate than enzymatic assays for detecting insecticide susceptibility differences. Higher esterase activity is likely a contributing factor to the difficulties with managing L. lineolaris in the Mississippi Delta region. © 2015 Society of Chemical Industry.

Clinical evaluation of a bioresorbable implant for medialization of the middle turbinate in sinus surgery.

BACKGROUND: During endoscopic sinus surgery (ESS), postoperative lateralization of the middle turbinate can lead to scarring and obstruction of key drainage pathways, including the osteomeatal complex. The technique of suturing the middle turbinate to the nasal septum to enhance exposure can be difficult and time consuming. This study presents the first clinical results using the Middle Turbinate Implant (MTI), a device composed of absorbable copolymer polylactide-co-glycolide and intended to medialize the middle turbinate during surgical procedures such as ESS. METHODS: The trial included 22 implantations (21 successful implantations) on 14 subjects (6 unilateral and 8 bilateral implantations). The primary outcome measure was the position of the middle turbinate at 1, 2, and 4 weeks postoperatively. The extent of tissue reaction at the site of implantation was also evaluated. RESULTS: At 1, 2, and 4 weeks postoperatively, 100% of the middle turbinates were held medially or in the neutral position with no significant synechiae present. At 1, 2, and 4 weeks postoperatively, there was either no (95%, 90%, and 95%) or mild (5%, 10%, and 5%) tissue reaction at the site of implantation. No complications were noted during implantation. CONCLUSION: The use of the bioresorbable MTI appears to be a safe and effective method of medializing the middle turbinate during ESS.