Correction: The Masters athlete in Olympic weightlifting: Training, lifestyle, health challenges, and gender differences.

[This corrects the article DOI: 10.1371/journal.pone.0243652.].

Early discharge after enhanced recovery rectal resection does not increase emergency department visits and readmissions: a single institution analysis.

BACKGROUND: Same-day discharge after colectomy in enhanced recovery pathways has been shown to be feasible. It is not clear how early patients with rectal resections may be safely discharged. The study aim was to determine if patients discharged ≤ 3 days after rectal resections are associated with increased rates of emergency department (ED) visits and hospital readmissions. METHODS: Retrospective analysis of enhanced recovery low anterior resection, abdominoperineal resection, and proctocolectomy patients in a prospectively maintained single institution colorectal surgery database from 01/01/2018 to 07/15/2022. Clinic visits were scheduled within 4-7 days and at 30 days after discharge, and every 1-2 weeks for stoma patients until no longer needed. Logistic regression models were used to analyze the association of discharge on postoperative days (POD)-1-3, POD-4-5, and POD ≥ 6 days with incidence of ED visits and readmissions. RESULTS: A total of 118 patients met inclusion criteria, 76 with stomas. Median postoperative length of stay was 5 [IQR 6.5] days. Mean age was 58.6 years; 59.3% were ASA-3; and 69.5% had a minimally invasive surgical approach. ED visits were not significantly different between discharge-day groups (p = 0.096). No patients were discharged same-day, one without a stoma was discharged on POD-1, ten patients (2 with stomas) on POD-2, and twenty-four patients (13 with stomas) on POD-3. ED visits were lowest for the POD-1-3 group (14.3%) but not significantly different than later discharge groups (p = 0.166). Readmission rate was also lowest for the POD-1-3 group (11.4%) and also not significantly different than later discharge groups (p = 0.261) and this was confirmed with logistic regression. Complication rate was lowest in the POD-1-3 group (p < 0.001). CONCLUSION: Early discharge after enhanced recovery partial or complete proctectomy is not associated with increased ED visits and readmissions. Follow up studies should identify post-discharge resources that allow safe early discharge and that may be standardized and generalizable.

Initial data analysis for longitudinal studies to build a solid foundation for reproducible analysis.

Initial data analysis (IDA) is the part of the data pipeline that takes place between the end of data retrieval and the beginning of data analysis that addresses the research question. Systematic IDA and clear reporting of the IDA findings is an important step towards reproducible research. A general framework of IDA for observational studies includes data cleaning, data screening, and possible updates of pre-planned statistical analyses. Longitudinal studies, where participants are observed repeatedly over time, pose additional challenges, as they have special features that should be taken into account in the IDA steps before addressing the research question. We propose a systematic approach in longitudinal studies to examine data properties prior to conducting planned statistical analyses. In this paper we focus on the data screening element of IDA, assuming that the research aims are accompanied by an analysis plan, meta-data are well documented, and data cleaning has already been performed. IDA data screening comprises five types of explorations, covering the analysis of participation profiles over time, evaluation of missing data, presentation of univariate and multivariate descriptions, and the depiction of longitudinal aspects. Executing the IDA plan will result in an IDA report to inform data analysts about data properties and possible implications for the analysis plan-another element of the IDA framework. Our framework is illustrated focusing on hand grip strength outcome data from a data collection across several waves in a complex survey. We provide reproducible R code on a public repository, presenting a detailed data screening plan for the investigation of the average rate of age-associated decline of grip strength. With our checklist and reproducible R code we provide data analysts a framework to work with longitudinal data in an informed way, enhancing the reproducibility and validity of their work.

The Fur-like regulatory protein MAP3773c modulates key metabolic pathways in Mycobacterium avium subsp. paratuberculosis under in-vitro iron starvation.

Johne's disease (JD) is a chronic enteric infection of dairy cattle worldwide. Mycobacterium avium subsp. paratuberculosis (MAP), the causative agent of JD, is fastidious often requiring eight to sixteen weeks to produce colonies in culture-a major hurdle in the diagnosis and therefore in implementation of optimal JD control measures. A significant gap in knowledge is the comprehensive understanding of the metabolic networks deployed by MAP to regulate iron both in-vitro and in-vivo. The genome of MAP carries MAP3773c, a putative metal regulator, which is absent in all other mycobacteria. The role of MAP3773c in intracellular iron regulation is poorly understood. In the current study, a field isolate (K-10) and an in-frame MAP3773c deletion mutant (ΔMAP3773c) derived from K-10, were exposed to iron starvation for 5, 30, 60, and 90 min and RNA-Seq was performed. A comparison of transcriptional profiles between K-10 and ΔMAP3773c showed 425 differentially expressed genes (DEGs) at 30 min time post-iron restriction. Functional analysis of DEGs in ΔMAP3773c revealed that pantothenate (Pan) biosynthesis, polysaccharide biosynthesis and sugar metabolism genes were downregulated at 30 min post-iron starvation whereas ATP-binding cassette (ABC) type metal transporters, putative siderophore biosynthesis, PPE and PE family genes were upregulated. Pathway analysis revealed that the MAP3773c knockout has an impairment in Pan and Coenzyme A (CoA) biosynthesis pathways suggesting that the absence of those pathways likely affect overall metabolic processes and cellular functions, which have consequences on MAP survival and pathogenesis.

Early Discharge after Enhanced Recovery Colectomy Does Not Increase Emergency Department Visits and Readmissions: A Single Institution Analysis.

BACKGROUND: Same-day discharge after colorectal surgery in enhanced recovery pathways is increasing. This study aimed to determine if discharge on postoperative days (POD) one or two is associated with increased rates of emergency department (ED) visits and hospital readmissions after left and right colectomy. METHODS: Single institution retrospective analysis of prospective institutional colorectal surgery database between 07/01/2018 and 07/15/2022. Primary outcomes were ED visit and readmission rates for enhanced recovery open and minimally invasive right and left colectomy using logistic regressions models. RESULTS: 820 patients met inclusion criteria. There were significant differences in discharge-day by diagnosis-58.5% of patients with Crohn's disease were discharged on POD ≥4 and 21.6% with benign colon neoplasia were discharged on POD-0-1 (P < .001). ED visits occurred in 12.9% of the study population and were not significantly different between discharge-day groups (P = .096). Overall readmission rate was 8.5% and significantly different between discharge-day groups (0% POD-0 vs 8.3% POD-1 vs 5.8% POD-2 vs 6.9% POD-3 vs 12.9% POD ≥4, P = .041). Logistic regression showed that ED visits and readmissions for longer discharge-days (POD-2, POD-3, POD ≥4) were not significantly different than POD-0-1. Readmission diagnoses for the study population were higher for ileus (17.1%) and surgical site infection (SSI) type-III (22.9%) than for acute kidney injury (1.4%) and SSI type-I/II (1.4%). CONCLUSION: Early discharge after left and right colectomy is not associated with increased rates of ED visits and readmissions. Same-day discharge may be feasible in selected enhanced recovery patients. Standardized post-discharge resources that safely allow same-day discharge require further investigation.

The short- and long-term effect of osteopathic manipulative treatment on pain, and psychosocial factors in adults with chronic low back pain.

CONTEXT: Chronic low back pain (CLBP) has long plagued mankind, but little progress has been made in finding a rational and effective treatment, let alone a common cause. This study is an attempt to fill that void by measuring short- and long-term effects of osteopathic manipulative treatment (OMT), including psychosocial and pain reduction in CLBP patients. OBJECTIVES: The objectives of this study were to investigate the effectiveness of neuromusculoskeletal medicine/osteopathic manipulative medicine (OMM) in treating CLBP, with a focus on biopsychosocial (pain sensitivity questionnaire [PSQ]) and pain control in chronic conditions. METHODS: The study involved a large, single cohort observational design of 101 patients. The inclusion criteria for selecting patients targeted those with "nonspecific" CLBP. The National Institutes of Health (NIH) Minimum Dataset for Chronic Low Back Pain (NMD) was the measurement tool and was administered at consent (baseline), 2, 4, and 8 weeks and at 6 and 12 months. Time trends were analyzed as overall mean. Pairwise differences were compared between time points. Mixed-effects models were utilized to test the association of time with pain and biopsychosocial scores. RESULTS: Pain and PSQ scores decreased over the study timeline. The most significant change for both pain and biopsychosocial scores occurred at 6 months compared to baseline, with a further reduction at 12 months. CONCLUSIONS: OMT has been demonstrated to significantly reduce pain and psychosocial factors related to CLBP in both the short and long term.

Operative trends following the adoption of nonoperative management of rectal cancer.

BACKGROUND: Differentiating clinical near-complete and complete responses (cCR) after neoadjuvant therapy (NT) is challenging in rectal cancer patients. We hypothesized that magnetic resonance imaging staging limitations for low rectal cancers may increase the proportion of abdominoperineal resection (APR) with permanent colostomy for those without a cCR. METHODS: Single institution retrospective analysis of rectal cancer cases before and after adoption of nonoperative "watch and wait" (W&W) pathway. APR as a percentage of rectal resections was the primary outcome. RESULTS: There were 76 total mesorectal excisions (TME) in the pre-W&W group and 98 in the post-W&W group. NT was significantly more common in the post-W&W group. There was no significant difference in the APR primary outcome (pre-W&W APR 33.3% vs. post-W&W APR 26.5%, p = 0.482). APR patients had fewer complete TME grades (69.2% vs. 46.2%) and more pathologic complete responses (0% vs. 26.9%) in the post-W&W period. The cCR rate for patients with nonoperative management was 51.4% (n = 37) and 13.5% (n = 5) had regrowths, all of whom underwent salvage surgery. CONCLUSION: APR for those without a cCR to NT has not increased in the nonoperative management era. Balancing the pathologic complete response rate may require restaging some patients with clinical near-complete responses.

Arthralgia in female Masters weightlifters.

BACKGROUND: Arthralgia or joint pain is a heterogeneous condition including organic and nonorganic joint pain. It is common in older populations, particularly in females. There is evidence that menopausal changes are associated with increased prevalence of arthralgia. While physical activities have been recommended to mitigate osteoarthritis (OA) and arthralgia, sport participation also carries risk factors due to excessive loading of some joints and possible injuries. The aim was to evaluate the association of training patterns, prior injuries, and severity of menopausal symptoms with arthralgia in female Masters weightlifters. METHODS: Competitive female Masters weightlifters (n=868, 30-78 years) from 30 countries completed an online survey including joint pain for different anatomical sites, weightlifting training and performance, sport history, and menopausal symptoms. Logistic regression models were used to estimate the association of training patterns, prior sport participation, and menopausal symptom severity with arthralgia separately for shoulders, spine, hips, knees, ankles, elbows, and hands. RESULTS: Arthralgia was most reported in knees (38.8%), shoulders (29.8%), hands/wrists (28.8%), and hips (24.9%). The prevalence of arthralgia was 51.5% in pre-menopausal women, 62.4% in women post natural menopause and 73.3% in women post medical or surgical menopause. Lifting heavier weights was associated with arthralgia in hips (OR=1.05, p=0.03), knees (OR=1.06, p=0.01), and hands/wrists (OR=1.05, p=0.04), but prior strength training was protective for arthralgia in the shoulders (OR=0.66, p=0.02). Prior injuries and psychological menopausal symptom severity were associated with an increased risk for arthralgia (p<0.01). CONCLUSIONS: Arthralgia was common in competitive female weightlifters. Training frequency was not associated with arthralgia, but lifting heavier weights relative to age and body mass was. Prior injuries and menopausal symptoms were associated with arthralgia, but prior strength training was protective of arthralgia in the shoulders. Athletes, coaches and sports medicine professionals should be aware that prevalence of polyarthralgia increases in post-menopausal athletes.

Comparison of Olympic-Style Weightlifting Performances of Elite Athletes: Scaling Models Account for Body Mass.

PURPOSE: We developed a scale for comparison of performances by weightlifters of different body mass and compare this scaling formula to current systems. METHODS: Data from Olympics and World and Continental Championships from 2017 to 2021 were obtained; results from athletes with doping violations were excluded, resulting in performances from 1900 athletes from 150 countries for use in analysis. Functional relationships between performance and body mass were explored by testing various transformations of body mass in the form of fractional polynomials that include a wide range of nonlinear relationships. These transformations were evaluated in quantile regression models to determine the best fit, examine sex differences, and distinguish fits for different performance levels (90th, 75th, and 50th percentiles). RESULTS: The resulting model used a transformation of body mass with powers -2 and 2 for males and females and was used to specify a scaling formula. The small percentage deviations between modeled and actual performances confirm the high accuracy of the model. In the subset of medalists, scaled performances were comparable across different body masses, whereas both Sinclair and Robi scalings, currently used in competitions, were more variable. The curves had similar shapes for the 90th and 75th percentile levels but were less steep for the 50th percentile. CONCLUSIONS: The scaling formula we derived to compare weightlifting performances across a range of body mass can easily be implemented in the competition software to determine the overall best lifters. This is an improvement over current methods that do not accurately account for differences in body mass and result in bias or yield large variations even with small differences in body mass despite identical performances.

Grip Strength and Sports Performance in Competitive Master Weightlifters.

Grip strength (GS) is correlated with major muscle group strength; weakness and asymmetry in older adults are predictive of future disease and functional limitation risk. GS at different ages and hand symmetry for Olympic-style weightlifters and their association with performance have not been established. GS was measured in 164 athletes participating in the 2022 World Master Weightlifting Championships. The objectives wereto study the magnitude of the age-associated decline in GS in weightlifters and the association of GS with weightlifting performance. Hand symmetry was considered as a potential factor in successful lifts. Ages ranged from 35 to 90 (mean 53 years). Participants reported weekly training averages of 8.3 h of weightlifting and 4.1 additional hours of physical activities. The age-associated decline in GS was less steep than the decline in weightlifting performance. GS was lower in weightlifters compared to athletes in other sports that require grasping or force application (t = -2.53, p=0.053 for females; t = -2.62, p= 0.029 for males). The rate of decline was similar across different populations (weightlifters, other athletes, community-dwelling adults). Height and age were associated with GS, but performance level and training hours were not. GS was associated with snatch performance (t = 3.56, p < 0.001) but not with clean and jerk (t = 0.48, p = 0.633).

Sport-related risk factors for moderate or severe urinary incontinence in master female weightlifters: A cross-sectional study.

BACKGROUND: Urinary incontinence (UI), defined as the involuntary loss of urine, is a common, multifactorial condition. It is unclear whether physical activities, their intensity or frequency, may affect the potential for UI in addition to known risk factors in the general population. Higher prevalence of UI has been observed when engaging in high-impact sports, but research is sparse regarding UI in strength sports. Since the Olympic-style weightlifting has seen an unprecedented increase in women's participation in recent years, this study provides much-needed data to investigate whether weightlifting predisposes women to UI. OBJECTIVES: The aim was to conduct a survey of female Master athletes in countries that are members of the International Weightlifting Federation using a validated incontinence severity index and to study (1) whether known risk factors in the general population increase the odds of UI in female competitive weightlifters and (2) whether sport-related factors are associated with UI after adjusting for known risk factors. The outcomes of interest were moderate or more severe UI and incontinence during lifts specific to weightlifting competitions. RESULTS: Respondents consisted of 824 female competitive weightlifters from 29 countries, ages 30 to 79, median 41 years. Prevalence of moderate or more severe incontinence was 32%. Higher BMI, prior pregnancies, and depressive mood increased the odds, but age was not associated. Athletes who had engaged in high-impact sports prior to starting weightlifting training were at a higher risk of UI, but participation in prior strength sports was not associated with UI. The predictive probability of moderate or more severe UI increased with more hours per week of weightlifting training. CONCLUSIONS: Our findings indicate that while female weightlifters had a higher prevalence of moderate or severe UI than in a general population according to the National Health and Nutrition Examination Survey, and that athletes who had engaged in high-impact sports prior to starting weightlifting were at a higher risk of UI.

Sex Differences in Age-Associated Rate of Decline in Grip Strength When Engaging in Vigorous Physical Activity.

Handgrip strength (GS) is used as an indicator of overall muscle strength and health outcomes for aging adults. GS has also been evaluated as a potential link with sport performances. We quantified the age-associated decline in grip strength for males and females engaged in weekly vigorous physical activity, differentiated by body mass, and investigated whether there was an acceleration of decline at any age. The Survey of Health, Ageing and Retirement in Europe is a multinational complex panel data survey with a target population of individuals aged 50 years or older. Data from 48,070 individuals from 20 European countries, collected from 2004 to 2015, were used in multivariable regression models to study the association of age and body weight with grip strength for individuals engaged in vigorous physical activity at least once a week. The annual rate of change in GS differed for males and females; it was constant from ages 50 to 55 years and then accelerated for females, possibly due to the menopausal transition. In contrast, the decline in GS accelerates with each year of increase in age for males. Higher body mass was associated with an increase in GS, but the increase was less pronounced for older males. The increase in GS diminished with a body mass above the median even with engagement in weekly vigorous physical activities. GS reference values for individuals engaged in vigorous physical activity add to existing reference values for general populations.

Health challenges and acute sports injuries restrict weightlifting training of older athletes.

Objectives: To quantify acute injuries sustained during weightlifting that result in training restrictions and identify potential risk factors or preventative factors in Master athletes and to evaluate potentially complex interactions of age, sex, health-related and training-related predictors of injuries with machine learning (ML) algorithms. Methods: A total of 976 Masters weightlifters from Australia, Canada, Europe and the USA, ages 35-88 (51.1% women), completed an online survey that included questions on weightlifting injuries, chronic diseases, sport history and training practices. Ensembles of ML algorithms were used to identify factors associated with acute weightlifting injuries and performance of the prediction models was evaluated. In addition, a subgroup of variables selected by six experts were entered into a logistic regression model to estimate the likelihood of an injury. Results: The accuracy of ML models predicting injuries ranged from 0.727 to 0.876 for back, hips, knees and wrists, but were less accurate (0.644) for shoulder injuries. Male Master athletes had a higher prevalence of weightlifting injuries than female Master athletes, ranging from 12% to 42%. Chronic inflammation or osteoarthritis were common among both men and women. This was associated with an increase in acute injuries. Conclusions: Training-specific variables, such as choices of training programmes or nutrition programmes, may aid in preventing acute injuries. ML models can identify potential risk factors or preventative measures for sport injuries.

Structured reporting to improve transparency of analyses in prognostic marker studies.

BACKGROUND: Factors contributing to the lack of understanding of research studies include poor reporting practices, such as selective reporting of statistically significant findings or insufficient methodological details. Systematic reviews have shown that prognostic factor studies continue to be poorly reported, even for important aspects, such as the effective sample size. The REMARK reporting guidelines support researchers in reporting key aspects of tumor marker prognostic studies. The REMARK profile was proposed to augment these guidelines to aid in structured reporting with an emphasis on including all aspects of analyses conducted. METHODS: A systematic search of prognostic factor studies was conducted, and fifteen studies published in 2015 were selected, three from each of five oncology journals. A paper was eligible for selection if it included survival outcomes and multivariable models were used in the statistical analyses. For each study, we summarized the key information in a REMARK profile consisting of details about the patient population with available variables and follow-up data, and a list of all analyses conducted. RESULTS: Structured profiles allow an easy assessment if reporting of a study only has weaknesses or if it is poor because many relevant details are missing. Studies had incomplete reporting of exclusion of patients, missing information about the number of events, or lacked details about statistical analyses, e.g., subgroup analyses in small populations without any information about the number of events. Profiles exhibit severe weaknesses in the reporting of more than 50% of the studies. The quality of analyses was not assessed, but some profiles exhibit several deficits at a glance. CONCLUSIONS: A substantial part of prognostic factor studies is poorly reported and analyzed, with severe consequences for related systematic reviews and meta-analyses. We consider inadequate reporting of single studies as one of the most important reasons that the clinical relevance of most markers is still unclear after years of research and dozens of publications. We conclude that structured reporting is an important step to improve the quality of prognostic marker research and discuss its role in the context of selective reporting, meta-analysis, study registration, predefined statistical analysis plans, and improvement of marker research.

Pythium insidiosum complex hides a cryptic novel species: Pythium periculosum.

Early phylogenetic analysis of Pythium insidiosum, the etiologic agent of pythiosis in mammals, showed the presence of a complex comprising three monophyletic clusters. Two included isolates recovered from cases of pythiosis in the Americas (Cluster I) and Asia (Cluster II), whereas the third cluster included four diverged isolates three from humans in Thailand and the USA, and one isolate from a USA spectacled bear (Cluster III). Thereafter, several phylogenetic analyses confirmed the presence of at least three monophyletic clusters, with most isolates placed in clusters I and II. Recent phylogenetic analyses using isolates from environmental sources and from human cases in India, Spain, Thailand, and dogs in the USA, however, showed the presence of two monophyletic groups each holding two sub-clusters. These studies revealed that P. insidiosum possesses different phylogenetic patterns to that described by early investigators. In this study, phylogenetic, population genetic and protein MALDI-TOF analyses of the P. insidiosum isolates in our culture collection, as well as those available in the database, showed members in the proposed cluster III and IV are phylogenetically different from that in clusters I and II. Our analyses of the complex showed a novel group holding two sub-clusters the USA (Cluster III) and the other from different world regions (Cluster IV). The data showed the original P. insidiosum cluster III is a cryptic novel species, now identified as P. periculosum. The finding of a novel species within P. insidiosum complex has direct implications in the epidemiology, diagnosis, and management of pythiosis in mammalian hosts.

How Heavy Lifting Lightens Our Lives: Content Analysis of Perceived Outcomes of Masters Weightlifting.

Although the benefits of sport participation for older adults has been well-documented, the traditionally masculine sport of weightlifting has only recently become popular among older women, who now participate at rates comparable to men in the United States. This study describes the self-reported effects of participating in Masters-level Olympic weightlifting on other aspects of life. Contrasting with previous studies of Masters athletes in other sports, the gender balance and broad age range of our sample allowed us to explore whether the self-reported impact of sport on older adults was similar or different across age groups (35-44, 45-59, 60, and older) for both men and women. A total of 352 (191 women, 159 men, 2 other) who completed a survey of Masters lifters registered with the United States national organization (USAW) responded to an open-ended question about how weightlifting has affected other aspects of their life. Across gender and age categories, responses indicated that weightlifting has a positive impact on physical health (strength, mobility, fitness) and on psychological (mental health benefits, stress reduction) and social aspects such as community connections. Female lifters mentioned psychological benefits such as increased confidence and help with stress and depression more commonly than male lifters; older lifters were more likely than middle-aged lifters to mention physical health benefits. Competition was a prominent theme across genders and age groups. The themes mentioned by participants are consistent with previous literature on sports that are less strongly gender-typed than weightlifting.

How Do Master Weightlifters Train? A Transnational Study of Weightlifting Training Practices and Concurrent Training.

(1) Background: The wide range of preparedness, physical fitness, and capabilities of older athletes makes it challenging to recommend general training programs for this cohort ranging from ages 35 to 80 and older. Weightlifting has enjoyed an unprecedented growth in recent years, especially among women. The objectives of this study are to describe age and sex differences in self-reported training regimens and concurrent training for Masters weightlifters and investigate regional differences. (2) Methods: A total of 1051 Masters weightlifters from Australia, Canada, Europe, and the USA completed an online survey that included questions on sport history and training practices. (3) Results: A training session typically lasted 1.5 to 2 h for both sexes across all ages. Weightlifters engaged in concurrent training (66.9%), especially in endurance training (24.9%) and CrossFit (36.4%), but the proportions differed across geographic regions. Older females maintained training 4 days per week, while older males reduced this to 3 days per week. (4) Conclusions: Weightlifting training practice of Masters athletes was remarkably consistent across ages, but concurrent training differed between males and females and across regions. This study provides helpful information for athletes, coaches, and sport organizations about the variation in weightlifting training practices and concurrent training of older athletes.

Association of circulating leptin, adiponectin, and resistin concentrations with long-term breast cancer prognosis in a German patient cohort.

Adipokines including leptin, adiponectin and resistin have been linked to risk of obesity-related cancers potentially through low-grade chronic inflammation pathways. We aimed to assess the role of post-diagnosis circulating adipokines on long-term prognosis in a prospective breast cancer cohort. Adipokines were measured in blood collected at baseline shortly after diagnosis (2002-2005) and at follow-up (2009) from 3112 breast cancer patients enrolled in the population-based MARIE study. Half of the patients had measurements at both time-points. All-cause mortality, breast cancer specific mortality and recurrences were ascertained up to June 2015 (11 years median follow-up). Associations with time-varying adipokine concentrations overall and stratified by estrogen and progesterone receptor (ERPR) were evaluated using adjusted proportional hazard regression. At baseline (n = 2700) and follow-up (n = 2027), median concentrations for leptin, adiponectin and resistin were 4.6 and 2.7 ng/ml, 24.4 and 30.0 mg/l, 15.4 and 26.2 ng/ml, respectively. After adjustment, there was no evidence for associations between adipokines and any outcome overall. In ERPR negative tumors, highest vs. lowest quintile of adiponectin was significantly associated with increased breast cancer specific mortality (HR 2.51, 95%CI 1.07-5.92). Overall, post-diagnosis adipokines were not associated with long-term outcomes after breast cancer. In patients with ERPR negative tumors, higher concentrations of adiponectin may be associated with increased breast cancer specific mortality and warrant further investigation.

Weightlifting during the COVID-19 Pandemic-A Transnational Study Regarding Motivation, Barriers, and Coping of Master Athletes.

Sport has been heavily impacted by the pandemic for over a year with restrictions and closures of facilities. The main aims of this study are to identify motivation and barriers for an international group of Master weightlifters (ages 35 and up) and analyze age and gender differences in pandemic-related changes to physical activities. A sample of 1051 older athletes, 523 women and 528 men, aged from 35 to 88 years, from Australia, Canada, Europe, and the USA provided responses to an online survey conducted in June 2021. A confirmatory factor analysis was performed to examine age, gender, and regional differences about motivation, barriers, and pandemic impact on sport and physical activities. Participants showed enthusiasm for the opportunity to compete despite health challenges with increasing age but faced barriers due to access to training facilities and qualified coaches even before the pandemic. The oldest athletes had the greatest reduction in physical activities during the pandemic. Weightlifters had the opportunity to compete in virtual competitions and 44% would like to see some of these continued in the future, especially women. These findings highlight the benefits of competitive sports and may provide future directions in strength sports for organizations, sports clubs, and coaches.