Women's experience of adopting lateral positions during the second stage of labour compared with conventional lithotomy positions: A cross-sectional study.

AIMS: Maternal positions during childbirth play an important role in safe vaginal births and might also influence women's childbirth experiences greatly. Lateral positions, as a potential position to reduce negative maternal and neonatal outcomes, have become popular in recent years, especially in China where the adoption of conventional lithotomy positions is still common. However, the childbirth experience of those who gave birth in lateral positions has been rarely studied. This study aimed to describe and compare women's childbirth experiences of adopting the newly introduced lateral positions and the conventional lithotomy positions during the second stage of labour. STUDY DESIGN: A cross-sectional study was conducted in two tertiary hospitals in China involving a total of 658 primiparous and parous women who adopted lateral and lithotomy positions during the second stage of labour from July to November 2020. Sociodemographic characteristics, maternal and neonatal outcomes as well as childbirth experience assessed by the Childbirth Experience Questionnaire (CEQ) were collected. This study followed the STROBE guidelines. RESULTS: Women who once adopted lateral positions during the second stage of labour had better positive childbirth experiences compared with those in the lithotomy positions group, as demonstrated by their overall higher CEQ scores. Women in the lateral position group also reported better participation and perceived safety, and a greater sense of control during childbirth. Lateral positions remained an influential factor in CEQ scores after controlling for potential confounders. In this study, adverse maternal and neonatal outcomes were rare. Women in lateral positions had comparatively better perineal outcomes. CONCLUSION: This study described and compared women's childbirth experiences of adopting conventional lithotomy positions and lateral positions during the second stage of labour using a valid instrument. Women who adopted lateral positions during the second stage of labour reported better childbirth experiences than those giving birth in the conventional lithotomy positions. Thus, assisting women in giving birth in lateral positions might be a promising way to improve women's childbirth experience.

Gender Disparity in Academic Trauma Surgery: The Current State of Affairs.

INTRODUCTION: Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America. MATERIAL AND METHODS: FRIEDA was used to identify trauma surgery programs. A thorough website review of each program obtained further information on faculty members, including their name, age, gender, and faculty rank. Trauma surgeons with an MD or DO qualification and a faculty rank of Professor, Associate Professor, or Assistant Professor were selected for inclusion in this study. SCOPUS was used to assess the H-index and the number of publications and citations of surgeons. RESULTS: The total number of programs included was 136, consisting of 715 faculty members. Less than a quarter (n = 166; 23.2%) comprised females and less than one-fifth (n = 30; 19%) of female surgeons were Professors. The difference in the research productivity of male and female trauma surgeons was statistically significant (P < .05), with the average H-index being 10 vs 7.5, respectively, amongst the top 50 surgeons of both genders. Based on a multiple regression analysis, academic rank was significantly associated (P < .05), and gender was not significantly associated (P > .05) with H-index. CONCLUSION: Gender disparity exists in the field of trauma surgery, as noted in senior faculty ranks and leadership positions. Female-inclusive state policies, appropriate mentorship, and supportive institutions can help to bridge this gap.

Examining Chlorophyll Extraction Methods in Sesame Genotypes: Uncovering Leaf Coloration Effects and Anatomy Variations.

This study focuses on optimizing chlorophyll extraction techniques, in which leaf discs are cut from places on the leaf blade to enhance chlorophyll concentration in sesame (Sesamum indicum L.) leaves. Thirty sesame genotypes, categorized into light green (LG), middle green (MG), and deep green (DG) pigment groups based on leaf coloration, were selected from a larger pool of field-grown accessions. The investigation involved determining optimal Soil Plant Analysis Development (SPAD) value index measurements, quantifying pigment concentrations, exploring extraction solvents, and selecting suitable leaf disk positions. Significant variations in chlorophyll content were observed across genotypes, greenness categories, and leaf disk positions. The categorization of genotypes into DG, MG, and LG groups revealed a correlation between leaf appearance and chlorophyll content. The study highlighted a consistent relationship between carotenoids and chlorophyll, indicating their role in adaptation to warm environments. An examination of leaf disk positions revealed a significant chlorophyll gradient along the leaf blade, emphasizing the need for standardized protocols. Chlorophyll extraction experiments identified DMSO and 96% ethanol, particularly in those incubated for 10 min at 85 °C, as effective choices. This recommendation considers factors like cost-effectiveness, time efficiency, safety, and environmental regulations, ensuring consistent and simplified extraction processes. For higher chlorophyll extraction, focusing on leaf tips and the 75% localization along the sesame leaf blade is suggested, as this consistently yields increased chlorophyll content. Furthermore, our examination revealed significant anatomical variations in the internal structure of the mesophyll tissue leaves between deep green and light green sesame plants, primarily linked to chloroplast density and pigment-producing structures. Our findings, therefore, provide insightful knowledge of chlorophyll gradients and encourage the use of standardized protocols that enable researchers to refine their experimental designs for precise and comparable chlorophyll measurements. The recommended solvent choices ensure reliable outcomes in plant physiology, ecology, and environmental studies.

[Three-dimensional finite element analysis of lumbar disc herniation under different body positions].

OBJECTIVE: To campare biomechanical effects of different postural compression techniques on three-dimensional model of lumbar disc herniation (LDH) by finite element analysis. METHODS: Lumbar CT image of a 48-year-old female patient with LDH (heighted 163 cm, weighted 53 kg) was collected. Mimics 20.0, Geomagic Studio, Solidwords and other software were used to establish three-dimensional finite element model of LDH on L4,5 segments. Compression techniques under horizontal position, 30° forward bending and 10° backward extension were simulated respectively. After applying the pressure, the effects of compression techniques under different positions on stress, strain and displacement of various tissues of intervertebral disc and nerve root were observed. RESULTS: L4, 5 segment finite element model was successfully established, and the model was validated. When compression manipulation was performed on the horizontal position, 30° flexion and 10° extension, the annular stress were 0.732, 5.929, 1.286 MPa, the nucleus pulposus stress were 0.190, 1.527, 0.295 MPa, and the annular strain were 0.097, 0.922 and 0.424, the strain sizes of nucleus pulposus were 0.153, 1.222 and 0.282, respectively. The overall displacement distance of intervertebral disc on Y direction were -3.707, -18.990, -4.171 mm, and displacement distance of nerve root on Y direction were +7.836, +5.341, +3.859 mm, respectively. The relative displacement distances of nerve root and intervertebral disc on Y direction were 11.543, 24.331 and 8.030 mm, respectively. CONCLUSION: Compression manipulation could make herniated intervertebral disc produce contraction and retraction trend, by increasing the distance between herniated intervertebral disc and nerve root, to reduce symptoms of nerve compression, to achieve purpose of treatment for patients with LDH, in which the compression manipulation is more effective when the forward flexion is 30°.

Smoking-Induced DNA Hydroxymethylation Signature Is Less Pronounced than True DNA Methylation: The Population-Based KORA Fit Cohort.

Despite extensive research on 5-methylcytosine (5mC) in relation to smoking, there has been limited exploration into the interaction between smoking and 5-hydroxymethylcytosine (5hmC). In this study, total DNA methylation (5mC+5hmC), true DNA methylation (5mC) and hydroxymethylation (5hmC) levels were profiled utilizing conventional bisulphite (BS) and oxidative bisulphite (oxBS) treatment, measured with the Illumina Infinium Methylation EPIC BeadChip. An epigenome-wide association study (EWAS) of 5mC+5hmC methylation revealed a total of 38,575 differentially methylated positions (DMPs) and 2023 differentially methylated regions (DMRs) associated with current smoking, along with 82 DMPs and 76 DMRs associated with former smoking (FDR-adjusted p < 0.05). Additionally, a focused examination of 5mC identified 33 DMPs linked to current smoking and 1 DMP associated with former smoking (FDR-adjusted p < 0.05). In the 5hmC category, eight DMPs related to current smoking and two DMPs tied to former smoking were identified, each meeting a suggestive threshold (p < 1 × 10-5). The substantial number of recognized DMPs, including 5mC+5hmC (7069/38,575, 2/82), 5mC (0/33, 1/1), and 5hmC (2/8, 0/2), have not been previously reported. Our findings corroborated previously established methylation positions and revealed novel candidates linked to tobacco smoking. Moreover, the identification of hydroxymethylated CpG sites with suggestive links provides avenues for future research.

Sustainability of the Subspecialty of Anesthesiology Critical Care: An Expert Consensus and Review of the Literature.

While considerable literature exists with respect to clinical aspects of critical care anesthesiology (CCA) practice, few publications have focused on how anesthesiology-based critical care practices are organized and the challenges associated with the administration and management of anesthesiology critical care units. Currently, numerous challenges are affecting the sustainability of CCA practice, including decreased applications to fellowship positions and decreased reimbursement for critical care work. This review describes what is known about the subspecialty of CCA and leverages the experience of administrative leaders in adult critical care anesthesiologists in the United States to describe potential solutions.

Uncovering young people's situational construction of sexual consent.

Aim: To investigate how young Danes construct sexual consent generally, but also specifically in relation to heavy alcohol intoxication. Methods: Drawing on 30 qualitative in-depth interviews with young people, aged 19-25 years, and adopting a critical discursive psychological framework, we explored the interpretative repertoires that the participants made use of to construct sexual consent and the subject positions those repertoires enabled. Results: The participants made use of three interpretative repertoires that we named as follows: (1) sexual consent as an agreement between rational individuals; (2) sexual consent as a heteronormative practice; and (3) intoxicated sexual consent. Discussion: Young people draw on different repertoires when discussing sexual consent in general, sexual consent in relation to gendered practices and expectations, and sexual consent in relation to heavy alcohol intoxication. Conclusion: It is vital to keep the situational nature of young people's constructions of sexual consent in mind if we wish to understand and eventually reduce the number of non-consensual sexual experiences.

Neural Respiratory Drive During Different Dyspnea Relief Positions and Breathing Exercises in Individuals With COPD.

BACKGROUND: When the work load of the respiratory muscles increases and/or their capacity decreases in individuals with COPD, respiratory muscle activation increases to maintain gas exchange and respiratory mechanics, and perception of dyspnea occurs. The present study aimed to compare diaphragm and accessory respiratory muscle activation during normal breathing, pursed-lip breathing, and breathing control in different dyspnea relief positions, supine and side lying. METHODS: A cross-sectional study design was used. Sixteen individuals with COPD age between 40-75 y were included. Pulmonary function was evaluated by spirometry, muscle activation by surface electromyography, and dyspnea by the modified Borg scale. Muscle activation was measured in the diaphragm, scalene, sternocleidomastoid, and parasternal muscles. The evaluation was made in the dyspnea relief positions (sitting leaning forward, sitting leaning forward at a table, leaning forward with back against a wall, standing leaning forward, and high lying), seated erect, supine, and side lying. RESULTS: There were significant differences between the 8 positions (P < .001). There was no significant difference in muscle activation between sitting leaning forward and sitting leaning forward at a table position with analyzing post hoc test results (P > .99 for each muscle). However, muscle activation was lower in these 2 positions than in the other positions (P < .001 for each muscle). Muscle activation was greater in the supine position than in the other positions (P < .001 for each muscle). No difference was observed in muscle activation between the seated erect, leaning forward with back against a wall, standing leaning forward, high-lying, or side-lying positions (P > .05 for each muscle with a minimum P value of .09). CONCLUSIONS: The use of sitting leaning forward and sitting leaning forward at a table positions together with breathing control may help people with COPD to achieve more effective dyspnea relief and greater energy efficiency.

Variations in abdominal muscle activities of obese females during abdominal bracing exercise in different body positions.

AIMS: This study evaluated the activities of the Rectus Abdominis (RA) and Transversus Abdominis (TrA) muscles during abdominal bracing exercises (ABE) in different body positions. METHODOLOGY: Electrical activities of both components of the RA and TrA muscles were assessed respectively in 25 obese females via surface electromyography during ABE in four (4) different body positions (crook lying, side lying, standing, and sitting). Each trial lasted for five (5) seconds with an hour rest period between trials. RESULTS: Electrical activities of each of the right RA (p = 0.008) and TrA (p = 0.001) muscles significantly varied across the four trials. For the left components of the RA (p = 0.243) and TrA (p = 0.332) muscles, no significant differences were observed across trials. The highest muscular activities were recorded during the standing trial while the crook lying position resulted in the least muscular activities. CONCLUSION: For the best results, abdominal bracing exercises should be performed in a standing position. The efficacy of adopting these body positions for long-term rehabilitation purposes should be investigated in future studies.

Work fatigue and musculoskeletal disorders in gas station operators in Pontianak city, Indonesia.

This study analyzes the relationship between work fatigue and musculoskeletal disorders in gas station operators in Pontianak City. This study used with a cross-sectional approach. The sample consists of 150 gas station workers. Data collection was carried out by observing and interviewing. Respondents characteristics were recorded through interviews using a questionnaire. Data on work fatigue were obtained by interviews using the IFRC questionnaire and musculoskeletal data using the Nordic Body Map questionnaire. The study results show that 50% of workers experience a high level of work fatigue, and 26% of workers experience severe musculoskeletal disorders. There is a significant relationship between work fatigue and musculoskeletal diseases (p = 0.001). The study established the need for intervention as a preventive measure by providing sufficient rest time, stretching, setting work shifts, improving ergonomic work positions for gas station operators, and controlling the work environment through environmental improvement and monitoring and using personal protective equipment.

Comparative Analysis of Chemical Descriptors by Machine Learning Reveals Atomistic Insights into Solute-Lipid Interactions.

This study explores the research area of drug solubility in lipid excipients, an area persistently complex despite recent advancements in understanding and predicting solubility based on molecular structure. To this end, this research investigated novel descriptor sets, employing machine learning techniques to understand the determinants governing interactions between solutes and medium-chain triglycerides (MCTs). Quantitative structure-property relationships (QSPR) were constructed on an extended solubility data set comprising 182 experimental values of structurally diverse drug molecules, including both development and marketed drugs to extract meaningful property relationships. Four classes of molecular descriptors, ranging from traditional representations to complex geometrical descriptions, were assessed and compared in terms of their predictive accuracy and interpretability. These include two-dimensional (2D) and three-dimensional (3D) descriptors, Abraham solvation parameters, extended connectivity fingerprints (ECFPs), and the smooth overlap of atomic position (SOAP) descriptor. Through testing three distinct regularized regression algorithms alongside various preprocessing schemes, the SOAP descriptor enabled the construction of a superior performing model in terms of interpretability and accuracy. Its atom-centered characteristics allowed contributions to be estimated at the atomic level, thereby enabling the ranking of prevalent molecular motifs and their influence on drug solubility in MCTs. The performance on a separate test set demonstrated high predictive accuracy (RMSE = 0.50) for 2D and 3D, SOAP, and Abraham Solvation descriptors. The model trained on ECFP4 descriptors resulted in inferior predictive accuracy. Lastly, uncertainty estimations for each model were introduced to assess their applicability domains and provide information on where the models may extrapolate in chemical space and, thus, where more data may be necessary to refine a data-driven approach to predict solubility in MCTs. Overall, the presented approaches further enable computationally informed formulation development by introducing a novel in silico approach for rational drug development and prediction of dose loading in lipids.

Unique Specific Jumping Test for Measuring Explosive Power in Young Basketball Players: Differences by Gender, Age, and Playing Positions.

When playing basketball, players are required to have high explosive power, which requires the ability to move in efficient, specific, and game-specific movement patterns that combine both horizontal and vertical abilities. Differences have been seen between young male and female basketball players in this measure. The aim of this study was to examine differences in players' unique movements by gender, age, and playing positions using a novel test for basketball players. This study included 232 young basketball players, male and female, from a range of Israeli leagues, who were divided into three categories: under-14, under-16, and under-18. Our findings showed that males presented better results than females in all age categories. Moreover, females in the under-18 category presented better results than those in the under-14 category, but not more than those in the under-16 category. Differences in playing positions were only examined between males and females in the under-18 category, where players begin to specialize in playing positions, and here, guards showed better results than forwards and centers. Our conclusions highlight the importance of including unique, sport-specific tests in talent identification and selection processes, as these tests can provide valuable information about a player's skill set and potential for success. The findings are presented in an achievement table of the expected physical fitness results by age and gender for the benefit of basketball coaches and strength and conditioning coaches when assessing their players.

A selective anatomically based lymph node sampling can replace a side specific pelvic lymphadenectomy in endometrial cancer with failed sentinel node mapping.

AIM: To evaluate the locations of metastatic pelvic sentinel nodes (SLN) and the proportion of SLNs outside and within defined typical anatomical positions along the upper paracervical lymphatic pathway (UPP). PATIENTS AND METHODS: Consecutive women with endometrial cancer (EC) of all risk groups underwent pelvic SLN-detection using cervically injected indocyanine green (ICG). A strict anatomically based algorithm and definitions of SLNs was adhered to. The positions of ICG-defined SLNs were intraoperatively depicted on an anatomical chart. All SLNs were examined using ultrastaging and immunohistochemistry. The proximal third of the obturator fossa and the interiliac area were defined as typical positions. The parauterine lymphovascular tissue (PULT) was separately removed. The proportions of metastatic SLNs, overall and isolated, typically, and atypically positioned were analyzed per woman. RESULTS: A median of two (range 1-12) SLN metastases along the UPP including the PULT were found in 162 women. 41 of 162 women (25.3 %) had isolated metastases in the obturator fossa harboring 49.1 % of all SLN metastases. Three women (1,9 %) had isolated PULT metastases. SLN metastases outside typical positions were identified in 28/162 women (17.3 %); isolated metastases were seen in seven women (4.3 %), so 95.7 % of pelvic node positive women had at least one metastatic SLN located at a typical position. CONCLUSION: A selective removal of lymph nodes at typical proximal obturator and interiliac positions and the PULT can replace a full side specific pelvic LND when SLN mapping is unsuccessful. The obturator fossa is the predominant location for metastatic disease.

Studying intersectionality using ideological dilemmas: The case of paid domestic labour.

Intersectionality has gained a great deal of academic purchase within the social sciences but there is still a need for further conceptual and methodological innovation and clarity. As such, this study uses paid domestic labour as a case study to apply Billig et al.'s (Ideological dilemmas: A social psychology of everyday thinking, 1988) notion of ideological dilemmas to explore the common sense that paid domestic workers draw on to position themselves as women and workers. The analysis highlights how participants use (often contradictory) themes of common sense when speaking about their place in the household through dilemmas of servitude, belonging, and intimacy. Speakers draw on gendered ideology, not as a fixed set of ideas, but rather as a mobile discursive resource that can be deployed in situ, allowing them to justify, subvert, and evaluate social positions of domestic womanhood. The study provides both a conceptual window and a robust method for studying nonessentialist intersectionality through ideological dilemmas.

L1 slope: an overlooked spinal parameter.

OBJECTIVE: Lumbar lordosis can be divided into two parts by a horizontal line, creating the L1 slope and the sacral slope. Despite being a major spinopelvic parameter, the L1slope (L1S) is rarely reported. However, there is some evidence that L1S is a relatively constant parameter. This study aimed to analyze the L1 slope and its relationships with other spinopelvic parameters. METHODS: Standing lateral lumbosacral x-ray radiographies of 76 patients with low back pain and CT scans of 116 asymptomatic subjects were evaluated for spinal and spinopelvic parameters including L1 slope (L1S). The x-ray and CT groups were divided into subgroups according to mean sacral slope (SS) or pelvic incidence (PI) values. The mean values of the spinopelvic parameters and the correlations between them were investigated and compared. RESULTS: L1S was 19.70 and 18.15 in low SS and high SS subgroups of x-ray respectively. L1S was 7.95 and 9.36 in low and high PI subgroups of CT, respectively, and the differences were insignificant statistically. L1S was the only spinal parameter that did not change as SS or PI increased in standing and supine positions. L1S was correlated with lumbar lordosis (LL) proximal lumbar lordosis (PLL) and distal lumbar lordosis (DLL) in both x-ray and CT groups. L1S was also the strongest correlated parameter with pelvic incidence lumbar lordosis mismatch (PI-LL) mismatch in supine position. CONCLUSIONS: L1S is a relatively constant parameter and is around 16°-18° and 8°-9° in the standing and supine positions, respectively. It was significantly correlated with LL, PLL, DLL, and PI-LL. In the standing position it was nearly equal to PLL while this equality was present in low PI subgroups of CT. There is strong evidence that L1S is significantly correlated with health-related quality of life scores.

A 10-year analysis of application and match rates for pain medicine training in the United States.

OBJECTIVE: We analyzed application and match rates for pain medicine training in the United States and hypothesized that there would be (1) greater growth in the number of training positions than applicants, (2) higher match rates among US allopathic graduates relative to non-US allopathic graduates, and (3) greater number of unfilled training positions over time. DESIGN: Retrospective, cross-sectional study of all applicants for pain medicine training in the United States. METHOD: National Resident Matching Program data were obtained over a ten-year period (2014-2023). Match rates and applicant-to-position ratios were calculated and compared over time with linear regression. Comparisons were made with chi-square tests. RESULTS: Growth in the number of annual training positions (261-377, 44% increase) exceeded growth in the number of interested applicants (398-415, 4% increase) (P < .001). Annual applicant-to-training position ratios decreased (1.5-1.1, P < .001). The representation of US allopathic graduates among incoming pain medicine fellows decreased over the study period (73%-58%, P < .001) while US osteopathic graduates increased (9%-28%, P < .001).Match rates increased for both US allopathic graduates (71%-91%, P < .001) and non-US allopathic graduates (51%-81%, P < .001). From 2018 to 2023, US allopathic graduates (79%) had higher match rates than US osteopathic graduates (60%, P < .001) and international medical graduates (57%, P < .001). More available annual training positions went unfilled over the study period (2%-5%, P = .006). CONCLUSIONS: Stagnant annual applicant volume and increasing number of available training positions have led to increasing match rates for pain medicine fellowship training. Fewer US allopathic graduates are pursuing pain medicine training. The increasing percentage of unfilled training positions warrants ongoing surveillance.

Beyond the Jump: A Scoping Review of External Training Load Metrics in Volleyball.

CONTEXT: Volleyball is a complex sport involving multifaceted movements and high-velocity actions, leading to diverse external training loads (ETLs) that have profound implications for player performance and injury risk. OBJECTIVE: To provide a comprehensive overview of the measurement of ETL in volleyball, identify gaps in current understanding, and offer valuable insights for stakeholders in the field. DATA SOURCES: The literature search was conducted across the following electronic databases: PubMed/Medline, Scopus, Web of Science, and SPORTDiscus. STUDY SELECTION: Studies were selected based on their relevance to the measurement of ETL in volleyball. STUDY DESIGN: A scoping review methodology was chosen to map and summarize the broad body of literature related to ETL measurement in volleyball. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data related to ETL measurements in volleyball were extracted and analyzed from the selected studies, focusing on metrics utilized, player positions examined, and technologies employed. RESULTS: A total of 18 studies related to ETL in volleyball were identified and examined for this review. Despite the importance of sagittal plane movements in volleyball, the review identified a substantial research gap regarding ETL measurements beyond this plane, as well as a lack of focus on the unique demands of different player positions like the liberos. The use of technologies such as inertial measurement units was prevalent, but more comprehensive measurement methods are needed. CONCLUSION: There is a critical need for diversified ETL metrics in volleyball, extending beyond the conventional sagittal plane measurements. The findings highlight a substantial research gap in addressing the unique demands of different player positions, notably the liberos. This study underscores the importance of incorporating multiplanar movement data, player-specific roles, and advanced measurement technologies to develop more tailored training programs and injury prevention strategies.

Physical match demands across different playing positions during transitional play and high-pressure activities in elite soccer.

This study explored physical match demands across different playing positions during transitional play, to inform the need for position-specific training interventions. Data was collected using 10 Hz GPS units from 10 competitive matches including 23 elite soccer players of the 1st Polish Division (Ekstraklasa) in season 2020-21. A total of 4249 positional observations were made; center backs (n = 884), full backs (n = 972), central defensive midfielders (n = 236), central attacking midfielders (n = 270), central midfielders (n = 578), wingers (n = 778), and attackers (n = 531). Match data reflected distances covered per minute (m · min-1): total distance (TD), high-speed running distance (HSRD, > 19.8 km · h-1), sprint distance (SD, > 25.2 km · h-1), and the frequency of high-intensity accelerations and decelerations (A+D, > 3 m · s-2; n · min-1). Total absolute sprint distance (SD, > 25.2 km · h-1) and total relative sprint distance (Rel B5) were also quantified. A univariate analysis of variance revealed position-specific differences. Significant effects of position were found for all analysed metrics during transitional play (large ESs; p <.001). Central attacking midfielders displayed higher TD (m · min-1), fullbacks covered highest SD (m · min-1) and wingers achieved the highest A+D (n · min-1) (p ≤ 0.05). Centre backs displayed the lowest physical outputs when compared to all other positions, except in A+D (n · min-1) during defensive transitions (p ≤ 0.05). Attackers displayed the highest physical metrics during high pressure activities (p ≤ 0.05). Coaches should carefully consider positional transitional demands to better inform training design. With specific attention paid to drills that replicate game play.

Sound the Alarm: The Sonographer Shortage Is Echoing Across Healthcare.

OBJECTIVES: The growth in ultrasound usage necessitates concurrent growth in the number of sonographers. Despite the increasing importance of ultrasound, there is a shortage of sonographers in the United States that has never been specifically quantified. This study examines recent trends in the number of ultrasound exams, sonography graduates, open sonographer positions, and wages. METHODS: This retrospective study uses public databases and surveys including the Medical Expenditure Panel Survey (MEPS), Bureau of Labor Statistics (BLS), Integrated Postsecondary Education Data System (IPEDS), and Zippia, a human resources platform to determine metrics. These metrics include the number of ultrasound exams conducted in the United States (excluding inpatient setting), number of sonographers and sonographer wages, sonography graduates, and open sonographer positions. RESULTS: Ultrasound exams in the United States from 2011 to 2021 increased from 38.6 million to 59.8 million (+55.1%,) while the number of sonographers (2011-2021) increased from 54,760 to 78,640 (+43.6%). There was a significant difference between supply and demand of sonographers with the number of sonography graduates (2011-2021) increasing from 4,386 to 5,393 (+23.0%) while the number of open sonographer positions (2012-2021) increased from 18,462 to 25,162 (+36.3%). CONCLUSIONS: From 2011 to 2021, the increase in the number of ultrasound exams has significantly outpaced the increase in the number of sonographers. Furthermore, the increase in demand for sonographers has grown significantly faster than the supply, leading to a shortage and consequent strain on the healthcare system. To address the shortage, the number of sonography school openings should be increased, and the attendant challenges addressed.

The emergence of the Medical University of Vienna 20 years ago.

At the beginning of the 2000s the Austrian public universities were characterized by staffing rigidities, little competitive research, outdated study curricula and free access to all fields of study, the latter combined with high dropout rates and long study durations. As a countermeasure the universities were granted full legal capacity. For new employees the status of civil servants was herewith cancelled and, being now subject to the Employment Act, tenured employments for anyone who wanted to stay at the university were no longer possible. Medical faculties always had special provisions which would be difficult to reconcile with the full legal capacity of the universities: (i) the requirements of the hospitals affiliated to universities for research and teaching in addition to patient care had to be reimbursed to the Austrian federal states maintaining the hospitals, (ii) the physicians of university-affiliated hospitals were largely employed by the respective university and (iii) to ensure financing of clinical research and teaching at the hospital, the medical faculties received a budget separated from the rest of the university. As it was neither politically possible nor foreseeable that universities would be able to form a subcorporation with the affiliated hospital (integration model) or at least a close cooperation with the hospital if that has legal capacity per se (cooperation model), the necessary budgetary sovereignty of the medical faculties could only be guaranteed by their transition to medical universities. Nonetheless, reservations about this spin-off of medicine were enormous, but quickly fell silent, as the newly established medical universities maintained close cooperations with their parent as well as other universities and achieved, for Austrian standards, favorable positions in international rankings.