Coccidioides Serologic Screening Practices in Individuals With Rheumatic and Autoimmune Diseases.

OBJECTIVE: We aimed to estimate Coccidioides serologic screening rates before initiation of biologic disease-modifying antirheumatic drugs including tofacitinib (b/tsDMARDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and/or noninhaled corticosteroids. METHODS: This retrospective cohort study used 2011 to 2016 US Medicare claims data and included beneficiaries with rheumatic or autoimmune disease residing in regions within Arizona, California, and Texas endemic for Coccidioides spp. with ≥1 prescription for a b/tsDMARD, csDMARD, and/or noninhaled corticosteroid. We estimated prior-year serologic screening incidence before initiating b/tsDMARDs, csDMARD, and/or noninhaled corticosteroid. RESULTS: During 2012 to 2016, 4,331 beneficiaries filled 64,049 prescriptions for b/tsDMARDs, csDMARDs, and noninhaled corticosteroids. Arizona's estimated screening rate was 20.1% (95% confidence interval [95% CI] 14.5-25.7) in the year before prescription initiation for b/tsDMARDs, 8.1% (95% CI 6.5-9.7) before csDMARDs, and 6.9% (95% CI: 5.6-8.2) before corticosteroids. Screening rates for b/tsDMARDs (2.8%, 95% CI 0.0-6.7), csDMARDs (1.0%, 95% CI 0.0-2.0), and corticosteroids (0.8%, 95% CI: 0.4-1.1) were negligible in California and undetected in Texas. Adjusted screening rate before prescription for b/tsDMARDs in Arizona increased from 14.5% (95% CI 7.5-21.5) in 2012 to 26.7% (95% CI 17.6-35.8) in 2016. Rheumatologists prescribing b/tsDMARDs in Arizona screened more than other providers (20.9% [95% CI 13.9-27.9] vs 12.9% [95% CI 5.9-20.0]). CONCLUSION: Coccidioides serologic screening rates among Medicare beneficiaries with rheumatic/autoimmune diseases on b/tsDMARDs, csDMARDs, and noninhaled corticosteroids was low in Coccidioides spp.-US endemic regions between 2012 and 2016. Alignment of screening recommendations and clinical practice is needed.

Relative Age and Positive Youth Development in Youth Sport: Do Developmental Assets Play a Role in Creating Advantage Reversals in Female Soccer?

Relative age effects (RAEs) are commonly associated with advantages for older athletes. However, a variety of benefits attributed to 'advantage reversals' have been observed among relatively younger professional athletes. Considering psychosocial development as a proposed mechanism, the purpose of this study was twofold: (1) To explore an association between developmental assets (i.e., facilitators of positive youth development [PYD]) and RAEs; (2) To assess whether overall developmental asset levels are protective against sport dropout. The Developmental Assets Profile© was distributed to members of a one-year cohort of post-adolescent, female soccer players from Ontario, Canada. The presence of differences between groups of relatively older (H1; n = 64) and younger (H2; n = 57) participants and developmental asset scales were assessed using discriminant analysis. A binary logistic regression was conducted to assess whether overall developmental asset levels are protective against sport dropout, with consideration of relevant factors. Findings suggest that relatively younger, female players score higher in two internal categories: commitment to learning and positive values. The overall developmental asset scores were not found to be protective against dropout. This study provides preliminary, albeit cautious, support that 'advantage reversals' may be in part associated with enhanced PYD resulting from developmental sport experiences.

The influence of foreperiod duration on the preparation and control of sequential aiming movements.

Reaction time (RT) and movement times (MTs) to the first target are typically longer for two-target sequential movements compared to one-target movements. While this one-target advantage has been shown to be dependent on the availability of advance information about the numbers of targets, there has been no systematic investigation of how foreperiod duration (i.e., interval between presentation of the target(s) and stimulus) influences the planning and execution of sequential movements. Two experiments were performed to examine how the one-target advantage is influenced by the availability and timing of advance target information. In Experiment 1, participants performed one- and two-target movements in two separate blocks. In Experiment 2, target conditions were randomised from trial to trial. The interval between target(s) appearing and stimulus tone (i.e., foreperiod) was varied randomly (0, 500, 1,000, 1,500, and 2,000 ms). The results of Experiment 1 revealed that while the one-target advantage in RT was not influenced by foreperiod duration, the one-target advantage in MT increased as foreperiod duration increased. The variability of endpoints at the first target was greater in the two- compared to one-target condition. In Experiment 2, the one-target advantage in both RT and MT increased as the length of the foreperiod increased. However, there was no difference in limb trajectory variability between target conditions. The implication of these findings for theories of motor planning and execution of multiple segment movements is discussed.

What Makes A "Successful" Kasai Portoenterostomy "Unsuccessful"?

OBJECTIVES: Clearance of jaundice (CoJ) is the first key objective of Kasai portoenterostomy (KPE) for biliary atresia (BA) and its achievement is by far the best index of long-term prognosis. We sought to identify the reasons for failure [subsequent liver transplant (LT)] in this cohort. METHODS: Review of single-center prospective BA database. Successful KPE was defined by achieving a postoperative bilirubin of ≤20 µmol/L. Pre-KPE and post-KPE variables were identified together with a multivariate logistic regression model to identify those observable at 3 months post-KPE. Data are quoted as median (range). A P value of ≤0.05 was significant. RESULTS: One hundred thirty-five infants underwent KPE between January 2012 and December 2018, of which 90 (67%) achieved CoJ. From these 20 (22%) (Cohort A) underwent LT with the remainder continuing with native liver (Cohort B) (median follow-up of 4.15 years). There was no difference in age at KPE ( P = 0.41), APRi (aspartate aminotransferase-to-platelet ratio) ( P = 0.07), associated anomalies ( P = 0.7), and cytomegalovirus status ( P = 0.7) between the 2 groups. Postoperatively, both cholangitis [any episode, 18/20 (90%) vs 15/70 (21%); P < 0.0001] and portal hypertension (PHT) [gastrointestinal (GI) bleed, 10/20 (50%) vs 2/70 (2.8%); P < 0.0001] were significantly more common in cohort A. Univariate analysis showed that the most significant predictive values at 3 months for LT by 2 years were high APRi, bilirubin, international normalized ratio, and ultrasound (US)-detected ascites with multivariate logistic modeling confirming these variables with predictive values of r2 = 0.79, AUROC = 0.98. CONCLUSIONS: Failure is not preordained at KPE but due to recurrent cholangitis and/or symptoms of PHT.

Does Relative Age Influence Organized Sport and Unorganized Physical Activity Participation in a Cohort of Adolescents?

Despite their prevalence, the longitudinal impacts of relative age effects (RAEs) on sport and other forms of physical activity (PA) are understudied. This study examined longitudinal participation patterns in organized sport (team and individual), unorganized PA, and non-participation with respect to RAEs in a prospective cohort of adolescents. Data from the first 24 cycles of the MATCH study were used for analyses. Elementary students (n = 929) were recruited from 17 schools in Atlantic Canada. Respondents self-reported PA three times/year. Mixed multilevel logistic models compared the likelihood of participating in each context across birth quarter. Chronological age and gender were considered, along with the interaction between chronological and relative age. Individuals born in Quarter 1/Quarter 2 were more likely to report participation in organized team sport but not individual sports. Relatively older participants born in Quarter 2 were more likely to report participation in unorganized PA. Increasing chronological age was associated with decreased participation in organized sport (particularly team-based) and increased non-participation. Gender was not associated with organized sport participation, but girls were under-represented in unorganized PA and more likely to report non-participation. The interaction parameters suggested that RAEs were consistent throughout adolescence in each context. Longitudinal analyses suggest RAEs are context dependent.

Movement and mortality of invasive suckermouth armored catfish during a spearfishing control experiment.

Control of non-native, invasive species in groundwater-dependent ecosystems that are also inhabited by regionally endemic or at-risk species represents a key challenge in aquatic invasive species management. Non-native suckermouth armored catfish (SAC; family Loricariidae) have invaded freshwater ecosystems on a global scale, including the groundwater-dependent upper San Marcos River in Texas, USA. We used passive integrated transponder tags to follow the movements and fates of 65 fish in a 1.6 km spring-fed reach of the upper San Macros River to assess the efficacy of a community-based spearfishing bounty hunt for controlling SAC. We found the weekly probability of SAC survival was negatively correlated with the number of fish removed as a part of the bounty hunt each week (P = 0.003, R 2 = 0.86), while the probability of SAC being speared and reported was positively correlated with the number of fish removed (P = 0.011, R 2 = 0.53). The majority of SAC used < 25 m2 of river over a nine-week tracking period, but the area of river fish used correlated positively with the number of relocations (P < 0.001, R 2 = 0.36) as might be expected for a population that disperses through diffusive spread. These findings collectively suggest local-scale suppression of the SAC population is possible through community engagement in spearfishing, but over longer time periods immigration might offset some of the removal success. This conclusion provides an explanation for the pattern in which long-term spearfishing tournaments have reduced biomass but ultimately not resulted in eradication of the population. Supplementary Information: The online version contains supplementary material available at 10.1007/s10530-022-02834-2.

An Examination of Relative Age and Athlete Dropout in Female Developmental Soccer.

Sport dropout rates among children and youth are a concern for researchers and policy makers. The impact of relative age effects (RAEs) on dropout trends has not been adequately examined in female samples. The purpose of this study was to longitudinally examine dropout in a female soccer cohort in Ontario, Canada. Registration entries for a one-year cohort were examined across a seven-year period (n = 9908; age 10-16 years). A chi-square analysis established the presence of RAEs in the initial year of registration. Survival analyses assessed the impact of relative age, competition level, and community size on athlete dropout. A median survival rate of four years was observed for players born in the first quartile, while all remaining quartiles had a median survival of three years. Community size did not predict dropout in this analysis; however, competition level was a significant predictor, with competitive players being more likely to remain engaged vs. recreational players (55.9% vs. 20.7%). The observed trends are likely to have a significant impact from both a healthy development and systems perspective (e.g., economic/market loss). Intervention is needed to mitigate current dropout trends in female athletes. Practical applications are discussed.

Introduction to Cognitive Restructuring for Medical Students.

Introduction: Medical students list stigma and lack of time as reasons to avoid seeking mental health care. Many patients do not receive appropriate mental health care due to a lack of knowledge regarding available treatments among their medical providers. We created this activity to enhance medical student knowledge and well-being by introducing cognitive restructuring principles and skills in a highly interactive module. Methods: We administered a 90-minute learning activity, which included a short videotaped lecture, clinical case vignette, small-group discussion, and application exercise. Immediately following the learning activity, students and faculty completed anonymous evaluations. Results: A total of 139 first-year medical students and 152 second-year medical students completed the activity. For the first-year cohort, upwards of 80% of students and 100% of faculty respondents rated the session either good or excellent. For the second-year cohort, over 80% of students and over 90% of faculty rated the session either good or excellent. Approximately 90% of first- and second-year medical students and 100% of faculty recommended offering the session to future students. Open-ended feedback from students was overwhelmingly positive. Discussion: The resources included in this module allow educators at any institution to implement this learning activity, as no specific content knowledge/expertise is required of faculty. As the activity was well received by students and faculty, the investment of curricular time appears to have been well spent.

Confusion Reigns: An Analysis of Responses to U.S. Soccer Age Cut-Off Date Policy Change.

Relative age effects (RAEs) have been associated with the common practice of grouping athletes by chronological age. Development and selection advantages are often awarded to those who are born closer to, but following, the cut-off date employed by sport systems. In 2015, the U.S. Soccer Federation announced that it would be changing its birth-year registration cut-off date from August 1st to January 1st. This change was introduced to align the U.S. youth soccer calendar with international standards, and simultaneously provide clearer information on player birthdates to "lessen" RAEs. The magnitude of this policy change has led to considerable controversy, with members of the soccer community taking to social media and website blogs, as well as the U.S. Youth Soccer's website, to voice their opinions and general unhappiness with this decision. Thus, the purpose of this study was to provide a summary of online reactions to the policy change, with attention to the manner in which the U.S. Soccer Federation framed (i.e., the underlying rationale for the decision) and publicly communicated its decision to change the annual cut-off date. Qualitative content analysis was used to analyze data collected from 63 social media sites (websites, n = 43; forums, n = 16; blogs, n = 4). From the 3,851 pages of text derived from these sources, a total of 404 unique passages of text were identified within 262 stakeholder posts. Four categories emerged from the data: stakeholder discussion, outcomes identified by stakeholders, recommended courses of action, and communication regarding the policy change. In general, the actions of the U.S. Soccer Federation and related outcomes were negatively perceived by stakeholders at various levels of the sport. Resistance to the change may have been reduced through enhanced communication from the national level and opportunities for stakeholder input. While one objective of this policy change was to combat RAEs, previous research suggests this organizational change will only shift which group of athletes experience relative age (dis)advantages. There appears to be a disconnect between the academic literature and sport policy with respect to solutions for RAEs, which can lead to unintended consequences for various sport stakeholders.

Female Youth Soccer Participation and Continued Engagement: Associations With Community Size, Community Density, and Relative Age.

Environmental context can impact youth engagement in sport and athlete development. Previous work has examined the population size of the birthplace of elite athletes; commonly known as the birthplace or community size effect. Community density has also been recognized as an important variable. Exact estimates for the ideal community characteristics and a thorough understanding of the underlying mechanisms has been somewhat elusive. Existing studies are cross-sectional in nature and there is evidence to suggest that significant variation exists within imposed categories. An athlete's birthdate position in a similar-age cohort can also impact development and has been associated with (dis)advantages resulting from subtle age differences (i.e., the relative age effect); it remains unknown if this variable is associated with population density. The objective of this study was to establish longitudinal participation trends among female youth soccer players in Ontario Canada, with consideration of community size, community density, and relative age. Within-category variation and associations between the variables were assessed. Registration entries at age 10 years (n = 9,826) and 16 years (n = 2,305) were isolated for analysis. Odds ratio analyses were conducted within each community size and density category for all 10 year old registrants; 95% confidence intervals were obtained. This procedure was repeated for all registrants at 16 years of age using the expected distribution at age 10 years to examine continued engagement. Findings suggest medium-sized communities (i.e., 10,000-249,999 inhabitants) provide the best odds of participation and continued engagement. Less densely populated communities (i.e., 50-<400 population/km2) appeared to be ideal for facilitating participation at age 10 years, but not for engagement at age 16 years. However, within-category variation was evident when each community was inspected individually. Consistent with previous attempts to find an association between community size and the relative age effect, there did not appear to be an association between community density and birth quartile distribution. Observations from this study show that community size and community density are truly unique and separate variables. Future studies should consider the underlying contributions to both low and high participation and continued engagement, while being mindful of within-category variation.

Manipulative Therapies: What Works.

Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain. Although manipulative therapy is sometimes recommended to treat conditions in children (e.g., musculoskeletal problems, otitis media, respiratory conditions, infantile colic, allergies), there is supporting evidence only for reducing the length of hospital stay for preterm infants. Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy. Although serious adverse events such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury are rare, they can cause significant disability or death. Given the limited proven benefits of manipulative therapies and small risk of serious adverse events, additional high-quality, adequately powered studies are needed before definitive recommendations can be made for treating many conditions.

Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series.

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is gaining popularity over endoscopic retrograde cholangiopancreatography (ERCP) for the management of common bile duct stones. However, its application has been almost exclusively following preoperative stone confirmation via magnetic retrograde cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) or ERCP. We present our series of LCBDE following detection of common bile duct stones with intraoperative imaging (IOI) alone, in consecutive elective and emergency patients with suspected choledocholithiasis. MATERIALS AND METHODS: All patients with suspected but unconfirmed choledocholithiasis undergoing LC with intention to proceed to LCBDE between January 2015 and June 2017 were included. LCBDE was performed following the discovery of choledocholithiasis on IOI. RESULTS: 371 patients with suspected choledocholithiasis underwent LC with IOI. CBD stones or obstructing sludge was identified in 107 patients (29%), with sensitivity of 96.2% and specificity of 98.5%. 100 patients, median age 59, went on to have LCBDE as indicated by intraoperative imaging. 76% were performed as emergency cases and conversion to open rate was 2%. There were no mortalities. Bile leak and retained stones occurred in 4% and 3% respectively. 7/100 patients required re-intervention, with re-look laparoscopy (n = 4) and ERCP (n = 3). Median length of stay was 1.5 and 3 days for elective and emergency cases respectively, and 30 readmission rate was 8%. DISCUSSION AND CONCLUSION: Traditionally patients presenting with suspicion of choledocholithiasis undergo preoperative MRCP/EUS and/or ERCP prior to eventual LC. We propose an alternative, more streamlined, pathway of treatment without requiring preoperative cholangiography, applicable to both elective and emergency patients.

Adult foot fractures: A guide.

This review can help you refine your approach to the diagnosis and management of adult foot fractures, while offering guidance on when to pursue advanced imaging.

Correction to: Relative Age Effects Across and Within Female Sport Contexts: A Systematic Review and Meta-Analysis.

An Online First version of this article was made available at https://link.springer.com/article/10.1007/s40279-018-0890-8 on 13 March 2018. Some errors were subsequently identified by the authors, particularly in regard to Table 4. Although the details pertained to in the table were correct in the original manuscript, it appears that errors were introduced during production of the article. The published article has now been updated with a corrected version of Table 4. This corrected version of the table is also shown below.

Relative Age Effects Across and Within Female Sport Contexts: A Systematic Review and Meta-Analysis.

BACKGROUND: Subtle differences in chronological age within sport (bi-) annual-age groupings can contribute to immediate participation and long-term attainment discrepancies; known as the relative age effect. Voluminous studies have examined relative age effects in male sport; however, their prevalence and context-specific magnitude in female sport remain undetermined. OBJECTIVE: The objective of this study was to determine the prevalence and magnitude of relative age effects in female sport via examination of published data spanning 1984-2016. METHODS: Registered with PROSPERO (No. 42016053497) and using Preferred Reporting Items for Systematic Reviews and Meta-analysis systematic search guidelines, 57 studies were identified, containing 308 independent samples across 25 sports. Distribution data were synthesised using odds ratio meta-analyses, applying an invariance random-effects model. Follow-up subgroup category analyses examined whether relative age effect magnitudes were moderated by age group, competition level, sport type, sport context and study quality. RESULTS: When comparing the relatively oldest (quartile 1) vs. youngest (quartile 4) individuals across all female sport contexts, the overall pooled estimate identified a significant but small relative age effect (odds ratio = 1.25; 95% confidence interval 1.21-1.30; p = 0.01; odds ratio adjusted = 1.21). Subgroup analyses revealed the relative age effect magnitude was higher in pre-adolescent (≤ 11 years) and adolescent (12-14 years) age groups and at higher competition levels. Relative age effect magnitudes were higher in team-based and individual sport contexts associated with high physiological demands. CONCLUSION: The findings highlight relative age effects are prevalent across the female sport contexts examined. Relative age effect magnitude is moderated by interactions between developmental stages, competition level and sport context demands. Modifications to sport policy, organisational and athlete development system structure, as well as practitioner intervention are recommended to prevent relative age effect-related participation and longer term attainment inequalities.

Obesity Statistics.

Obesity is a chronic disease that is strongly associated with an increase in mortality and morbidity including, certain types of cancer, cardiovascular disease, disability, diabetes mellitus, hypertension, osteoarthritis, and stroke. In adults, overweight is defined as a body mass index (BMI) of 25 kg/m(2) to 29 kg/m(2) and obesity as a BMI of greater than 30 kg/m(2). If current trends continue, it is estimated that, by the year 2030, 38% of the world's adult population will be overweight and another 20% obese. Significant global health strategies must reduce the morbidity and mortality associated with the obesity epidemic.

Exercise in Pregnancy: A Clinical Review.

CONTEXT: Health professionals who care for pregnant women should discuss potential health benefits and harms of exercise. Although most pregnant women do not meet minimal exercise recommendations, there are a growing number of physically active women who wish to continue training throughout pregnancy. EVIDENCE ACQUISITION: A search of the Web of Science database of articles and reviews available in English through 2014. The search terms exercise pregnancy, strenuous exercise pregnancy, and vigorous exercise pregnancy were used. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: With proper attention to risk stratification and surveillance, exercise is safe for the mother and fetus. Benefits of exercise in pregnancy include reduction in Cesarean section rates, appropriate maternal and fetal weight gain, and managing gestational diabetes. Exercise as a means of preventing gestational diabetes, preeclampsia, or perinatal depression cannot be reliably supported. Overall, the current evidence suffers from a lack of rigorous study design and compliance with physical activity interventions. CONCLUSION: Research thus far has been unable to consistently demonstrate proposed benefits of exercise in pregnancy, such as preventing gestational diabetes, preeclampsia, or perinatal depression. However, moderate- and high-intensity exercise in normal pregnancies is safe for the developing fetus and clearly has several important benefits. Thus, exercise should be encouraged according to the woman's preconception physical activity level.

Intracranial arteriovenous malformation in a college football player and return-to-play considerations.

: The reported prevalence rates of arteriovenous malformations (AVMs) in the general population range from 0.001% to 0.50%. The following case describes the initial presentation of hemorrhage from an intracranial AVM in an 18-year-old college football player. It also discusses treatment of the AVM with stereotactic radiosurgery and successful return to football 17 months after radiosurgery (18.5 months after initial presentation). It is the first published description of return to contact sports after stereotactic radiosurgery for intracranial AVM.

Radiotherapy in the management of giant cell tumor of bone.

OBJECTIVES: To evaluate the long-term treatment outcomes for patients with giant cell tumor of bone (GCTB) treated with radiotherapy with or without surgical resection. METHODS: This retrospective review includes 34 patients with GCTB treated with megavoltage radiotherapy between January 1973 and January 2008 at the University of Florida. Patients' ages ranged from 16 to 85 years (median, 29). Tumor sizes ranges from 2.5 to 12 cm (median, 4.8 cm) in the maximum dimension. Twenty-one patients received radiation for gross disease, either de novo (22 patients) or recurrent (12 patients). Thirteen patients were treated with postoperative radiation after gross total resection. The median dose was 45 Gy in both the definitive and adjuvant settings. RESULTS: The median follow-up was 16.8 years. The 5- and 10-year local-control (LC) rates were 85% and 81%, respectively. Six patients developed an isolated local recurrence (2/13 treated postoperatively and 4/21 who were treated for gross disease). All 6 patients who developed a local recurrence were successfully salvaged with surgery; therefore, the ultimate LC rate was 100%. Both the 5- and 10-year freedom from distant metastasis rates were 91%. Three patients developed lung metastases, including 1 patient who experienced GCTB transformation into a high-grade sarcoma. The 5- and 10-year progression-free survival rates were both 78%. CONCLUSIONS: Moderate-dose radiotherapy for GCTB provides a long-term LC >80%, justifying its role as an alternative to morbid surgery.

Barriers are not the limiting factor to participation in physical activity in canadian seniors.

The identification of barriers to physical activity and exercise has been used for many decades to explain exercise behavior in older adults. Typically health concerns are the number one barrier to participation. Data from CCHS-HA dataset (N = 20, 875) were used to generate a sample of Canadians, 60+ years, who did not identify a health condition limitation, illness, or injury as a barrier to participation in physical activity (n = 4,900) making this dataset unique in terms of the study of barriers to participation. While the vast majority of older adults participated in physical activity, 9.4% did not. The relationships between nonparticipation, barriers, self-reported health status, and chronic health conditions were determined using binary logistic regression. The main findings suggest that traditional barriers and self-reported health status are not responsible for nonparticipation. Nonparticipation was best predicted by chronic health conditions suggesting a disconnect between self-reported health status and underlying health conditions. The data are clear in suggesting that barriers are not the limiting factor and physical activity programming must be focused on meeting the health needs of our aging population.