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Introduction: Locomotion activities are part of most human daily tasks and are the basis for subsistence activities, particularly for hunter–gatherers. Therefore, differences in speed walking‐related variables may have an effect, not only on the mobility of the group, but also on its composition. Some anthropometric parameters related to body length could affect walking speed‐related variables and contribute to different human behaviors. However, there is currently little information on the influence of these parameters in nonadult individuals. Methods: Overall, 11 females and 17 male child/adolescents, 8–17 years of age, volunteered to participate in this cross‐sectional study. Five different pace walking tests were performed on a treadmill to calculate the optimal locomotion speed (OLS) and U‐shaped relationship between the walking energy expenditure and speed (χ2 cost of transport [CoT]) (i.e., energetic walking flexibility). Results: The mean OLS was 3.05 ± 0.13 miles per hour (mph), with no differences between sexes. Similarly, there were no sex differences in walking flexibility according to the χ2 CoT. Body height (p <.0001) and femur length (p <.001) were positively correlated with χ2 CoT; however, female child/adolescents mitigated the effect of height and femur length when walking at suboptimal speeds. Conclusion: Consistent with prior observations in adults, our findings suggest that anthropometric parameters related to body stature are associated with reduced suboptimal walking flexibility in children and adolescents. Taken together, these results suggest that children and adolescents can adapt their pace to the one of taller individuals without a highly energetic penalty, but this flexibility decreases with increasing body size. [ABSTRACT FROM AUTHOR]

YF3: (Eu3+, Nd3+) nanoparticles (orthorhombic phase, D~130 nm) were synthesized via the co-precipitation method, with subsequent hydrothermal treatment and annealing. The Eu3+ τdecay linearly descends with the increase of temperature in the 80–320 K range. The τdecay (T) slope values of the annealed YF3: Eu3+ (2.5 and 5.0 mol.%) nanoparticles were the highest (110·10−4 and 67·10−4, μs/K) in the whole 80–320 K range, respectively. Thus, these samples were chosen for further doping with Nd3+. The maximum Sa and Sr values based on the LIR (IEu/INd) function were 0.067 K−1 (at 80 K) and 0.86%·K−1 (at 154 K), respectively. As mentioned above, the single-doped YF3: Eu3+ (2.5%) nanoparticles showed the linearly decreasing τdecay (T) function (5D0–7F1 emission). The main idea of Nd3+ co-doping was to increase this slope value (as well as the sensitivity) by increasing the rate of τdecay (T) descent via the addition of one more temperature-dependent channel of 5D0 excited state depopulation. Indeed, we managed to increase the slope (Sa) to 180·10−4 K−1 at 80 K. This result is one of the highest compared to the world analogs. [ABSTRACT FROM AUTHOR]

Microbial monitoring in marine recreational waterways often overlooks environmental variables associated with pathogen occurrence. This study employs a predictive boosted regression trees (BRT) model to predict Staphylococcus aureus abundance in the Tampa Bay estuary and identify related environmental variables associated with the microbial pathogen's occurrence. We provide evidence that the BRT model's adaptability and ability to capture complex interactions among predictors make it invaluable for research on microbial indicator research. Over 18 months, water samples from 7 recreational sites underwent microbial quantitation and S. aureus isolation, followed by genetic validation. BRT analysis of S. aureus occurrence and environmental variables revealed month, precipitation, salinity, site, temperature, and year as relevant predictors. In addition, the BRT model accurately predicted S. aureus occurrence, setting a precedent for pathogen–environment research. The approach described here is novel and informs proactive management strategies and community health initiatives in marine recreational waterways. [ABSTRACT FROM AUTHOR]

Background and objectives: There is a scarcity of data stemming from largescale epidemiological longitudinal studies focusing on potentially preventable and controllable risk factors for Alzheimer's disease (AD) and AD-related dementia (ADRD). This study aimed to examine the effect of multiple metabolic factors and cardiovascular disorders on the risk of cognitive decline and AD/ADRD. Methods: We analyzed a cohort of 6,440 participants aged 45-84 years at baseline. Multiple metabolic and cardiovascular disorder factors included the five components of the metabolic syndrome [waist circumference, high blood pressure (HBP), elevated glucose and triglyceride (TG) concentrations, and reduced high-density lipoprotein cholesterol (HDL-C) concentrations], C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), factor VIII, D-dimer, and homocysteine concentrations, carotid intimal-medial thickness (CIMT), and urine albumin-to-creatinine ratio (ACR). Cognitive decline was defined using the Cognitive Abilities Screening Instrument (CASI) score, and AD/ADRD cases were classified using clinical diagnoses. Results: Over an average follow-up period of 13 years, HBP and elevated glucose, CRP, homocysteine, IL-6, and ACR concentrations were significantly associated with the risk of mortality in the individuals with incident AD/ADRD or cognitive decline. Elevated D-dimer and homocysteine concentrations, as well as elevated ACR were significantly associated with incident AD/ADRD. Elevated homocysteine and ACR were significantly associated with cognitive decline. A dose-response association was observed, indicating that an increased number of exposures to multiple risk factors corresponded to a higher risk of mortality in individuals with cognitive decline or with AD/ADRD. Conclusion: Findings from our study reaffirm the significance of preventable and controllable factors, including HBP, hyperglycemia, elevated CRP, D-dimer, and homocysteine concentrations, as well as, ACR, as potential risk factors for cognitive decline and AD/ADRD. [ABSTRACT FROM AUTHOR]

In this work, the physical characterization of LiGdxY1−xF4 (x = 0.05, 0.3, 0.7, and 1.0) and LiGdF4:Eu3+ microparticles was performed. The distribution coefficient of LiGdxY1−xF4 (x = 0.05) was determined for the first time (0.84). Based on kinetic characterization data, the LiGdF4 sample was chosen for further Eu3+ doping (0.1 and 1.0 at.%). For the LiGdF4:Eu3+ sample, Eu3+ emission was clearly observed under the excitation of Gd3+. This fact indicates an effective energy transfer from Gd3+ to Eu3+. The temperature-dependent spectral characterization of the LiGdF4:Eu3+ (1.0%) sample revealed that in the 30–250 K temperature range, a broad emission peak is evidenced. Its intensity sharply increases with the temperature decrease. We made a suggestion that this phenomenon is related to the irradiation-induced defects. The integrated luminescence intensity ratio of this broad peak and the Eu3+ emission were taken as temperature-dependent parameters. The sensitivity values are very competitive, and the first maximum occurs at 174 K (3.18%/K). The kinetic characteristics of both Gd3+ and Eu3+ did not demonstrate a notable temperature dependence. The LiGdF4:Eu3+ sample showed the possibility of being used as an optical temperature sensor, operating in the cryogenic temperature range. [ABSTRACT FROM AUTHOR]

What does it mean to cultivate a "healthy reflection culture" in HPE? For @moniztracy1 and @StellaHPE, it means acceptance and management of "not knowing" and an explicit framing of the essence of being a professional practitioner; to get there, writing can help. [ABSTRACT FROM AUTHOR]

Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones. [ABSTRACT FROM AUTHOR]

Throughout history, Historically Black Colleges and Universities (HBCUs) have overcome countless challenges to achieve their goals of maintaining cultural traditions, providing key leadership and role models, assuring economic functions, addressing issues between minority and majority populations, and producing Black agents for research, institutional training, and information dissemination within the Black and other minority communities. Using a Scholarly Personal Narrative (SPN), this article focuses on the function, legacy, and relevance of current HBCUs. Using W. E. B. Du Bois's "double consciousness" as a theoretical framework, each of the 12 contributing scholars address these questions: How have you reconciled your individual strivings? Has the HBCU placed a role in your reconciliation process? What SPN is emblematic of your reconciliation process? These questions are addressed through vivid narrative accounts that speak to the critical constructs of belonging—Black identity; gifted education, selfhood, spirituality, and theoretical frameworks. Each of these constructs represents an identity vector that points inward to the core—the HBCU. [ABSTRACT FROM AUTHOR]

AA-amyloidosis in Siamese and Oriental shorthair cats is a lethal condition in which amyloid deposits accumulate systemically, especially in the liver and the thyroid gland. The age at death of affected cats varies between one and seven years. A previous study indicated a complex mode of inheritance involving a major locus. In the present study, we performed a multi-locus genome-wide association study (GWAS) using five methods (mrMLM, FASTmrMLM, FASTmrEMMA, pLARmEB and ISIS EM-BLASSO) to identify variants associated with AA-amyloidosis in Siamese/Oriental cats. We genotyped 20 affected mixed Siamese/Oriental cats from a cattery and 48 healthy controls from the same breeds using the Illumina Infinium Feline 63 K iSelect DNA array. The multi-locus GWAS revealed eight significantly associated single nucleotide polymorphisms (SNPs) on FCA A1, D1, D2 and D3. The genomic regions harboring these SNPs contain 55 genes, of which 3 are associated with amyloidosis in humans or mice. One of these genes is SAA1, which encodes for a member of the Serum Amyloid A family, the precursor protein of Amyloid A, and a mutation in the promotor of this gene causes hereditary AA-amyloidosis in humans. These results provide novel knowledge regarding the complex genetic background of hereditary AA-amyloidosis in Siamese/Oriental cats and, therefore, contribute to future genomic studies of this disease in cats. [ABSTRACT FROM AUTHOR]

We report on the first simultaneous high-time resolution X-ray and infrared (IR) observations of a neutron star low mass X-ray binary in its hard state. We performed |$\approx 2\,$|  h of simultaneous observations of 4U 1728−34 using HAWK-I@VLT, XMM–Newton , and NuSTAR. The source displayed significant X-ray and IR variability down to sub-second time-scales. By measuring the cross-correlation function between the IR and X-ray lightcurves, we discovered a significant correlation with an IR lead of |$\approx 30 \!-\! 40\,$|  ms with respect to the X-rays. We analysed the X-ray energy dependence of the lag, finding a marginal increase towards higher energies. Given the sign of the lag, we interpret this as possible evidence of Comptonization from external seed photons. We discuss the origin of the IR seed photons in terms of cyclo-synchrotron radiation from an extended hot flow. Finally, we also observed the IR counterpart of a type-I X-ray burst, with a delay of |$\approx 7.2\,$|  s. Although some additional effects may be at play, by assuming that this lag is due to light travel time between the central object and the companion star, we find that 4U 1728−34 must have an orbital period longer than |$3\,$|  h and an inclination higher than 8○. [ABSTRACT FROM AUTHOR]

During a systematic search for new X-ray pulsators in the XMM–Newton archive, we discovered a high amplitude (⁠|$PF\simeq 86~{{\ \rm per\ cent}}$|⁠) periodic (⁠|$P\simeq 7.25\, \mathrm{s}$|⁠) modulation in the X-ray flux of 4XMM J045626.3–694723 (J0456 hereafter), a previously unclassified source in the Large Magellanic Cloud (LMC). The period of the modulation is strongly suggestive of a spinning neutron star (NS). The source was detected only during one out of six observations in 2018–2022. Based on an absorbed power-law spectral model with photon slope of Γ ≃ 1.9, we derive a 0.3–10 keV luminosity of |$L_\mathrm{X}\simeq 2.7\times 10^{34}\, \mathrm{erg}\, \mathrm{s}^{-1}$| for a distance of 50 kpc. The X-ray properties of J0456 are at variance with those of variable LMC X-ray pulsars hosted in high-mass X-ray binary systems with a Be-star companion. Based on Southern African Large Telescope (SALT) spectroscopic observations of the only optical object that matches the X-ray uncertainty region, we cannot completely rule out that J0456 is an NS accreting from a late-type (G8-K3) star, an as-yet-unobserved binary evolutionary outcome in the Magellanic Clouds (MCs). We show that the source properties are in better agreement with those of magnetars. J0456 may thus be the second known magnetar in the LMC after SGR 0526–66. [ABSTRACT FROM AUTHOR]

Introduction: As burnout within medicine escalates, residency programmes should strive to understand how training structures may contribute. Back‐up call systems that address gaps in overnight resident call coverage are one possible contributing structure. However, the intersection between back‐up call policies and burnout remains unclear. The authors explored residents' decision‐making process when deciding whether or not to activate a back‐up resident for call coverage, perspectives surrounding the legitimacy of call activations and the impact of back‐up call systems on education and experienced burnout. Methods: Internal medicine residents at the University of Toronto were recruited through email. Eighteen semi‐structured one‐on‐one interviews were conducted with residents from September 2019 to February 2020. Interviews explored participants' experiences and perceptions with back‐up call and call activations. A constructivist grounded theory approach was used to develop a conceptual understanding of the back‐up system as it relates to residents' decisions underlying activations, downstream impacts and relationships to burnout. Results: Residents described a complex thought process when deciding whether to activate back‐up. Decisions were coloured by inner conflicts including sense of collegiality, need to maintain an image and time of year balanced against self‐reported burnout. Residents described how back‐up calls can lead to burnout, usually in the form of exhaustion, lowering their threshold to trigger future back‐up activations. Impacts included anxiety of not knowing whether an activation would occur, decreased educational productivity and the 'domino effect' of increased workload for colleagues. Discussion: Residents weigh inner tensions when deciding to activate back‐up. Their collective experience suggests that burnout is both a trigger and consequence of back‐up calls, creating a cyclical relationship. Escalating rates of call activations may signal that burnout amongst residents is high, warranting educational leads to assess for resident wellness and to critically evaluate the structure of such systems with respect to unintended consequences. The authors demonstrate how back‐up call systems put in place to address resident illness and patient volume may be linked with General Practice trainee burnout. [ABSTRACT FROM AUTHOR]

The basic mechanisms of absorption of THz range radiation in optically perfect LiGdF4 single crystals were studied using the broadband experimental data and the dielectric response function analysis within the harmonic oscillator model. The polarized IR reflection spectra have allowed one to determine the phonon contribution in the absorption coefficient in the THz range, while transmission spectra in the THz range were used to obtain the birefringence value and the effects of various mulitparticle processes. Additionally, we established the optical and electrodynamic parameters of the LiGdF4 single crystal, which are necessary for the design of nonlinear optical devices. [ABSTRACT FROM AUTHOR]

Adaptive expertise (AE) and reflective practice (RP), two influential and resonant theories of professional expertise and practice in their own right, may further benefit health professions education if carefully combined. The current societal and systemic context is primed for both AE and RP. Both bodies of work position practitioners as agentive, learning continually and thoughtfully throughout their careers, particularly in order to manage unprecedented situations well. Similar on the surface, the roots and practices of AE and RP diverge at key junctures and we will focus on RP's movement toward critically reflective practice. The roots of AE and RP, and how they relate to or diverge from present-day applications matter because in health professions education, as in all education, paradigmatic mixing should be undertaken purposefully. This paper will explore the need for AE and RP, their shared commitments, distinctive histories, pedagogical possibilities both individually and combined, and next steps for maximizing their potential to positively impact the field. We argue that this exploration is urgently needed because both AE and RP hold much promise for improving health care and yet employing them optimally—whether alone or together—requires understanding and intent. We build an interprofessional education case situated in long-term care, throughout the paper, to demonstrate the potential that AE and RP might offer to health professions education individually and combined. This exploration comes just in time. Within the realities of uncertain practice emphasized by the pandemic, practitioners were also called to act in response to complex and urgent social movements. A combined AE and RP approach, with focus on critically reflective practice in particular, would potentially prepare professionals to respond effectively, compassionately, and equitably to future health and social crises and challenges. [ABSTRACT FROM AUTHOR]

In this paper, we report the synthesis, characterization, and optical properties of core-shell CeO2/CeF3 nanoparticles. Fabrication of these composite nanoparticles was carried out by fluorination of CeO2 nanoparticles with tetrafluoroethane R-134a gas at high temperatures (800–1200 °C) in a special vacuum furnace with a tubular graphite heater. The obtained X-ray diffraction spectra (XRD) and luminescence measurements confirm the formation of composite CeO2/CeF3 nanoparticles. Simulation of XRD spectra and calculation of lattice parameters were carried out. A proposed method of synthesis can be used for other rare-earth oxide nanoparticles to fabricate core-shell oxyfluoride nanosized composites that combine the properties of oxide and fluoride nanoparticles. [ABSTRACT FROM AUTHOR]

The X-ray light curves of accreting black holes and neutron stars in binary systems show various types of quasi-periodic oscillations (QPOs), the origin of which is still debated. The relativistic precession model identifies the QPO frequencies with fundamental time-scales from General Relativity, and has been proposed as a possible explanation of certain types of such oscillations. Under specific conditions (i.e. the detection of a particular QPOs triplet) such a model can be used to obtain self-consistent measurements of the mass and spin of the compact object. So far this has been possible only in the black hole binary GRO J1655-40. In the RXTE/PCA data from the 1999–2000 outburst of the black hole transient XTE J1859+226 we found a QPO triplet, and used the relativistic precession model to obtain high-precision measurements of the black hole mass and spin – M  = (7.85 ± 0.46) M⊙, a * = 0.149 ± 0.005 – the former being consistent with the most recent dynamical mass determination from optical measurements. Similarly to what has been already observed in other black hole systems, the frequencies of the QPOs and broad-band noise components match the general relativistic frequencies of particle motion close to the compact object predicted by the model. Our findings confirm previous results and further support the validity of the relativistic precession model, which is the only electromagnetic-measurement-based method that so far has consistently yielded spins close to those from the gravitational waves produced by merging binary black holes. [ABSTRACT FROM AUTHOR]

Despite some reports of cardiometabolic disorders associated with the risk of Alzheimer's disease (AD), limited studies have been conducted to examine the association between excessive sugar intake (a risk factor for cardiometabolic disorders) and AD risk. The purpose of our study was to evaluate if excessive sugar intake has a significant long-term effect on the risk of AD. A population sample of 37,689 participants, who enrolled in the United States (US) Women's Health Initiative – Dietary Modification Trial (WHI-DM) in 1993–2005 and its extended observational follow-up study through 1 March 2019, were analyzed. Dietary sugar intake was measured using food frequency questionnaires. AD was classified by reports using a standard questionnaire. A dietary pattern that explained the maxima variations in sugar intake was constructed using reduced rank regression (RRR) technique. Associations of RRR dietary pattern scores and sugar intake (g/day) by quartiles (Q1 through Q4) with AD risk were examined using Cox proportional hazards regression analysis with adjusting for key covariates. During a mean follow-up of 18.7 years, 4586 participants reported having incident AD. The total incidence rate (95% confidence interval [CI]) of AD was 6.5 (6.3–6.7) per 1000 person-years (PYs). The incidence rates (95% CI) of AD by total sugar intake were 6.2 (5.8–6.6), 6.4 (6.0–6.8), 6.6 (6.3–7.0), and 6.9 (6.5–7.3) per 1000 PYs among those in quartiles (Q) 1 to Q4 (toward higher sugar consumption) of total sugar intake, respectively (test for trend of AD incident rates, p < 0.001). Individuals in Q4 of total sugar intake had a 1.19 higher risk of incident AD than those in Q1 (hazard ratio [HR] = 1.19, 95% CI: 1.05–1.34, p = 0.01). An estimated increase of 10 g/day in total sugar intake (about 2.4 teaspoons) was associated with an increased AD risk by 1.3–1.4%. Of six subtypes of sugar intake, lactose was significantly associated with AD risk. Our study indicates that excessive total sugar intake was significantly associated with AD risk in women. Of six subtypes of sugar intake, lactose had a stronger impact on AD risk. [ABSTRACT FROM AUTHOR]

The efficacy of thrombolysis is inversely correlated with thrombus age. During early thrombogenesis, activated factor XIII (FXIIIa) cross-links α 2-AP to fibrin to protect it from early lysis. This was exploited to develop an α 2-AP-based imaging agent to detect early clot formation likely susceptible to thrombolysis treatment. In this study, this imaging probe was improved and validated using 111 In SPECT/CT in a mouse thrombosis model. In vitro fluorescent- and 111 In-labelled imaging probe-to-fibrin cross-linking assays were performed. Thrombus formation was induced in C57Bl/6 mice by endothelial damage (FeCl 3 ) or by ligation (stenosis) of the infrarenal vena cava (IVC). Two or six hours post-surgery, mice were injected with 111 In-DTPA-A16 and ExiTron Nano 12000, and binding of the imaging tracer to thrombi was assessed by SPECT/CT. Subsequently, ex vivo IVCs were subjected to autoradiography and histochemical analysis for platelets and fibrin. Efficient in vitro cross-linking of A16 imaging probe to fibrin was obtained. In vivo IVC thrombosis models yielded stable platelet-rich thrombi with FeCl 3 and fibrin and red cell-rich thrombi with stenosis. In the stenosis model, clot formation in the vena cava corresponded with a SPECT hotspot using an A16 imaging probe as a molecular tracer. The fibrin-targeting A16 probe showed specific binding to mouse thrombi in in vitro assays and the in vivo DVT model. The use of specific and covalent fibrin-binding probes might enable the clinical non-invasive imaging of early and active thrombosis. [ABSTRACT FROM AUTHOR]

We use a generalised Langevin equation scheme to study the thermal transport of low dimensional systems. In this approach, the central classical region is connected to two realistic thermal baths kept at two different temperatures [H. Ness et al., Phys. Rev. B 93, 174303 (2016)]. We consider model Al systems, i.e., one-dimensional atomic chains connected to three-dimensional baths. The thermal transport properties are studied as a function of the chain length N and the temperature difference ΔT between the baths.We calculate the transport properties both in the linear response regime and in the non-linear regime. Two different laws are obtained for the linear conductance versus the length of the chains. For large temperatures (T ... 500 K) and temperature differences (ΔT ... 500 K), the chains, with N > 18 atoms, present a diffusive transport regime with the presence of a temperature gradient across the system. For lower temperatures (T . 500 K) and temperature differences (Δ ... 400 K), a regime similar to the ballistic regime is observed. Such a ballistic-like regime is also obtained for shorter chains (N ≤ 15). Our detailed analysis suggests that the behaviour at higher temperatures and temperature differences is mainly due to anharmonic effects within the long chains. [ABSTRACT FROM AUTHOR]

Critical reflection supports enactment of the social roles of care, like collaboration and advocacy. We require evidence that links critical teaching approaches to future critically reflective practice. We thus asked: does a theory-informed approach to teaching critical reflection influence what learners talk about (i.e. topics of discussion) and how they talk (i.e. whether they talk in critically reflective ways) during subsequent learning experiences? Pre-clinical students (n = 75) were randomized into control and intervention conditions (8 groups each, of up to 5 interprofessional students). Participants completed an online Social Determinants of Health (SDoH) module, followed by either: a SDoH discussion (control) or critically reflective dialogue (intervention). Participants then experienced a common learning session (homecare curriculum and debrief) as outcome assessment, and another similar session one-week later. Blinded coders coded transcripts for what (topics) was said and how (critically reflective or not). We constructed Bayesian regression models for the probability of meaning units (unique utterances) being coded as particular what codes and as critically reflective or not (how). Groups exposed to the intervention were more likely, in a subsequent learning experience, to talk in a critically reflective manner (how) (0.096 [0.04, 0.15]) about similar content (no meaningful differences in what was said). This difference waned at one-week follow up. We showed experimentally that a particular critical pedagogical approach can make learners' subsequent talk, ways of seeing, more critically reflective even when talking about similar topics. This study offers the field important new options for studying historically challenging-to-evaluate impacts and supports theoretical assertions about the potential of critical pedagogies. [ABSTRACT FROM AUTHOR]

Current inclusive education practices remain entrenched in deficit-oriented discourses. An interrogation of these discourses is necessary to enact inclusion driven by diversity and collective belonging. This collective case study explored 10 cases of parent and child experiences in inclusive school settings and addressed the following questions: What disability discourses are (re)produced in inclusive school settings? What are the effects of these discourses on families' experiences of inclusion in inclusive school settings? Using disability discourses as sensitizing concepts, 5 themes were generated framed in 'disability as' statements: disability as fragile, deviant, currency, defining, and affirmative. Despite a shift towards inclusive rhetoric, normative and oppressive discourses permeated inclusive school settings examined in this study. Normative discourses produced the following effects: the Othering of disabled children, governance of disability, internalised oppression, ontological violence, and invisible work. Findings from this study call for critical reflexivity on current inclusive education policies. In this study we asked parents and disabled children about their experiences in inclusive school settings. Parents and children talked about how disability was largely viewed as negative by others, which led to the exclusion of disabled children in their neighbourhood schools. Findings from this study remind us that even if a school setting is labelled as inclusive it does not necessarily mean disabled children and parents feel included. Becoming aware of the negative messages about disability operating within inclusive school settings can help schools become more welcoming and inclusive of disabled children and their families. [ABSTRACT FROM AUTHOR]

Background: The HEALTHY Study was a multicomponent school-based intervention, designed to prevent type 2 diabetes mellitus (T2DM) in middle-school students.Objectives: We examined whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study.Methods: A total of 2181 ethnically diverse students, from 11.3 to 13.7 y of age, with completed dietary records, BMI percentile, and plasma glucose and insulin concentrations at 6th and 8th grades were included. Dietary magnesium intake was self-reported using the Block Kids FFQ. A hierarchical multiple regression model was used to determine whether the differences in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake and total energy intake.Results: The difference in dietary magnesium intake was significantly related to changes in BMI percentile from 6th to 8th grade in intervention and in control schools [intervention: β: -0.07; 95% CI: -0.58, -0.02; P = 0.03; R2 (regression coefficient effect size): 0.14; 95% CI for R2: 0.10, 0.17; control: β: -0.08; 95% CI: -0.63, -0.09; P = 0.01; R2: 0.12; 95% CI for R2: 0.08, 0.15]. The difference in dietary magnesium intake was not related to plasma glucose and insulin concentrations in intervention and in control schools.Conclusions: We conclude that a multicomponent intervention was associated with reduced risk of T2DM, and that this association may be modulated, in part, by magnesium. The differences in dietary magnesium intake from 6th to 8th grade were negatively related to changes in BMI percentile among middle-school students. [ABSTRACT FROM AUTHOR]

Background: This study aimed to (1) examine the proportion of patients presenting to an emergency department (ED) for acute cardiac symptoms with comorbid mental health conditions (MHCs) comprising current depression, generalized anxiety disorder, and panic disorder; (2) compare cardiac patients with and without MHCs regarding sociodemographic, medical, and psychological characteristics; and (3) examine recognition and treatment rates of MHCs. Methods: Multimorbid patients, aged ≥50 years, presenting to an inner‐city ED with acute cardiac symptoms including chest pain, dyspnea, and palpitations, completed validated self‐report instruments assessing MHCs and a questionnaire collecting psychosocial and medical information. In addition, routine medical data were extracted from the electronic health record. Results: A total of 641 patients were included in the study. Mean (±SD) age was 68.8 (±10.8) years and 41.7% were female. Based on screening instruments, 28.4% of patients were affected with comorbid MHCs. Patients reported clinically significant symptoms of depression (23.3% PHQ‐9 ≥10), generalized anxiety disorder (12.2% GAD‐7 ≥10), and panic disorder (4.7% PHQ‐PD). Patients with MHCs were more likely to be younger, female, lower educated, and unemployed. The presence of MHCs was associated with higher cardiac symptom burden and subjective treatment urgency as well as more psychosocial distress (PHQ‐stress) and impaired quality of life (SF‐12v2). Of all patients, 15.6% were identified with new or unrecognized MHCs. Conclusions: MHCs are prevalent in nearly one‐third of patients presenting with cardinal cardiac symptoms. Thus, the ED visit offers an opportunity to identify and refer patients with MHCs to appropriate and timely care after exclusion of life‐threatening conditions. [ABSTRACT FROM AUTHOR]

In this article we introduce a synthesis of education "paradigms," adapted from a multi-disciplinary body of literature and tailored to health professions education (HPE). Each paradigm involves a particular perspective on the purpose of education, the nature of knowledge, what knowledge is valued and included in the curriculum, what it means to learn and how learning is assessed, and the roles of teachers and learners in the learning process. We aim to foster awareness of how these different paradigms look in practice and to illustrate the importance of alignment between teaching, learning and assessment practices with paradigmatic values and assumptions. Finally, we advocate for a pluralistic approach that purposefully and meaningfully integrates paradigms of education, enhancing our ability to drive quality in HPE. [ABSTRACT FROM AUTHOR]

We study the contributions to the relativistic Fe K  α line profile from higher order images (HOIs) produced by strongly deflected rays from the disc which cross the plunging region, located between the innermost stable circular orbit (ISCO) radius and the event horizon of a Kerr black hole. We investigate the characteristics features imprinted by the HOIs in the line profile for different black hole spins, disc emissivity laws, and inclinations. We find that they extend from the red wing of the profile up to energies slightly lower than those of the blue peak, adding ∼0.4–1.3 per cent to the total line flux. The contribution to the specific flux is often in the ∼1 to 7 per cent range, with the highest values attained for low and negative spin (a ≲ 0.3) black holes surrounded by intermediate inclination angle (i ∼ 40°) discs. We simulate future observations of a black hole X-ray binary system with the Large Area Detector of the planned X-ray astronomy enhanced X-ray Timing and Polarimetry Mission (eXTP) and find that the Fe K α line profiles of systems accreting at ≲1 per cent the Eddington rate are affected by the HOI features for a range of parameters. This would provide evidence of the extreme gravitational lensing of HOI rays. Our simulations show also that not accounting for HOI contributions to the Fe K α line profile may systematically bias measurements of the black hole spin parameter towards values higher by up to ∼0.3 than the inputted ones. [ABSTRACT FROM AUTHOR]

Background: Screening for depression in patients with coronary heart disease (CHD) remains controversial. There is limited data on the actual depression management need in routine care. The aim of this study was to examine the prevalence, treatment rates, prognosis, and management need of clinical and subclinical depression in CHD patients according to the American Heart Association recommendations and the National Institute for Health and Care Excellence (NICE) guideline "Depression in Adults with a Chronic Physical Health Problem".Methods: Patients were recruited at 2 German university clinics between 2012 and 2014. Depressive disorders were assessed according to the DSM-IV and depressive symptom severity at baseline and during follow-up was evaluated with the Patient Health Questionnaire (PHQ-9). Depression management need was determined by the severity and longitudinal course of depression symptoms.Results: Of 1,024 patients (19% women), 12% had clinical depression (depressive disorder) and 45% had subclinical depression (PHQ-9 score ≥5) at baseline. Among those with clinical depression, 46% were in treatment at least once during 12 months; 26% were continuously in treatment during follow-up. Depressive disorder and depressive symptoms were significant risk factor-adjusted predictors of the 12-months mortality (adjusted HR = 3.19; 95% CI 1.32-7.69, and adjusted HR = 1.09; 95% CI 1.02-1.16, respectively). Depressive symptoms persisted in 85% of the clinically depressed and in 47% of the subclinically depressed patients. According to current recommendations, 29% of all CHD patients would require depression management within 1 year.Conclusions: There is a need for enhanced recognition, referral, and continuous and improved clinical management of depression in CHD patients. [ABSTRACT FROM AUTHOR]

We report on simultaneous radio and X-ray observations of the radio-emitting magnetar 1E 1547.0–5408 on 2009 January 25 and February 3, with the 64 m Parkes radio telescope and the Chandra and XMM-Newton X-ray observatories. The magnetar was observed in a period of intense X-ray bursting activity and enhanced X-ray emission. We report here on the detection of two radio bursts from 1E 1547.0–5408 reminiscent of fast radio bursts (FRBs). One of the radio bursts was anticipated by ∼1 s (about half a rotation period of the pulsar) by a bright SGR-like X-ray burst, resulting in a Fradio/FX ∼ 10−9. Radio pulsations were not detected during the observation showing the FRB-like radio bursts, while they were detected in the previous radio observation. We also found that the two radio bursts are neither aligned with the latter radio pulsations nor with the peak of the X-ray pulse profile (phase shift of ∼0.2). Comparing the luminosity of these FRB-like bursts and those reported from SGR 1935+2154, we find that the wide range in radio efficiency and/or luminosity of magnetar bursts in the Galaxy may bridge the gap between "ordinary" pulsar radio bursts and the extragalactic FRB phenomenon. [ABSTRACT FROM AUTHOR]

Body composition measurements remain one of the best objective ways to analyze tissue distribution in athletes. The purpose of this study was to establish an average body composition profile for professional male ice hockey players, assess the yearly fluctuations of body composition after a single season, and assess body composition changes among different positions. Body composition was measured using dual-energy X-ray absorptiometry in 36 professional male ice hockey players. Descriptive statistics were used to determine average values. A paired samples t-test was applied to determine differences over a one-year period. A one-way analysis of variance was used to determine differences between positions, at both time points. Alpha levels were set a priori at p<0.05. Significant increases were observed in percent body fat across time points for all positions (p=0.019). There were significant differences in percent body fat between positions played (p=0.012) after one year. We demonstrated that there was low variability among the different positions in professional male ice hockey players. Additionally, we observed how a single year minimally influences changes in body composition. More research is required to evaluate body composition in male ice hockey players. [ABSTRACT FROM AUTHOR]

Depression and coronary heart disease (CHD) are prevalent and often co-occurring disorders. Both have been associated with a dysregulated stress system. As a central element of the stress system, the FKBP5 gene has been shown to be associated with depression. In a prospective design, this study aims to investigate the association of FKBP5 with depressive symptoms in CHD patients. N = 268 hospitalized CHD patients were included. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS-D) at four time points (baseline, and after 1 month, 6 months, and 12 months). The functional FKBP5 single-nucleotide polymorphism (SNP) rs1360780 was selected for genotyping. Linear regression models showed that a higher number of FKBP5 C alleles was associated with more depressive symptoms in CHD patients both at baseline (p = 0.015) and at 12-months follow-up (p = 0.025) after adjustment for confounders. Further analyses revealed that this effect was driven by an interaction of FKBP5 genotype with patients' prior CHD course. Specifically, only in patients with a prior myocardial infarction or coronary revascularization, more depressive symptoms were associated with a higher number of C alleles (baseline: p = 0.046; 1-month: p = 0.026; 6-months: p = 0.028). Moreover, a higher number of C alleles was significantly related to a greater risk for dyslipidemia (p =.016). Our results point to a relevance of FKBP5 in the association of the two stress-related diseases depression and CHD. [ABSTRACT FROM AUTHOR]

Involving patients in medical education as teachers is not a novel approach, yet it has not been widely adopted by undergraduate surgical curricula in Canada. The Patients as Teachers initiative in surgery (PAT) program, with an arts-based reflection assignment, was developed for surgical clerks with the goals of emphasizing patient-centredness in surgical practice, humanistic aspects of medicine, and to counterbalance the commonplace emphasis on technical competency in surgery. Qualitative data was collected exploring the question: What was the experience and impact of the PAT program on patient teachers and students? Patient teachers (n = 5) were invited to participate in one-on-one interviews and students (n = 46) were invited to participate in focus groups at the end of the program. Findings converged around two main themes: what students/patient teachers valued about the PAT program and what they perceived was learned. While patient teachers felt a sense of emotional healing and appreciated a chance to contribute to medical education, students valued having protected time to learn in depth from the patient teachers. Students also begrudgingly came to appreciate the arts-based reflection assignment. By bringing patient voice to the forefront and encouraging reflection, the PAT program emphasized to students the compassionate and humanistic side of surgical care. Future studies could examine the mechanisms by which learning occurs and long-term impacts. [ABSTRACT FROM AUTHOR]

Trajectory surface hopping (TSH) is one of the most widely used quantum-classical algorithms for nonadiabatic molecular dynamics. Despite its empirical effectiveness and popularity, a rigorous derivation of TSH as the classical limit of a combined quantum electron-nuclear dynamics is still missing. In this work, we aim to elucidate the theoretical basis for the widely used hopping rules. Naturally, we concentrate thereby on the formal aspects of the TSH. Using a Gaussian wave packet limit, we derive the transition rates governing the hopping process at a simple avoided level crossing. In this derivation, which gives insight into the physics underlying the hopping process, some essential features of the standard TSH algorithm are retrieved, namely (i) non-zero electronic transition rate ('hopping probability') at avoided crossings; (ii) rescaling of the nuclear velocities to conserve total energy; (iii) electronic transition rates linear in the nonadiabatic coupling vectors. The well-known Landau-Zener model is then used for illustration. [ABSTRACT FROM AUTHOR]

Background: Content knowledge surrounding transgender (trans) medicine is currently lacking in the formal medical education curricula. Evidence indicates that the main protocols used to assess and refer trans patients for gender-affirming medicine are misunderstood by health professionals, and require flexible adaptation to achieve health equity and patient-centred care. Approach: A free online educational tool for gender-affirming medicine, The Path to Patient-Centred Care, was developed to teach learners how to adapt assessment protocols. Resource creation was supported by a knowledge translation grant that endorsed design thinking, a human-centred and solutions-focused framework recommended for use in curriculum development. Evaluation: The Path to Patient-Centred Care provides learners with information related to key principles of patient-centred care in gender-affirming medicine, including a guide on how to adapt the main assessment protocols to achieve equitable care. The curriculum also includes narratives from trans patients and health professionals that focus on health equity, and a clinical vignette about a complex case, designed to foster critical thinking on medical ethics. Project future directions involve an implementation and evaluation pilot study with a diverse group of continuing professional development medical learners using a mixed-methods program evaluation design. Reflection: The use of design thinking to develop this resource exemplifies a novel approach to curriculum development. By using pedagogical strategies that foster critical reflection, this innovative online education tool strives to teach self-directed learners how to provide care that emphasizes trans people's self-determination and autonomy in medical decision-making. [ABSTRACT FROM AUTHOR]

Background Multinutrient protein-enriched supplements are promoted to augment the effects of exercise on muscle mass and strength, but their effectiveness in middle-aged women, or whether there are any additional benefits to physical function, remains uncertain. Objectives We aimed to evaluate whether a multinutrient-fortified milk drink (MFMD) could enhance the effects of exercise on functional muscle power (stair climbing) in middle-aged women. Secondary aims were to evaluate the intervention effects on physical function, muscle strength, lean mass (LM), fat mass (FM), bone mineral content (BMC), muscle cross-sectional area (CSA), muscle density, balance, flexibility, aerobic fitness, inflammation, oxidative stress, bone and cartilage turnover, blood pressure, and blood lipids. Methods In this 4-mo, double-blind, placebo-controlled, randomized trial, 244 women (45–65 y) participated in a multimodal resistance-type exercise program 3 d/wk, with random allocation to a twice-daily MFMD containing added protein, vitamin D, calcium, milk fat globule membrane (phospholipids and other bioactives), and other micronutrients (Ex + MFMD, n  = 123) or an energy-matched placebo (Ex + placebo, n  = 121). Results A total of 216 women (89%) completed the study. After 4 mo, both groups experienced similar 3.6%–4.3% improvements in the primary outcomes of fast-pace 5- and 10-step stair ascent power. In contrast, Ex + MFMD experienced greater improvements in 5-step regular-pace stair descent time [net difference (95% CI): −0.09 s (−0.18, 0.00 s), P  = 0.045], countermovement jump height [0.5 cm (0.04, 1.0 cm), P  = 0.038], total body LM [0.3 kg (0.04, 0.60 kg), P  = 0.020], FM [−0.6 kg (−1.0, −0.2 kg), P  = 0.004], BMC [0.4% (0.1%, 0.6%), P  = 0.020], muscle CSA [thigh: 1.8% (0.6%, 2.9%), P  = 0.003; lower leg: 0.9% (0.3%, 1.6%), P  = 0.005], balance eyes closed [3.3 s (1.1, 5.4 s), P  = 0.005], 2-min step performance [8 steps (3, 12 steps), P  = 0.003], and sit-and-reach flexibility [1.4 cm (0.6, 2.2 cm), P  = 0.026]. MFMD did not enhance the effects of exercise on any measures of muscle strength, gait speed, dynamic balance, reaction time, or blood lipids, and there was no effect of either intervention on blood pressure, markers of inflammation, or cartilage turnover. Ex + placebo had a greater improvement in the oxidative stress marker protein carbonyls (P  < 0.01). Conclusions In middle-aged women, daily consumption of an MFMD did not enhance the effects of a multimodal exercise program on the primary outcome of stair climbing ascent power, but did elicit greater improvements in multiple secondary outcomes including various other measures of functional performance, LM, muscle size, FM, balance, aerobic capacity, flexibility, and bone metabolism. This trial was registered at www.anzctr.org.au as ACTRN12617000383369. [ABSTRACT FROM AUTHOR]

Educators, practitioners, and policy makers are calling for stronger connections between continuing education (CE) for professionals and the concerns of workplaces where these professionals work. This call for greater alignment is not unique to the health professions. Researchers within the field of higher education have long wrestled with the complexities of aligning professional learning and workplace concerns. In this study, we extend this critical line of inquiry to explore the possible conceptual intersections between two CE programs acting within a single healthcare organization. Both programs are concerned with improving patient care, primarily by changing the ways professionals think and talk with one another. However, the two programs have different historical origins: one in a workplace, the other within a university setting. Introducing the concept of "modes of ordering" as a way to analyze the curricula, we argue the programs are operating through separate logics of learning. We label these two modes of ordering: (1) learning as standardization and (2) learning as identification. Through our discussion, we explore how these different modes demand different roles for educators and participants. Ultimately, we argue that both have value. However, we also argue that educators require conceptual tools to sensitize them to the possibility of competing logics of learning and the subsequent implications for their practice as educators. In conclusion, we offer the metaphor of CE educator as choreographer, connecting concepts and practices within these logics in productive ways while continually navigating the various learning imperatives acting on professionals at any given time. [ABSTRACT FROM AUTHOR]

Background Exercise and increased dietary protein have been linked to improved muscle and cognitive health, but the combination may be more effective. Objective In this study performed in community-dwelling older adults undergoing a 3-d/wk resistance-based exercise training program, we investigated whether those who consumed lean red meat compared to carbohydrates on the 3 training days per wk would experience greater exercise-induced improvements in total body and leg lean mass (LM), muscle strength, and executive function (multiple primary outcomes), as well as muscle size and density, functional performance, cognition, inflammatory and neurotrophic markers, blood pressure, and lipid concentrations. Design In a 24-wk, 2-arm parallel randomized controlled trial, 154 adults aged ≥65 y participated in a multicomponent 3-d/wk resistance-based exercise program with random allocation to either a lean red meat group (two 80-g servings of cooked red meat), the exercise plus lean red meat (Ex + Meat) group (n = 77) or a control group receiving carbohydrates in the form of one-half cup (approximately 225 g cooked weight) of rice or pasta or 1 medium potato, the exercise plus carbohydrate control (C + Ex) group (n  = 77), on the training days. Results Exercise-induced improvements (mean within group changes) did not significantly differ between groups for the primary outcomes of total body LM (0.6 to 0.8 kg), leg LM (0.1 to 0.2 kg), thigh muscle cross-sectional area (3.7% to 4.9%), leg and back muscle strength (26% to 40%), and executive function (z -score SD: 0.33 to 0.39), nor the secondary outcomes of global cognition function (0.17 to 0.23 SD), fat mass (−0.65 to −0.75 kg), physical function measures (sit-to-stand, both 15%; 4-square step test, 2% to 7%), or systolic blood pressure (−3.2 to −4.1 mm Hg). The Ex + Meat group experienced greater improvements than the C + Ex in arm LM (0.07 kg; 95% CI: 0.01, 0.14; P  = 0.029), gait speed (0.05 m/s; 95% CI: 0.00, 0.11; P  = 0.042), muscle density (1.0%; 95% CI: 0.2, 1.9; P  = 0.015), and appendicular LM in the per-protocol analysis (0.21 kg; 95% CI: 0.02, 0.40; P  = 0.03). The C + Ex group had greater net improvements in working memory/learning after 12 wk (SD: 0.24; 95% CI: 0.05, 0.43; P  = 0.011) and 24 wk (SD: 0.27; 95% CI: 0.06, 0.49; P  = 0.007). Inflammatory and neurotrophic markers did not change in either group. Conclusion In healthy community-dwelling older adults undertaking resistance-based exercise training 3-d/wk, participants who consumed lean red meat in line with current Australian dietary recommendations did not experience any significant additional benefits in the primary outcome measures of muscle mass, strength, or cognitive function compared to participants consuming carbohydrates. This trial is registered with the Australian and New Zealand Clinical Trials Registry as ACTRN12613001153707. [ABSTRACT FROM AUTHOR]

We discovered 2.8 s pulsations in the X-ray emission of the ultraluminous X-ray source (ULX) M51 ULX-7 within the UNSEeN project, which was designed to hunt for new pulsating ULXs (PULXs) with XMM-Newton. The pulse shape is sinusoidal, and large variations of its amplitude were observed even within single exposures (pulsed fraction from less than 5% to 20%). Source M51 ULX-7 is variable, generally observed at an X-ray luminosity between 1039 and 1040 erg s−1, located in the outskirts of the spiral galaxy M51a at a distance of 8.6 Mpc. According to our analysis, the X-ray pulsar orbits in a 2 day binary with a projected semimajor axis 28 lt-s. For a neutron star (NS) of 1.4 M⊙, this implies a lower limit on the companion mass of 8 M⊙, placing the system hosting M51 ULX-7 in the high-mass X-ray binary class. The barycentric pulse period decreased by ≃0.4 ms in the 31 days spanned by our 2018 May–June observations, corresponding to a spin-up rate. In an archival 2005 XMM-Newton exposure, we measured a spin period of ∼3.3 s, indicating a secular spin-up of , a value in the range of other known PULXs. Our findings suggest that the system consists of a massive donor, possibly an OB giant or supergiant, and a moderately magnetic (dipole field component in the range 1012 G G) accreting NS with weakly beamed emission (). [ABSTRACT FROM AUTHOR]

The magnetar SGR J1745−2900, discovered at a distance of parsecs from the Milky Way central black hole, Sagittarius A⋆, represents the closest pulsar to a supermassive black hole ever detected. Furthermore, its intriguing radio emission has been used to study the environment of the black hole, as well as to derive a precise position and proper motion for this object. The discovery of SGR J1745−2900 has led to interesting debates about the number, age, and nature of pulsars expected in the Galactic center region. In this work, we present extensive X-ray monitoring of the outburst of SGR J1745−2900 using the Chandra X-ray Observatory, the only instrument with the spatial resolution to distinguish the magnetar from the supermassive black hole (2.″4 angular distance). It was monitored from its outburst onset in 2013 April until 2019 August, collecting more than 50 Chandra observations for a total of more than 2.3 Ms of data. Soon after the outburst onset, the magnetar emission settled onto a purely thermal emission state that cooled from a temperature of about 0.9–0.6 keV over 6 yr. The pulsar timing properties showed at least two changes in the period derivative, increasing by a factor of about 4 during the outburst decay. We find that the long-term properties of this outburst challenge current models for the magnetar outbursts. [ABSTRACT FROM AUTHOR]

Context: Critical reflection may improve health professionals' performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value‐conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches. Methods: The study context was the interface between health care and education for children with chronic conditions or disabilities necessitating health‐related recommendations and supports (eg accommodations or equipment) at school. We conducted a secondary analysis of 42 interview transcripts from an institutional ethnographic study involving health professionals, school‐based educators and parents of children with chronic conditions or disabilities. We coded all transcripts for instances of critical reflection, moments that seemed to lack but could benefit from critical reflection, and participant‐attributed sources of critically reflective insights. Results: Critically reflective practice involved getting to know the other, valuing and leveraging different forms and sources of knowledge, identifying and communicating workarounds (ie strategies to circumvent imperfect systems), seeing inequities, and advocating as collaborators, not adversaries. Participants invariably attributed critically reflective insights to personal experiences such as former careers or close personal relationships. Conclusions: This study shows that personal experiences and connections inspire critically reflective views, and that being critically reflective is not a binary trait possessed (or not) by individuals. It is learnable through personally meaningful experiences. Health professions education could aim to preserve philosophical space for personal experience as a source of learning and integrate evidence‐informed approaches to foster critically reflective practice. Ng et al. explore the implications of their observation that critical reflection improved social aspects of practice (advocacy and collaboration) when clinicians worked with schools to support children with disabilities, but that it did so opportunistically. [ABSTRACT FROM AUTHOR]

Mouth rinsing has been proposed as a strategy to minimize performance decrements during Ramadan. We investigated the effect of 4 weeks of Ramadan on kicking performance in 27 Taekwondo athletes performing weekly Taekwondo Anaerobic Intermittent Kick Tests (TAIKT). The effects of a placebo, 6.4% glucose and 6-mg/kg caffeine mouth rinses on TAIKT performance and perceived exertion were investigated before, during weekly training sessions, and after Ramadan in a counterbalanced, crossover design. Ramadan had a significant negative impact on the percentage of successful kicks in Week 1 of Ramadan (pre: 76.7±0.4%, Week 1: 69.9±3.2%). The percentage of successful kicks was significantly greater in the caffeine mouth rinse condition compared to the glucose and placebo conditions during the first 3 weeks of Ramadan (caffeine: 38.3±6.8%, glucose: 36.4±6.9%, placebo: 36.0±6.5%). Caffeine decreased perceived exertion during Ramadan (0.74-1.15 AU, p>0.05). Our results showed that Ramadan had a significant negative effect on repeated high-intensity kicking efforts that should be considered when training and competing. Additionally, there were significant positive effects of a caffeine mouth rinse in a sport-specific test. These data suggest that athletes can consider mouth rinsing as a strategy to enhance performance when undertaking training or competition during a period of privation. [ABSTRACT FROM AUTHOR]

Evidenced by leading journals in academic medicine, health professions education has taken up the call to advance equitable healthcare. One pressing area where gaps and inequities are apparent is transgender (trans) people's access to gender-affirming medicine such as hormones and surgeries. Reasons for the dire state of care include education gaps. While specific content knowledge has been identified as lacking in medical school curricula, less research has focused on the complex social practices required of clinicians and educators working in gender-affirming medicine, and how these skills are learned through practice. In order to inform health professions education in this key area of need, we conducted a study to better understand the social practices, and the learning that occurs therein, of gender-affirming medicine. We identified the work processes of 22 clinicians, clinician-educators, trans patients, and clinical care administrators with attention to how policies and protocols influenced practice, learning, and teaching. The results of our study elucidate: (1) that practicing of gender-affirming medicine is strictly dictated by standardized assessment protocols, which serve as a form of curriculum; and (2) how health professionals learn and teach health advocacy as a form of resistance to protocols identified as creating inequities. These findings suggest an opportunity to view protocols-and their inherent limitations-more deliberately as teaching and learning tools, specifically for learning advocacy. [ABSTRACT FROM AUTHOR]

Transgender (trans) people experience high rates of mental health issues including depression and suicidality. Improving access to transition-related medicine such as hormones and surgeries is suggested as an important mechanism to address these mental health issues. Yet clinicians experience challenges assessing and referring trans people for transition-related medicine. Standardized assessment protocols have been therefore recommended to optimize care. Although standardized protocols are purported to expand access to hormones and surgeries for trans people, it is unclear whether these tools achieve this goal. We therefore conducted an institutional ethnography to explicate how standardized readiness assessments coordinate access to hormones and surgeries in Canada. We analyzed key texts, talked with trans people, clinicians, clinician-educators, and administrators (total n = 22), and observed clinician-education workshops. In the context of determining transition readiness, standardized protocols direct clinicians to explore alternative diagnoses and assess the degree to which any complex mental health condition is "managed" prior to initiating hormones or surgeries. In response, we found that trans patients downplay or withhold mental health concerns from clinicians, or otherwise do additional work (e.g., take up unwanted psychiatric interventions) to convince providers they are "mentally ready" to transition. This phenomenon is paradoxical in that transition-related medicine is recommended to mitigate trans people's psychosocial distress, but when patients reveal symptoms of distress they encounter significant barriers to treatment. We conclude that the logic underpinning pre-transition "mental readiness" assessments discredits the claim that standardized protocols optimize access to hormones and surgeries. [ABSTRACT FROM AUTHOR]

The standard for assessing dietary sodium intake is to measure 24-hour urine sodium. On average, 93% of daily sodium intake is excreted over 24-hours. Expense and difficulties in obtaining complete 24-hour collections have led to the measurement of sodium concentration in spot and single-void urine samples, using predictive equations to estimate 24-hour urine sodium. Although multiple predictive equations have been developed, in addition to having an average bias, all the equations overestimate 24-hour sodium at lower levels of 24-hour sodium and underestimate 24-hour urine sodium at higher levels of 24-hour sodium. One of the least biased estimating equations is the INTERSALT equation, which incorporates a spot urine creatinine concentration. The authors hypothesized that differential fractional excretion of sodium (FeNa)(derived from a morning void collection) relative to creatinine would impact on the accuracy of the INTERSALT equation in estimating 24-hour urine sodium. In a prospective study of 139 adults aged 65 years and over, three sequential morning void and 24-hour urine samples were examined. There was a significant correlation between increasing FENa and the difference between estimated and measured 24-hours urine sodium (r = 0.358, P < .01). In the lowest quartile of FENa, the INTERSALT equation overestimated 24-hour urine sodium, but underestimated 24-hour urine sodium with greater magnitude in each of the subsequent quartiles of FENa. Differential excretion of sodium relative to creatinine, potentially impacted by renal blood flow and hydration, among other factors, affected the accuracy of the INTERSALT equation. Additional research may refine the INTERSALT and other predictive equations to increase their accuracy. [ABSTRACT FROM AUTHOR]

The solution of the time-dependent Schrödinger equation for systems of interacting electrons is generally a prohibitive task, for which approximate methods are necessary. Popular approaches, such as the time-dependent Hartree-Fock (TDHF) approximation and time-dependent density functional theory (TDDFT), are essentially single-configurational schemes. TDHF is by construction incapable of fully accounting for the excited character of the electronic states involved in many physical processes of interest; TDDFT, although exact in principle, is limited by the currently available exchange-correlation functionals. On the other hand, multiconfigurational methods, such as the multiconfigurational time-dependent Hartree-Fock (MCTDHF) approach, provide an accurate description of the excited states and can be systematically improved. However, the computational cost becomes prohibitive as the number of degrees of freedom increases, and thus, at present, the MCTDHF method is only practical for few-electron systems. In this work, we propose an alternative approach which effectively establishes a compromise between efficiency and accuracy, by retaining the smallest possible number of configurations that catches the essential features of the electronic wavefunction. Based on a time-dependent variational principle, we derive the MCTDHF working equation for a multiconfigurational expansion with fixed coefficients and specialise to the case of general open-shell states, which are relevant for many physical processes of interest. [ABSTRACT FROM AUTHOR]