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The primary objective of this research is to analyze and compare the effects of physical activity on patients diagnosed with obstructive sleep apnea (OSA), a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and various health complications. Methods: A systematic and strategic search of 16 peer-reviewed articles was conducted to assess the impact of different types of physical exercise on the apnea–hypopnea index (AHI), a key metric used to quantify the severity of OSA. The selected studies focused on two main exercise modalities: aerobic exercise alone and a combination of aerobic and resistance training. These modalities were examined to determine their respective influences on the AHI among individuals with OSA. Results: The findings revealed that aerobic exercise alone did not significantly alter the apnea–hypopnea index (p = 0.15), suggesting limited effectiveness in reducing the severity of OSA when performed in isolation. However, in patients who engaged in combined physical activity—incorporating both aerobic and resistance exercises—a significant reduction in the AHI was observed (p < 0.01), indicating a more substantial therapeutic effect. Conclusions: This study concludes that a structured exercise program combining aerobic and resistance training produces a significant improvement in the apnea–hypopnea indices of patients with obstructive sleep apnea. These results highlight the potential of combined exercise regimens as a non-pharmacological intervention that could complement traditional OSA treatments, offering a viable approach to managing the condition and improving patient outcomes. Future research should aim to explore the optimal exercise intensity, duration, and frequency to maximize these benefits. [ABSTRACT FROM AUTHOR]

Physical activity and sport (PAS) programmes are an important part of organized extracurricular activities for children and young people. They appear as potentially inclusive environments where students could be provided with holistic development based on active and healthy lifestyles. The aim of this study was to evaluate and describe the Gipuzkoa School Sport Programme (GSSP) from the positive youth development (PYD). The research was carried out based on CPAR (Critical Participatory Action-Research) methodology: a "CPAR group" was created -including researchers and policymakers- to carry out the evaluation of the GSSP in which we analyzed (a) the social environment or PYD climate and (b) life skills. The evaluation and description of the GSSP confirmed that it meets most requirements for providing positive development contexts and opportunities for PYD. The choice of prioritizing multisport and deliberate play and putting early specialization aside seem key conditions to ensure PYD-promoting environments. This work could serve as a referent for decision-makers in organizations dedicated to designing, developing, implementing, and evaluating PYD-focused extracurricular youth sport programmes. [ABSTRACT FROM AUTHOR]

Background: Increasing overlap exists between surgeries performed by podiatrists and orthopaedic surgeons. Large-scale cost comparisons between the two are lacking despite the current climate of cost containment in health care. Using national Medicare data, we aimed to compare per-case Medicare payments between podiatrists and orthopaedic surgeons for ankle fracture fixation. Methods: This retrospective cohort study included patients in an outpatient setting undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair from the national Medicare Limited Data Set (2013-2019). Type of surgeon (podiatrist or orthopaedic surgeon) was determined using publicly available information. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost. A subset analysis was also done to directly compare costs of orthopaedic surgeons to podiatric surgeons while excluding other fees (eg, hospital facility fees and surgery-related imaging payments). Additionally, patient demographics and hospital characteristics were compared to determine if any factors associated with costs may influence group differences. Univariable tests assessed significance of group differences. Results: Overall, 16 927 unimalleolar, 17 244 bimalleolar, and 11 717 trimalleolar fracture repairs were included; 86.7% and 13.3%, 92.4% and 7.6%, and 92.2% and 7.8% were performed by an orthopaedic surgeon or podiatrist, respectively. Median age (70-71 years) and median Charlson-Deyo Comorbidity Index (0) did not significantly differ between patients treated by either surgeon type. Median procedure-specific Medicare payments for all 3 categories of ankle fracture repairs (uni-, bi-, trimalleolar) were significantly lower for orthopaedic surgeons compared to podiatrists: $4156 vs $4300, $4205 vs $4379, and $4396 vs $4525, respectively (all P <.001). Conclusion: Our investigation using a national Medicare data set (2013-2019) found that the 3 types of ankle fractures (unimalleolar, bimalleolar, and trimalleolar) performed by orthopaedic surgeons in an outpatient setting were less expensive and that cost differences do not appear to be driven by patient characteristics. These results and further research into the causes of the cost differences may help improve the cost-effectiveness of ankle fracture surgery. [ABSTRACT FROM AUTHOR]

A new structural typology of a Steel-Reinforced Wooden (SRW) purlin made of rectangular laminated wood and C-section type cold-formed steel is presented in this article. The steel C-section profile is fitted onto the wooden purlin so that both work together as a composite unit. Although the wooden sections are weaker and have a lower elastic modulus than the steel sections, the overall dimensions of the SRW purlins are no larger than the steel C-section purlin sizes. The SRW purlins also form lighter structures than either plain steel or wooden purlins and they therefore have lower CO2 emissions. In addition, lighter purlins reduce the load on the main structure, which in turn reduces the material needed for the main structure of the building. So, reinforcement of the wooden purlin with steel sections within certain areas notably improved performance when compared with ordinary single-material purlins. The use of the SRW purlins can, therefore, improve the overall sustainability of a building. The improvements were analyzed in terms of sustainability and lower weight, as a function of span length and design load. The behaviors of the single material purlins and the SRW purlin were also compared. Both material strength and deformation design criteria and their influence were studied using an analytical approach based on loading and span length. The simple, innovative, and reliable design procedure described in this study ensured compliance with all technical requirements. Moreover, the savings relating to material weight were evaluated, neutralizing the carbon footprint in all cases under analysis. [ABSTRACT FROM AUTHOR]

We discuss two-photon physics, taking for illustration the particular but topical case of resonance fluorescence. We show that the basic concepts of interferences and correlations provide at the two-photon level an independent and drastically different picture than at the one-photon level, with landscapes of correlations that reveal various processes by spanning over all the possible frequencies at which the system can emit. Such landscapes typically present lines of photon bunching and circles of antibunching. The theoretical edifice to account for these features rests on two pillars: (i) a theory of frequency-resolved photon correlations and (ii) admixing classical and quantum fields. While experimental efforts have been to date concentrated on correlations between spectral peaks, strong correlations exist between photons emitted away from the peaks, which are accessible only through multi-photon observables. These could be exploited for both fundamental understanding of quantum-optical processes as well as applications by harnessing these unsuspected resources. This article is part of the theme issue 'Celebrating the 15th anniversary of the Royal Society Newton International Fellowship'. [ABSTRACT FROM AUTHOR]

Service robots could provide benefits for hotels in terms of productivity and even service quality. However, hotel managers in Spain (and Europe) have not implemented them as yet or are doing so only tentatively. This could be due to the fact that current literature is fragmented (i.e., dominated by hybrid models) and inconclusive and does not provide consistent guidelines for practitioners. This research narrows this gap by showing that a parsimonious application of the Theory of Planned Behavior is useful to predict attitude and buying intention toward robot-served hotels. Through an empirical analysis of 600 consumers in Spain, our findings indicate that hotel managers could focus on intrinsic motivations (enjoyment and challenge). They should also communicate the advantages of hybrid human–robot teams, in which the robots supplement humans instead of substituting them. The anthropomorphism of robots should not be emphasized as it seems to be perceived as a threat. Although utilitarian benefits matter, they seem to have a subordinate salience. [ABSTRACT FROM AUTHOR]

I. INTRODUCTION 361 II. SAME-SEX MARRIAGE 362 A. Background 362 B. The ObeRgefell Holding 362 C. Implementation and Enforcement Challenges Since Obergefell 364 III. STATE REGULATION OF MARRIAGE 366 A. [...]

Abstract Background Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited. Methods Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience—and resist—multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18–25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants’ experiences of health care discrimination were clustered into themes and sub-themes. Results Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination—both independently and simultaneously—in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks. Discussion Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.

This article examines the different meanings carried by the term poraka in the Jesuit missions of Paraguay. By crossing historical sources and contemporary ethnological works, we show that it designates both the hunting and the sharing of game. If the analysis of the Jesuit dictionaries shows that the missionaries try to privilege the technical dimension of the term, namely the supply of halieutic and cynegetic resources, an unpublished monolingual Guarani manuscript produced in the missions in the 18th-century shows that in daily language it designates the social dimension, the sharing of the game. In addition, the manuscript highlights the persisting tension, a century after the foundation of the missions, between the traditional Guaraní kinship system, and the Christian one, based on the nuclear family. The transformations of the meaning of the term poraka could thus reflect an effort by the Jesuits to modify the practices of sharing, reoriented towards the nuclear family. The article therefore proposes to examine kinship in the reductions through the sharing of game, an approach widely used in ethnology but unprecedented in the study of the Jesuit missions of Paraguay.

Steroids play a crucial role in modulating brain and behavior. While traditionally it is thought that the brain is a target of sex steroids produced in endocrine glands (e.g. gonads), the brain itself produces steroids, known as neurosteroids. Neurosteroids can be produced in regions involved in the regulation of social behaviors and may act locally to regulate social behaviors, such as reproduction and aggression. Our model species, the weakly electric fish Gymnotus omarorum, displays non-breeding aggression in both sexes. This is a valuable natural behavior to understand neuroendocrine mechanisms that differ from those underlying breeding aggression. In the non-breeding season, circulating sex steroid levels are low, which facilitates the study of neurosteroids. Here, for the first time in a teleost fish, we used liquid chromatography-tandem mass spectrometry (LC-MS/MS) to quantify a panel of 8 steroids in both plasma and brain to characterize steroid profiles in wild non-breeding adult males and females. We show that: 1) systemic steroid levels in the non-breeding season are similar in both sexes, although only males have detectable circulating 11-ketotestosterone, 2) brain steroid levels are sexually dimorphic, as females display higher levels of androstenedione, testosterone and estrone, and only males had detectable 11-ketotestosterone, 3) systemic androgens such as androstenedione and testosterone in the non-breeding season are potential precursors for neuroestrogen synthesis, and 4) estrogens, which play a key role in non-breeding aggression, are detectable in the brain (but not the plasma) in both sexes. These data are consistent with previous studies of G. omarorum that show non-breeding aggression is dependent on estrogen signaling, as has also been shown in bird and mammal models. Overall, our results provide a foundation for understanding the role of neurosteroids, the interplay between central and peripheral steroids and potential sex differences in the regulation of social behaviors.

PURPOSEHypofractionated breast radiotherapy has been found to be equivalent to conventional fractionation in many clinical trials. Using data from the European Society for Radiotherapy and Oncology Global Impact of Radiotherapy in Oncology survey, we identified preferences for hypofractionation in breast cancer across World Bank income groups and the perceived facilitators and barriers to its use.MATERIALS AND METHODSAn international, electronic survey was administered to radiation oncologists from 2018 to 2019. Demographics, practice characteristics, preferred hypofractionation regimen for specific breast cancer scenarios, and facilitators and barriers to hypofractionation were reported and stratified by World Bank income groups. Variables associated with hypofractionation were assessed using multivariate logistic regression models.RESULTSOne thousand four hundred thirty-four physicians responded: 890 (62%) from high-income countries (HICs), 361 (25%) from upper-middle–income countries (UMICs), 183 (13%) from low- and lower-middle–income countries (LLMICs). Hypofractionation was preferred most frequently in node-negative disease after breast-conserving surgery, with the strongest preference reported in HICs (78% from HICs, 54% from UMICs, and 51% from LLMICs, P < .001). Hypofractionation for node-positive disease postmastectomy was more frequently preferred in LLMICs (28% from HICs, 15% from UMICs, and 35% from LLMICs, P < .001). Curative doses of 2.1 to < 2.5 Gy in 15-16 fractions were most frequently reported, with limited preference for ultra-hypofractionation, but significant variability in palliative dosing. In adjusted analyses, UMICs were significantly less likely than LLMICs to prefer hypofractionation across all curative clinical scenarios, whereas respondents with > 1 million population catchments and with intensity-modulated radiotherapy were more likely to prefer hypofractionation. The most frequently cited facilitators and barriers were published evidence and fear of late toxicity, respectively.CONCLUSIONPreference for hypofractionation varied for curative indications, with greater acceptance in earlier-stage disease in HICs and in later-stage disease in LLMICs. Targeted educational interventions and greater inclusivity in radiation oncology clinical trials may support greater uptake.

Purpose Ankle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes. Methods This retrospective cohort study utilized data from the nationwide database (2006-2016) on TAA (n = 5,290) and ankle arthrodesis (n = 14,709) procedures. PNB use was defined from billing; outcomes included opioid utilization, length and cost of stay, discharge to a skilled nurse facility, and opioid-related complications. Mixed-effects models estimated the association between PNB use and outcomes, separate by procedure type and inpatient/outpatient setting. We report odds ratios and 95% confidence intervals (CI). Results Overall, PNB was utilized in 8.7% of TAA and 9.9% of ankle arthrodesis procedures, with increased utilization from 2006 to 2016 of 2.6% to 11.3% and 5.2% to 12.0%, respectively. After adjustment for relevant covariates, PNB use was significantly associated with decreased total opioid utilization specifically in the inpatient setting in TAA ( - 16.9% CI - 23.9%; - 9.1%) and ankle arthrodesis procedures ( - 18.9% CI - 24.4; - 13.0%), this was particularly driven by a decrease in opioid utilization on the day of surgery. No clinically relevant effects were observed for other outcomes. Conclusion PNB utilization is associated with substantial reductions in opioid utilization, particularly in the inpatient setting. Our study is in support of a wider use of this analgesic technique, which may translate into more benefits in terms of clinical outcomes and resource utilization. Level of Evidence III., Author(s): Jimmy J. Chan [sup.1], Evan Garden [sup.1], Jesse C. Chan [sup.1], Jashvant Poeran [sup.2], Nicole Zubizarreta [sup.2], Madhu Mazumdar [sup.2], Leesa M. Galatz [sup.1], Ettore Vulcano [sup.1] Author Affiliations: [...]

Abstract Alterations in time-varying functional connectivity (FC) have been found in Parkinson’s disease (PD) patients. To date, very little is known about the influence of sex on brain FC in PD patients and how this could be related to disease severity. The first objective was to evaluate the influence of sex on dynamic FC characteristics in PD patients and healthy controls (HC), while the second aim was to investigate the temporal patterns of dynamic connectivity related to PD motor and non-motor symptoms. Ninety-nine PD patients and sixty-two HC underwent a neuropsychological and clinical assessment. Rs-fMRI and T1-weighted MRI were also acquired. Dynamic FC analyses were performed in the GIFT toolbox. Dynamic FC analyses identified two States: State I, characterized by within-network positive coupling; and State II that showed between-network connectivity, mostly involving somatomotor and visual networks. Sex differences were found in dynamic indexes in HC but these differences were not observed in PD. Hierarchical clustering analysis identified three phenotypically distinct PD subgroups: (1) Subgroup A was characterized by mild motor symptoms; (2) Subgroup B was characterized by depressive and motor symptoms; (3) Subgroup C was characterized by cognitive and motor symptoms. Results revealed that changes in the temporal properties of connectivity were related to the motor/non-motor outcomes of PD severity. Findings suggest that while in HC sex differences may play a certain role in dynamic connectivity patterns, in PD patients, these effects may be overcome by the neurodegenerative process. Changes in the temporal properties of connectivity in PD were mainly related to the clinical markers of PD severity.

Background: Synovial sarcoma (SS) is characterized by local invasiveness and a propensity to develop distant metastases. Current treatment for pediatric patients is based on the strategy used by the two main international groups, the Children's Oncology Group (COG) and the European group (EpSSG).Overall survival (OS) and event free survival (EFS) vary according to different publications; however, they tend to be dismal in initially metastatic patients, as well as relapsed patients. Objective: To describe the clinical, histopathological, molecular findings and outcome in a series of 22 pediatric patients treated at our institution over 15 years. Materials and methods: A retrospective, descriptive study in patients with a histopathological or molecular diagnosis of SS between December 2005 and August 2019, treated according to the EpSSGNRSTS 2005 protocol. Results: Median age at diagnosis was 138.1 months, 32.1% presented with a primary axial site, and 68% with a tumor larger than 5 cm. Initial metastatic disease was seen in 22.7%. Of initially localized patients, 70.6% were classified as high-risk. Chemotherapy was administered to 91% of our patients and 77.2% received radiotherapy.The 3-5- and 10-year OS and EFS was 66%, 58.7% and 48.9%, and 57%, 33%, 22.2% respectively. Localized patients had a 5- and 10-year OS of 73.3% and 61.1%, versus 40% and 0% in metastatic disease, respectively.The only statistically significant factors were presence of metastasis, tumor size and IRS group.Tumor relapse was seen in 31.8% of patients. Only patients with local recurrence that achieved a complete surgery are alive without disease. Treatment schemes after recurrence or progression included a combination of gemcitabine-docetaxel, vincristine-irinotecan-temozolomide, kinase tyrosine inhibitors, and metronomic therapy with cyclophosphamide or etoposide. A long progression free survival of 14 months was observed with etoposide. Conclusions: Although the sample size was not large enough to draw robust conclusions, in our series, OS and EFS rates were found to be lower than those reported in other studies, probably related to unfavorable prognostic factors, including a high incidence of metastasis and tumors larger than 5 cm. New therapeutic strategies are needed to improve outcome, especially in metastatic and relapsed disease. In addition, assessing the role of maintenance therapy in larger numbers of patients and broadening the use of metronomic chemotherapy would be necessary.

Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.