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Physicians have gravitated toward larger group practice arrangements in recent years. However, consolidation trends in colorectal surgery have yet to be well described. Our objective was to assess current trends in practice consolidation within colorectal surgery and evaluate underlying demographic trends including age, gender, and geography. We performed a retrospective cross-sectional study using the Center for Medicare Services National Downloadable File from 2015 to 2022. Colorectal surgeons were categorized by practice size and by region, gender, and age. From 2015 to 2022, the number of colorectal surgeons in the United States increased from 1369 to 1621 (+18.4%), while the practices with which they were affiliated remained relatively stable (693-721, +4.0%). The proportion of colorectal surgeons in groups of 1-2 members fell from 18.9% to 10.7%. Conversely, those in groups of 500+ members grew from 26.5% to 45.2% (linear trend P < 0.001). The midwest region demonstrated the highest degree of consolidation. Affiliations with group practices of 500+ members saw large increases from both female and male surgeons (+148.9% and +86.9%, respectively). New surgeons joining the field since 2015 overwhelmingly practice in larger groups (5.3% in groups of 1-2, 50.1% in groups of 500+). Colorectal surgeons are shifting toward larger practice affiliations. Although this change is happening across all demographic groups, it appears unevenly distributed across geography, gender, and age. New surgeons are preferentially joining large group practices. [ABSTRACT FROM AUTHOR]

The article focuses on catastrophic sports injuries in high school and college athletes, differentiating between traumatic and nontraumatic incidents. Topics discussed include the incidence trends over the past 40 years, specific sports associated with these injuries especially football, cheerleading, and basketball, and preventive measures, such as rule changes and targeted screenings for conditions like sickle cell trait and cardiac abnormalities.

The selective oxidation of n -butane to maleic anhydride is a strongly exothermic reaction. Resulting local hot-spots and intraparticle temperatures high above the surrounding fluid temperature are challenging for safe and economic operation of reactors. Detailed modelling on all length scales is therefore required for an accurate description of this process. In this contribution, the one dimensional description of the ring-shaped catalyst, commonly used in continuum reactor modelling, is compared to three dimensional computational fluid dynamics simulations for the case of a single catalyst particle at different inclination angles (0 to 90°). Polytropic chemical reaction is considered under typical n -butane oxidation conditions (R e p = 400), representing a catalyst particle close to the inlet, (T = 673 K) and at the hot-spot (T = 730 K) of an industrial reactor. Comparative analysis suggests that the one dimensional simplification is justified when external transport phenomena are not the limiting resistance. Otherwise, neglecting two spatial dimensions leads to erroneous predictions. [Display omitted] • Comparing single particle CFD & continuum model simulations for n -butane oxidation • Continuum model representation can lead to erroneous intraparticle profiles • Description of surface conditions decisive under external transport limitation [ABSTRACT FROM AUTHOR]

Background: Cutaneous lupus erythematosus (CLE) can present later in life, but frequency and risk factors of late-onset CLE patients are not well characterized. The study determined frequency of late-onset CLE and compared the demographic and disease characteristics between early-onset and late-onset CLE in a cohort of patients with CLE. Objectives: To determine the frequency and compare clinical features of early-onset and late-onset CLE. Methods: This was a cross-sectional study of CLE patients seen in outpatient dermatology clinics at University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, TX, from April 2009 to May 2019. The primary outcome was the age of CLE onset, stratified by early-onset (<50 years) and late-onset CLE (≥50 years). Predictor variables significantly associated with CLE onset groups were identified by univariate and multivariable logistic regression analyses. Results: Of the 291 CLE patients studied, 79% were early-onset, and 21% were late-onset. Multivariable logistic regression analyses identified that Caucasian race (odds ratio (OR): 2.23, 95% Confidence Interval (CI): 1.19–4.19, p = 0.013), having a CLE subtype other than chronic (OR: 2.18, 95% CI: 1.02–4.65, p = 0.044), and drug-induced cases (OR: 4.65, 95% CI: 1.18–18.24, p = 0.028) were significantly associated with late-onset CLE. Early-onset CLE patients were more likely to have oral ulcers (OR: 3.58, 95% CI: 1.46–8.78, p = 0.005) and renal disorders (OR: 4.02, 95% CI: 1.10–14.71, p = 0.036). Limitations: This was a single center study. Age of onset was self-reported and late-onset CLE cohort has a small sample size. Conclusions: Our diverse cohort of CLE patients had about one out of five patients with CLE experiencing disease onset after 50 years old. These patients have distinct demographic and clinical presentations compared to early-onset CLE patients. Providers should remain mindful of CLE in older patients with photosensitive rashes and mild systemic symptoms. [ABSTRACT FROM AUTHOR]

This analysis of Barack Obama's "Address on the 50th Anniversary of the Selma, Alabama March" argues that the president used the African oral element of nommo to locate the civil rights protest within a broader narrative of American exceptionalism. In two stages, Obama first appealed to American exceptionalism to reconceptualize the impediments to Black citizenship at the time of the protest and then utilized counterargument to manage the tension between inclusion and exclusion underscoring the contemporary struggle for African Americans. While Obama's deployment of American exceptionalism functioned as an attempt to create a transformative perspective for the nation's pursuit of equality, the myth's colonialist foundation created space to decenter the Black cultural perspective from the debate over structural racism. Supplemental data for this article is available online at https://doi.org/10.1080/10646175.2021.1929580. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the relationship between acute, chronic, and acute:chronic sleep on aerobic performance in female youth soccer athletes. Fifty-nine female soccer players (13–18 years) reported prior night (acute) and average prior month (chronic) sleep duration before undergoing cycle ergometer testing to determine maximal aerobic capacity (VO2max), time to exhaustion (Tmax), and ventilatory threshold (VO2VT). Variables were grouped by prior night and prior month sleep duration (< 8 h, ≥ 8 h) as well as acute:chronic sleep (< 1, ≥ 1) and compared between groups using least squares means from age-adjusted linear models. No statistically significant differences were identified between those participants who slept ≥ 8 h the prior night and those who slept < 8 h, with respect to VO2max (50.3 ± 5.9 vs. 47.6 ± 5.9 ml/kg/min, p = 0.10, d = 0.45), Tmax (15.7 ± 2.8 vs.14.9 ± 2.2 min, p = 0.17, d = 0.37), or VO2VT (43.2 ± 5.4 vs. 40.7 ± 5.4 ml/kg/min, p = 0.09, d = 0.46). Participants who averaged ≥ 8 h of sleep in the prior month demonstrated significantly greater VO2max (50.2 ± 5.7 vs. 45.4 ± 5.7 ml/kg/min, p = 0.023, d = 0.83) and VO2VT (43.0 ± 5.2 vs. 39.0 ± 5.2 ml/kg/min, p = 0.016, d = 0.78), but not Tmax (15.6 ± 2.2 vs. 14.8 ± 2.2 min, p = 0.24, d = 0.37). On the other hand, participants with higher acute:chronic sleep demonstrated greater Tmax (16.4 ± 2.1 vs. 14.9 ± 2.1 min, p = 0.012, d = − 0.73), but not VO2max (50.1 ± 6.0 vs. 48.7 ± 6.0 ml/kg/min, p = 0.38, d = − 0.25) or VO2VT (42.7 ± 5.5 vs. 41.9 ± 5.5 ml/kg/min, p = 0.60, d = − 0.15). Greater chronic prior month sleep duration is associated with increased VO2max and VO2VT, while increased acute prior night sleep relative to the preceding month was associated with increased Tmax. [ABSTRACT FROM AUTHOR]

The gravel-bedded White River drains a 1279 km² basin in Washington State, with lowlands sculpted by continental glaciation and headwaters on an actively glaciated stratovolcano. Chronic aggradation along an alluvial fan near the river's mouth has progressively reduced flood conveyance. In order to better understand how forecasted climate change may influence coarse sediment delivery and aggradation rates in this lowland depositional setting, we assessed the contemporary delivery and routing of coarse sediment through the watershed; this assessment was based on a rich set of topographic, sedimentologic, and hydrologic data from the past century, with a focus on repeat highresolution topographic surveys from the past decade. We found that most of the lower river's contemporary bed-load flux originates from persistent erosion of alluvial deposits in the lower watershed. This erosion is a response to a drop in local base level caused by a major avulsion across the fan in 1906 and then augmented by subsequent dredging. The 1906 avulsion and modern disequilibrium valley profiles reflect landscape conditioning by continental glaciation and a massive mid-Holocene lahar. In the proglacial headwaters, infrequent large sediment pulses have accomplished most of the observed coarse sediment export, with exported material blanketing downstream valley floors; during typical floods, transported bed material is largely sourced from erosion of these valley floor floods. Throughout the watershed, we observe decadal-scale coarse sediment dynamics strongly related to the filling or emptying of valley-scale sediment storage over 10²-104 yr time scales, often in response to major disturbances that either emplace large deposits or influence their redistribution. Paraglacial responses in large watersheds are suggested to be inherently complicated and punctuated as a result of internal landform interactions and stochastic/ threshold-dependent events. We argue that, in combination, Holocene disturbance, storage dynamics, and human flow modification make coarse sediment fluxes in the lower White River relatively insensitive to decadal climate variability. Results highlight the degree to which river sensitivity to contemporary disturbance, climatic or otherwise, may be contingent on local and idiosyncratic watershed histories, underscoring the need to unpack those histories while demonstrating the utility of watershed-scale high-resolution topography toward that end. [ABSTRACT FROM AUTHOR]

Congenital kidney failure not only affects the homeostatic functions of the kidney, but also affects neonatal respiratory integrity. Until recently, extracorporeal membrane oxygenation (ECMO) support was not used in this population because the need for ECMO clearly established nonviability. Since 2016, 31 neonates have been admitted to the NICU at Children's of Alabama with congenital kidney failure. Five patients were placed on ECMO for severe respiratory distress unresponsive to conventional interventions. We evaluated neonates with congenital kidney failure and pulmonary hypoplasia/hypertension refractory to conventional therapies who received ECMO support within the first 9 postnatal days. We describe the pre and postnatal diagnoses, ECMO course details, dialysis modalities, complications, procedures, and long-term outcomes of these patients. All 5 patients received kidney support therapy by postnatal day 7. Diagnoses included posterior urethral valves, bilateral renal dysplasia, and autosomal recessive polycystic kidney disease. Gestational age ranged from 35.6 to 37.1 weeks. Birth weight ranged from 2740 to 3140 g. Days on ECMO ranged from 4 to 23. Four survived and are living today. Pulmonary hypertension resolved in surviving patients. Three surviving patients require no oxygen support, and 1 patient requires nocturnal oxygen. Three survivors received a kidney transplant, and 1 awaits transplant evaluation. Patients with congenital kidney failure with severe pulmonary hypoplasia/pulmonary hypertension no longer warrant a reflexive assignment of nonviability. Meticulous ECMO, respiratory, nutritional, and kidney support therapies may achieve a favorable long-term outcome. Further investigation of strategies for optimal outcome is needed. [ABSTRACT FROM AUTHOR]

Radiation damage has been a known problem at many synchrotron radiations and free-electron lasers facilities, especially those that use hybrid or pure permanent magnet undulators to produce high brightness light. Field strength loss due to demagnetization makes it necessary to remove the insertion device from the tunnel for inspection and repair, which brings several inconveniences. We aimed to develop an in situ radiation damage detection system for undulators capable of diagnosing relative field changes of 10−4 (100 ppm) or smaller. The system measures the flux change in a flexible printed circuit board coil attached to the undulator magnet array by periodically measuring the integral flux change during the opening and closing of the undulator gap. If the magnet block damage occurs, the signal from the coil will decrease proportionally to the damage. First tests performed on variable gap hybrid undulators for the Linac Coherent Light Source II (LCLS-II) at SLAC National Accelerator Laboratory showed that the system is capable of measuring flux changes with a relative precision of approximately $0.7 \times 10^{-4}$ over several days. Relative field changes smaller than 10−4 were detected in short-term measurements. The novel system that we propose here opens the possibility of detecting radiation damage in undulators during operation. [ABSTRACT FROM AUTHOR]

This article argues that Barack Obama deployed irony in conjunction with the African American rhetorical practice of signifyin(g) to eulogize Clementa Pinckney while addressing the June 2015 racially motivated killings of nine African Americans in Charleston, South Carolina. The engagement of irony and signifyin(g) constitutes a symbiotic theoretical exchange in which each frame functions independently but also operates in tandem to help Obama transform the tragedy into an opportunity for progress. In three successive stages, Obama exploits the interplay between these theoretical frames to create a new outlook on the shooting, expose structural forms of racism reinforced by whiteness, and chart a path forward for the nation's journey to equality. [ABSTRACT FROM AUTHOR]

The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background--this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes--this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist--this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References--this section provides the relevant references for this document. (5) Appendices--this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document. [ABSTRACT FROM AUTHOR]

The effects on the title reaction of collision energy (Ecol) and five H2CO+ vibrational modes have been studied over a center-of-mass Ecol range from 0.1 to 2.3 eV. Electronic structure and Rice–Ramsperger–Kassel–Marcus calculations were used to examine properties of various complexes and transition states that might be important. Only the hydrogen abstraction (HA) product channel is observed, and despite being exoergic, HA has an appearance energy of ∼0.4 eV, consistent with a transition state found in the electronic structure calculations. A precursor complex-mediated mechanism might possibly be involved at very low Ecol, but the dominant mechanism is direct over the entire Ecol range. The magnitude of the HA cross section is strongly, and mode specifically affected by H2CO+ vibrational excitation, however, vibrational energy has no effect on the appearance energy. © 2004 American Institute of Physics. [ABSTRACT FROM AUTHOR]

In this experiment, Type 316L stainless steel rods were fabricated through laser additive manufacturing (LAM) in three different orientations, and microstructural and mechanical changes induced by high dose ion irradiation were characterized based on orientation. The rods were irradiated with Fe2+ self-ions to a peak dose of 80 displacements per atom at 475°C. Results were compared to concurrently irradiated conventionally manufactured control specimens. Electron backscatter diffraction of the rods yielded statistically relevant information related to grain microstructure and texture. Transmission electron microscopy revealed a high density of elongated radiation-produced defects in the LAM specimens that were aligned with the major axes of the defects parallel to the build direction. Mechanical testing of LAM rods revealed anisotropic radiation-induced hardening, where hardening is greatest perpendicular to the build direction and least parallel to the build direction. Several radiation-induced hardening phenomena are considered that contribute to the observed anisotropic strengthening. [ABSTRACT FROM AUTHOR]

A direct, controlled comparison of the photodegradation of imazethapyr has been made between imazethapyr in aqueous solutions, imazethapyr on the surface of epicuticular waxes of corn and soybean plants, and imazethapyr on the surface of intact corn and soybean plant leaves. In some experiments, the imazethapyr solutions were allowed to evaporate partially or fully after application to better model environmental conditions. The photodegradation of imazethapyr was fastest in aqueous solutions (k = 0.16 ± 0.02 h−1) and slowest on the surface of corn and soybean plants (kcorn = 0.00048 ± 0.001 h−1 and ksoy = 0.00054 ± 0.003 h−1). Experiments allowing evaporation during irradiation have intermediate rate constants (e.g., kcorn = 0.082 ± 0.005 h−1). Finally, identification of photoproducts was also examined on epicuticular waxes of corn and soybean plants for the first time. [ABSTRACT FROM AUTHOR]

We studied the impact of clickers, also known as electronic student response systems, on the performance of students on two undergraduate finance courses. Consistent with some of the recent literature, we found that clickers have very little impact on student performance, as measured by final course grades. Further, we found that clickers do not have a significant impact on course grades for students in relation to their designated performance ability (weak versus strong) or whether the course in question is less or more difficult. However, after simultaneously controlling for course difficulty and student aptitude, we found that clickers have a meaningfully positive impact on the performance of poorly performing students on more challenging quantitative courses. Our results suggest that the impact of clickers on student performance may depend on the type of student (academically weak, average or strong) and the type of course (average or difficult). This finding has particular implications for curriculum planners at the post-secondary level, although the findings may also have application at the secondary school level. [ABSTRACT FROM AUTHOR]

Studies the collisions of rare gas ions with fullerenes by means of a guided-beam tandem mass spectrometer. Charge transfer (CT) as dominant channel over the collision energy range; Dissociative CT and endohedral complex formation at high collision energies; Threshold energies for endohedral penetration.

We report cross sections for reaction of mass-selected carbon cluster ions (Cn+, n=2–14) with O2 over a collision energy range of 0.1–10 eV. The results give insight into the oxidation mechanism and how it is affected by the isomeric structure of the reactant cluster ion. Small clusters, which are linear, react with no activation barrier, producing primarily CnO+ at low energies. Larger clusters, which are monocyclic, have activation barriers for reaction, and the product distribution is quite different. Reactions were also studied under multiple collision conditions, and addition of up to two O atoms is observed. Possible reaction mechanisms are discussed and comparison is made with the thermal kinetics results of McElvany and co-workers [J. Chem Phys. 86, 715 (1987)]. [ABSTRACT FROM AUTHOR]

Absolute cross sections for all ionic products formed in reactions of B+1–13 with oxygen have been measured under single collision conditions, at collision energies from 0.25 to 10 eV. Three main reaction mechanisms appear to be important: oxidative fragmentation, collision induced dissociation, and boron atom abstraction. The dominant oxidation process are exoergic for all cluster sizes, but appear to have bottlenecks or activation barriers for the larger cluster ions. Clusters smaller than B+6 have similar chemistry, then there is a sharp transition in chemistry for clusters larger than B+6 . Correlations are explored between cluster reactivity and cluster stability, and the oxidation chemistry is compared to the similar results found for aluminum cluster ion oxidation. [ABSTRACT FROM AUTHOR]

We report a study of the absolute cross sections, reaction threshold energies, and product branching ratios for interactions of aluminum cluster ions (Al+n, n=1–9) with O2 and N2O. Most of the reactions are observed to have collision energy thresholds which are attributed to activation barriers or bottlenecks. At collision energies above threshold, exoergic oxidation of the cluster ions occurs, and the resulting energy release causes extensive fragmentation to yield a variety of product ions. Comparison of threshold behavior for different product channels suggests that in addition to the dominant oxidation reactions, the clusters undergo Al abstraction, O2–Al+ exchange, and collision induced dissociation. [ABSTRACT FROM AUTHOR]

Three photon resonant, four photon (3+1) ionization spectroscopy and photoelectron spectroscopy have been used to study the ungerade excited states of acetylene in the energy range from 74 500 to 90 000 cm-1. Sharp bands from the nR (π3u nsσg) and 1[uppercase_phi_synonym]u (π3u ndδg) Rydberg series dominate the MPI spectrum. A large number of Rydberg and valence states which are prominent in VUV absorption spectra are absent or weak in MPI studies. These weak bands are only observable under high power conditions, which suggests that nonradiative decay is rapid enough to depopulate these states before ionization occurs. The photoelectron results provide further insight into the nature of the excited states. Ionization through the sharp bands occurs via Δν=0 Franck–Condon transitions, resulting in ions in a single vibrational state. Ionization through bands which are mixed results in complicated ion vibrational distributions including excitation of both cis and trans bends. [ABSTRACT FROM AUTHOR]

A molecular beam of phenol, cooled by a supersonic expansion, is crossed at right angles by the output of a pulsed frequency-doubled dye laser, causing 1+1 resonance enhanced multiphoton ionization. The kinetic energy of the resulting photoelectrons is determined as a function of laser wavelength with time-of-flight analysis, permitting the assignment of 11 vibrational frequencies for the 2B1 phenol-h6 cation and ten vibrational frequencies for phenol-d5. Of these, all but the lowest frequency one in each case are in-plane vibrations of which phenol has a total of 19. An approximate harmonic force field for the in-plane modes of the phenol cation is derived along with its associated frequencies and mode forms. This in turn facilitates the vibrational analysis. Analogous force field calculations have been carried out on the ground (1A1) and first excited (1B2) states of the neutral parent, permitting conclusions to be reached concerning bonding changes upon removal of an electron from the phenol electron system. [ABSTRACT FROM AUTHOR]

The article offer information on an alternative conception of coercion to try to mediate between the widespread view that some offers are coercive and the predominant view of coercion. It mentions the distinctive role coercers play in subjecting the wills of coercees; and also mentions that English-language analytic philosophers have begun to develop a body of work on the topic of vulnerability.

Medical devices, in the case of malfunction, can have tangible impact on patient safety. Their security, in a world where the Internet of Things has become a reality, is paramount to the continued safety of patients that are dependent upon these devices. The international standard ISO/IEC 80001 – Application of risk management for IT-networks incorporating medical devices presents a unified and amalgamated approach to the safety of medical devices connected to IT networks. Whilst this standard presents a guide for security and risk management in health delivery organisations, its effectiveness with regard to contemporary cybersecurity is unknown. This research employed a structured review process to compare and analyse the ISO/IEC 80001 technical controls standards (ISO/IEC 80001-2-2 and ISO/IEC 80001-2-8), with contemporary cybersecurity best practice, guidelines and standards. The research deconstructed the technical controls and drew links between these standards and cybersecurity best practice to assess the level of harmonisation. Subsequently, a deeper analysis identified the areas of omission, coverage, addition or improvement that may impact the effectiveness of ISO/IEC 80001 to provide effective cybersecurity protection. ISO/IEC 80001 aims to provide a minimal level of cybersecurity however this research demonstrates that there are deficiencies in the standard and identifies the important aspects of cybersecurity that could be improved. This situation has arisen due to the rapidly evolving nature of the cybersecurity environment and the protracted time to revise and republish international standards. This research identified several areas that require urgent consideration, including Emergency Access, Health Data De-Identification, Physical Locks on Devices, Data Backup, Disaster Recovery, Third-Party Components in Product Lifecycle Roadmap, Transmission Confidentiality, and Transmission Integrity. The research will provide health delivery organisations implementing ISO/IEC 80001, assurance as to the level of protection supplied by the ISO/IEC 80001 standard, and the areas that may need enhancement to increase cybersecurity protection and consequently increase in patient safety. Further, the outcomes are expected to influence development of the related international standard, as the findings from this research are being provided to the International Organisations for Standardisation, TC215 Health Informatics, Joint Working Group 7, to inform the review of ISO/IEC 80001 currently in progress. [ABSTRACT FROM AUTHOR]

On 17 June 2017, a landslide-generated tsunami reached the village of Nuugaatsiaq, Greenland, leaving four persons missing and presumed dead. Here, we present a preliminary high-resolution analysis of the tsunamigenic landslide scar based on three-dimensional (3D) reconstructions of oblique aerial photographs taken during a post-failure reconnaissance helicopter overflight. Through a 3D quantitative comparison with pre-failure topography, we estimate that approximately 58 million m3 of rock and colluvium (talus) was mobilized during the landslide, 45 million m3 of which reached the fjord, resulting in a destructive tsunami. We classify this event as a “tsunamigenic extremely rapid rock avalanche,” which likely released along a pre-existing metamorphic fabric, bounded laterally by slope-scale faults. Further analysis is required to properly characterize this landslide and adjacent unstable slopes, and to better understand the tsunami generation. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect against HPV-related head and neck cancer (HNC) in addition to HPV-related cervical and anogenital disease. While the association between HPV infection and cervical cancer is widely understood, its relation to HNC is less well known. The purpose of this study was to better understand HPV counseling practices for infection and vaccination in relation to HNC of primary care physicians (PCPs), Obstetricians/Gynecologists (OBGYNs), and Otolaryngology - Head and Neck Surgeons (OHNSs) in Canada. Methods: A Canada-wide electronic questionnaire regarding counseling practices on HPV infection, transmission, and vaccination was designed and distributed to PCPs, OBGYNs, and OHNSs across Canada through electronic and paper-based methods. Basic Descriptive statistics were used to analyze responses. Results: In total, 337 physicians responded (239 family physicians, 51 OHNSs, 30 OBGYNs, and 17 pediatricians). Three out of four PCPs reported routine counseling of their patients regarding HPV infection, transmission, and vaccination. Among this group, 68% reported "never" or "rarely" counseling patients that HPV can cause HNC. The most commonly reported reason that PCPs cited for not counseling was a lack of knowledge. The majority of OHNSs (81%) and OBGYNs (97%) counseled patients regarding HPV infection, transmission, and vaccination. However, very few OHNSs (10%) regularly counseled patients with HPV-related HNC about HPV-related anogenital cancer. Similarly, very few OBGYNs (18%) regularly counseled patients with HPV related cervical/anogenital cancer about HPV related HNC. Conclusions: The rate of counseling on HPV infection, transmission, and vaccination in relation to HNC among PCPs is low. The most common reason is a lack of knowledge. Specialists rarely counsel patients with confirmed HPV-related cancer about other HPV-related malignancies. More research is needed on the relationship between different HPV-related cancers in order to better inform counseling practices. [ABSTRACT FROM AUTHOR]

Study Purpose: Framed by intersectionality theory, this study examined how gender and sense of community belonging interact to influence sedentary behaviour during leisure among Métis adults in Canada. Methods: Data were obtained from 1,169 Métis adults who completed the Canadian Community Health Survey in 2012. Weighted linear regression models examined associations between sedentary behaviour and community belonging stratified by gender, adjusting for confounders. Results: Male gender, younger age, physical activity, and increased socioeconomic status were associated with less sedentary behaviour among Métis adults. Métis men with a very strong sense of community belonging spent 3.6 fewer hours per week engaged in sedentary pursuits during leisure than Métis men who reported a very weak sense of community belonging. Conversely, Métis women with a very strong sense of community belonging spent 1 additional hour per week engaged in sedentary pursuits during leisure than Métis women who reported a very weak sense of community belonging. These associations remained significant after adjustment for sociodemographic covariates and perceived mental health and overall health, suggesting other factors were influencing these differences. Conclusions: A strong sense of community belonging among Métis men may reduce sedentary behaviour during leisure by as much as 30 minutes per day, which may be clinically significant. Increased community belonging among Métis women was associated with increased sedentary behaviour. These findings suggest that interactions between community belonging and gender should be considered when developing interventions to reduce leisure sedentary behaviour among Métis adults in Canada. [ABSTRACT FROM AUTHOR]

Objective: To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals. Background: Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals. Recommendations: Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity. [ABSTRACT FROM AUTHOR]

To quantify trends in ophthalmology practice consolidation in the United States. A retrospective cross-sectional study. Providers in the Centers for Medicare and Medicaid Services (CMS) National Downloadable File with a primary specialty designation of ophthalmology. We used the CMS database to determine national practice consolidation trends in ophthalmology on individual physician and group practice levels and analyzed by region, sex, and years spent in practice. We used the Cochran-Armitage test to determine the statistical significance of practice size differences between 2015 and 2022. Temporal practice size trends for physicians and practices in ophthalmology and regional, sex-specific, and age-related trends. Between 2015 and 2022, the number of ophthalmologists decreased from 17 656 to 17 615 (–0.2%), whereas the number of practices decreased from 7149 to 5890 (–18%). The percentage of ophthalmologists in practices of 1 to 2 members decreased from 35% to 28%, whereas those in groups of 50 or more increased from 7% to 11%. The percentage of practices with 1 to 2 members decreased from 75% to 71%, and those with 50 or more increased from 0.2% to 0.4%. Consolidation trends were significant on individual ophthalmologist (P < 0.001) and group practice (P < 0.001) levels. All regions, sexes, and subgroups of years spent in practice demonstrated consolidation (P < 0.001). The Northeast showed the greatest increase in groups of 50 or more physicians (+7%) between 2015 and 2022. Proportionally fewer female than male ophthalmologists were associated with practice sizes of 1 to 2 members in 2015 (29% and 36%, respectively) and 2022 (23% and 30%, respectively). Proportionally fewer ophthalmologists with 0 to 10 years of experience in practice were associated with practice sizes of 1 to 2 members than those with more than 30 years in practice in 2015 (18% and 48%, respectively) and 2022 (14% and 40%, respectively). Ophthalmology has undergone practice consolidation from 2015 to 2022. A decrease in the proportion of physicians affiliated with smaller practice sizes seems to have occurred. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Off-season training in year-round collegiate football is purported to be performance enhancing. Absent principles of exercise physiology, excesses in sport-training regimens pose risk to the participant athletes. Since 2000, 33 National Collegiate Athletic Association (NCAA) football players have died in sport: 27 nontraumatic deaths and 6 traumatic deaths, a ratio of 4.5 nontraumatic deaths for every traumatic death. On average, 2 NCAA football players die per season. Best practices, consensus guidelines, and precautions are ignored, elevating the risk. However, standards exist that will, if heeded, prevent nontraumatic death in athletes training for sport. Sickle cell trait status knowledge and tailored precautions are preventing deaths from exertional collapse associated with sickle cell trait. Adherence to established principles of exercise physiology and best-practice training standards, which is long overdue, will help to prevent not only deaths from exertional collapse associated with sickle cell trait but also sudden cardiac, exertional heat stroke, and asthma deaths. [ABSTRACT FROM AUTHOR]

Many recent theories of coercion broaden the scope of the conceptcoercionby encompassing interactions in which one agent pressures another to act, subject to some further qualifications. I have argued previously that this way of conceptualizing coercion undermines its suitability for theoretical use in politics and ethics. I have also explicated a narrower, more traditional approach—“the enforcement approach to coercion”—and argued for its superiority. In this essay, I consider the prospects for broadening this more traditional approach to cover some cases that don’t seem to fit this approach, but nonetheless seem coercive, such as the demands routinely made on people by credit card companies, demands on students by higher educational institutions, and demands made by European financial institutions on the government of Greece. I analyze the similarities and differences of these compared to more central cases of coercion, discussing what lessons can be drawn from this analysis. [ABSTRACT FROM AUTHOR]

Conspectus: Mass-selected Ptn+ ion deposition in ultrahigh vacuum (UHV) was used to prepare a series of size-selected electrodes with Ptn (n ≤ 14) clusters supported on either glassy carbon (GC) or indium tin oxide (ITO). After characterization of the physical properties of the electrodes in UHV, an in situ method was used to study electrocatalytic activity for the oxygen reduction and ethanol oxidation reactions, without significant air exposure. For each reaction studied, there are similarities between the catalytic properties of Ptn-containing electrodes and those of nanoparticulate or bulk Pt electrodes, but there are also important differences that provide mechanistic insights. For all systems, strong cluster size effects were observed. For comparison, select experiments were done under identical conditions but with the Ptn electrodes exposed to air prior to electrochemical studies, resulting in strong modification/suppression of catalytic activity due to adventitious contaminants. For ethanol oxidation at Ptn/ITO, activity varies with size nonmonotonically, by more than an order of magnitude. The sharp size dependence persists during at least 30 to 40 cycles through the Pt redox potential, indicating that processes that would tend to broaden the size distribution are not efficient. All but the least active sizes are substantially more active per mass of Pt, than Pt nanoparticles under the same conditions. The oscillatory dependence of activity on size is anticorrelated with the binding energy of the Pt 4d core level, demonstrating that activity is controlled by the electronic structure of the supported clusters. For oxygen reduction at Ptn/ITO, the branching between water and hydrogen peroxide production is strongly dependent on cluster size, with small clusters selectively producing peroxide with high activity. The selectivity appears to be related to the size of the active site, with no obvious correlation to Pt electronic properties. The most unusual effect seen was for Ptn/GC, studied under acid conditions appropriate to oxygen reduction. Pt7 and a few other cluster sizes show “normal” oxygen reduction activity, similar to what is measured for Pt nanoparticles on GC under the same conditions. Many of the small clusters, however, are found to catalyze highly efficient oxidation, by water, of the glassy carbon support, with essentially no overpotential. The high activity for carbon oxidation for many Ptn/GC electrodes and the absence of significant carbon oxidation for a GC electrode with Pt nanoparticles raise the question of whether small Pt clusters may be responsible for much of the corrosion observed in Pt/carbon electrodes. This system provides another example where activity for oxidation catalysis is anticorrelated with the Pt core level binding energies, indicating that it is electronic, rather than geometric, structure that limits activity. [ABSTRACT FROM AUTHOR]

This study examined how income and community belonging may interact to influence leisure sedentary behavior among Indigenous adults. Data were obtained from 1,304 First Nations adults who completed the Canadian Community Health Survey in 2012. Among average-income earners, a strong sense of belonging to local community was associated with less sedentary behavior, a finding also documented in the general population. Among low-income earners, a strong sense of belonging to local community was associated with more sedentary behavior, a finding that is novel in the literature. These associations remained significant after adjustment for sociodemographic covariates and mental and physical health, suggesting other factors are influencing this correlation. [ABSTRACT FROM AUTHOR]

Several prominent theorists have recently advocated reconceptualizing rape as "nonconsensual sex," omitting the traditional "force" element of the crime. I argue that such a conceptualization fails to capture what is distinctively problematic about rape for women and why rape is pivotal in supporting women's gender oppression. I argue that conceptualizing rape as coerced sex can replace both the force and nonconsent elements and thereby remedies some of the main difficulties with extant definitions, especially in recognizing "acquaintance" rape as such. I argue that this approach helps explain its distinctive badness both for the individual victims and for women as a group. [ABSTRACT FROM AUTHOR]

Sprint interval training (SIT) can elicit improvements in aerobic and anaerobic capacity. While variations in SIT protocols have been investigated, the influence of social processes cannot be overlooked. As research supports the use of groups to influence individual cognitions and behaviours, the current project assessed the effectiveness of a group-based intervention with participants conducting SIT. Specifically, 53 amateur athletes (age, 21.9 ± 2.9 years; 53% females) took part in a 4-week training program (3 sessions per week, 30-s 'all-out' efforts with 4 min active recovery, repeated 4-6 times per session), and were assigned to 'true group', aggregate, or individual conditions. Results indicated no significant differences between groups for the physiological measures. With regards to training improvements from baseline for all participants- regardless of condition - significant main effects for time were identified for maximal oxygen uptake (2.5-2.8 mL·kg−1·min−1, p < 0.001, η2 = 0.03), time-trial performance (14-32 s, p < 0.001, η2 = 0.37), and anaerobic power (1.1-1.7 k·h−1, p < 0.001, η2 = 0.66). With regards to the psychological measures, significant main effects between groups were found for motivation ( p = 0.033, η2 = 0.13), task self-efficacy ( p = 0.018, η2 = 0.15), and scheduling self-efficacy ( p = 0.003, η2 = 0.22). The true group experienced greater improvements in motivation than the individual condition, but the aggregate and individual conditions demonstrated greater increases in task and scheduling self-efficacy. Though the SIT paradigm employed induced training improvements similar to previous work, the group intervention was not able to further these improvements. [ABSTRACT FROM AUTHOR]

Mindfulness has received an abundance of research attention in recent years, largely due to mindfulness-based interventions demonstrating positive mental and physical health outcomes. However, less research has examined individual’s trait levels of mindfulness and how it is related to mental health, particularly among individuals seeking substance use treatment. Therefore, in the current study, we examined the relation between trait mindfulness and early maladaptive schemas (EMS), which are dysfunctional cognitive and behavioural patterns that theoretically underlie the development of mental health problems, among women seeking residential substance use treatment. Pre-existing, adult female, patient records from a residential substance abuse treatment facility were reviewed (N = 67). Results demonstrated that higher trait mindfulness was negatively associated with 12 of the 18 EMS. Moreover, patients who endorsed multiple EMS reported lower trait mindfulness than patients who endorsed zero (or one) EMS. These findings are the first to examine the relation between trait mindfulness and EMS among women seeking substance use treatment. Findings suggest that EMS and trait mindfulness are robustly related and future research should examine whether mindfulness-based interventions reduce EMS. [ABSTRACT FROM PUBLISHER]

The article focuses on a study concerning discrete past injuries of first-time National Collegiate Athletic Association varsity sport participants. It states 11 percent of student-athletes wad unresolved injuries which were still symptomatic at the time of the electronic preparticipation evaluation, while 30 percent of injured student-athletes had a history of at least one surgery for injuries. It mentions this accounted for 57 percent of the time lost from sports before college participation.

The relative importance of extreme events in the long-term exhumation of landscapes is difficult to determine; the degree to which modern records capture long-term mean process rates is therefore commonly unknown. In September 2013, a massive precipitation event in the Front Range of Colorado (USA) triggered over 1100 landslides and debris flows in a historically sedate landscape. Here we employ topographic differencing, utilizing repeat aerial lidar, to quantify net sediment transport volumes in 120 of these mass movements within an area of 102 km2 west of Boulder, Colorado. Comparing our results against published long-term erosion rates, we find that these mass movements evacuated the equivalent of hundreds to thousands of years of hillslope weathering products. We conclude that (1) rare debris flows perform the majority of sediment transport and channel erosion within steep channels along the eastern edge of the Front Range, potentially explaining discrepancies between modern sediment yields and long-term erosion rates in such settings, and (2) the high spatial density of debris flows along the corridors bounding steep canyons suggests that the landscape switches to debris-flow dominance as knickpoints pass headward along the canyons. [ABSTRACT FROM AUTHOR]

We describe a safety assessment of an oral supplement designed to nutritionally support the gastrointestinal system of horses. The supplement comprised a mixture of essential ( l -threonine) and conditionally essential ( l -glutamine) amino acids, polar lipids, oat bran rich in beta glucans and yeast extract. Young (1–2 years) horses of both sexes were allocated to control ( n = 7) and treatment groups ( n = 7) and studied for 9 weeks. Horses in the treatment group received the supplement daily for 8 weeks. After 8 weeks of supplementation, horses were studied for one additional week. Outcome measures included body mass, weight gain, results of clinical examination, hematology and plasma chemistry. There were no adverse events associated with supplementation and horses in both groups showed normal weight gain, clinical signs, hematology and chemistry. l -Glutamine, which is not yet listed as GRAS, was considered with respect to its potential for nutritional support and safety when ingested orally. It is concluded that this oral supplement, when ingested by horses at twice the recommended daily level, was safe and does not pose a health risk when used in accordance with good feeding practice. [ABSTRACT FROM AUTHOR]

Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non-substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment ( n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Antisocial (ASPD) and Borderline (BPD) personality disorder symptoms are prevalence among individuals seeking substance abuse treatment., Early maladaptive schemas are believed to underlie the development of ASPD and BPD symptoms, and are also prevalence among individuals seeking substance use treatment., Findings from the current study suggest that specific early maladaptive schema domains predict ASPD and BPD symptoms in a substance abuse treatment seeking sample of adult males., The treatment of ASPD and BPD among men seeking substance use treatment may want to focus on early maladaptive schemas. [ABSTRACT FROM AUTHOR]