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At COP28, Carbon Capture, Utilization, and Storage was declared a removal technology whose application must be accelerated. In 2017, the Society of Petroleum Engineers (SPE) published the CO2 Storage Resource Management System (SRMS) as a framework for stakeholder communication. The SRMS guidelines were designed to support the creation of reports that inform readers regarding the contingencies that must be overcome to obtain project approval, uncertainty in the mass of CO2 that can be stored, and the commerciality of the project. However, working examples where the SRMS has been used to communicate project status in the public domain are limited. In 2023, the authors of this paper referred to the SRMS as the standard for completing an expert report, termed a Competent Persons Report (CPR), for the Viking Carbon Capture and Storage (CCS) development in the United Kingdom. During the application of the SRMS framework, challenges were identified in conveying the progress made by the project proponent in identifying and addressing technical risks. This paper describes innovations developed to supplement the SRMS guidelines and improve communication with stakeholders. First, a flowchart was developed to explain a vital interpretation of the SRMS. Next, a defined framework of technical milestones was designed to assess the maturity of a given technical topic within the SRMS. This framework was combined with radial data visualization. The combination allowed multiple storage sites to be compared simultaneously and allowed stakeholders to quickly identify the maturity of technical analysis for any given site. We conclude that improving the consistency and clarity of CCS reporting to stakeholders can help build trust in this emerging industry.

As usinas hidrelétricas (UHE) ocupam importante papel na matriz energética brasileira. Sobretudo, na região da Amazônia, onde se localiza a maior parcela do potencial hidrelétrico inventariado. O presente trabalho teve como objetivo analisar os impactos socioeconômicos ocasionados nas etapas de construção e operação de UHE de grande porte na região da Amazônia Legal. Para isso, foram analisados os impactos socioeconômicos identificados em Salvador). Os impactos socioeconômicos foram segregados de acordo com a etapa do ciclo de vida do empreendimento (construção e operação); comparou-se os impactos em uma matriz e os dados foram analisados de forma descritiva. Verificou-se que existem muitas similaridades e correlação entre os impactos socioeconômicos levantados nos 5 estudos selecionados. Durante a análise, verificou-se que muitos dos impactos levantados nos estudos não foram devidamente mitigados. De maneira geral os custos sociais, como a realocação da população são subestimados, e os ganhos pela operação da UHE são superestimados. Espera-se que o levantamento realizado dos impactos socioeconômicos ocasionados por UHE na Amazônia Legal possibilite ampliar a discussão sobre estas obras em áreas de sensibilidade socioambiental. Por fim, conclui-se que os impactos socioeconômicos presentes nos estudos avaliados estão associados a múltiplos conflitos entre a população atingida pelo empreendimento, o poder público e o empreendedor.

Abstract Background We aimed to describe the roles and challenges of family caregivers involved in patients' cancer treatment decision‐making. Methods Family caregiver‐reported data were analyzed from a national survey conducted in the United States by CancerCare® (2/2021–7/2021). Four select‐all‐that‐apply caregiver roles were explored: (1) observer (patient as primary decision‐maker); (2) primary decision‐maker; (3) shared decision‐maker with patient and (4) decision delegated to healthcare team. Roles were compared across five treatment decisions: where to get treatment, the treatment plan, second opinions, beginning treatment and stopping treatment. Ten challenges faced by caregivers (e.g., information, cost, treatment understanding) were then examined. χ2 and regression analyses were used to assess associations between roles, decision areas, challenges and caregiver sociodemographics. Results Of 2703 caregiver respondents, 87.6% reported involvement in patient decisions about cancer treatment, including 1661 who responded to a subsection further detailing their roles and challenges with specific treatment decisions. Amongst these 1661 caregivers, 22.2% reported an observing role, 21.3% a primary decision‐making role, 53.9% a shared decision‐making role and 18.1% a role delegating decisions to the healthcare team. Most caregivers (60.4%) faced ≥1 challenge, the most frequent being not knowing how treatments would affect the patient's physical condition (24.8%) and quality of life (23.2%). In multivariable models, being Hispanic/Latino/a was the strongest predictor of facing at least one challenge (b = −0.581, Wald = 10.69, p

Abstract Purpose To assess the impact of primary‐site surgery plus systemic therapy compared to systemic therapy alone on overall survival in common metastatic cancer types. Methods Data sources included Embase, PubMed, and Web of Science (January 1, 1995–March 22, 2023). Randomized controlled trials were included that enrolled patients diagnosed with the 10 most common de novo metastatic cancer types in the Surveillance, Epidemiology, and End Results database and randomized patients to resection of the primary site and systemic therapy versus systemic treatment alone. Random‐effects models were used to pool associations by cancer type. Results Eight studies with 1774 patients evaluating the efficacy of surgery in breast, renal, stomach, and colorectal cancer were included. There was no statistically significant reduction in risk of all‐cause mortality associated with surgical intervention for metastatic breast (HR = 0.94, 95% CI 0.63–1.40) or renal cancer (HR = 0.79, 95% CI 0.53–1.20), although results were heterogeneous (I2 = 73.7% and 80.6%, respectively). One study evaluating gastrectomy in metastatic stomach cancer found no benefit (HR = 1.09, 95% CI 0.78–1.52), while a small trial suggested that surgery and hyperthermic intraperitoneal chemotherapy might be beneficial for colorectal cancer with peritoneal metastasis (HR = 0.55, 95% CI 0.32–0.95). Conclusions Few randomized trials have evaluated cancer‐directed surgery among patients with metastatic solid malignancies.

The aim of this article, of a qualitative approach and descriptive-exploratory nature, was to analyze the contribution of audiovisual material made available on the YouTube platform with the participation of Ubiratan D'Ambrosio on Ethnomathematics. The procedure was a survey and selection of audiovisual material on YouTube with a speech by D'Ambrosio that included the subject of Ethnomathematics and with more than 5,000 views. Six videos, which were made available between 2013 and 2020, were selected. They have a duration varying between five minutes and two hours. The audiovisual material available contains conceptualization and discussion of Ethnomathematics, in addition to the possibility of access and comprehension in a distinctive manner utilizing digital media. According to the theorist, and based on the video analysis, Ethnomathematics is a cultural construction carried out by different groups in their daily lives in the search for survival and transcendence. The importance of digital media as a means of access to information and democratization of knowledge is also emphasized.

Abstract Background Family caregivers play an increasing role in cancer treatment decision‐making. We examined bias reported by family caregivers in the support they and their patient received from their healthcare team when making these decisions, including associations with distress. Methods Analysis of 2021 national survey data of family caregivers of patients with cancer (N = 2703). Bias experienced in decision support was assessed with the item: “Have you felt that the support you and the person with cancer have received for making cancer‐related decisions by your doctor or healthcare team has been negatively affected by any of the following?” Check‐all‐that‐apply response options included: age, race, language, education, political affiliation, body weight, insurance type or lack of insurance, income, religion, sexual orientation, and gender/sex. Chi‐square and regression analyses assessed associations between bias and caregiver distress (GAD‐2, PHQ‐2). Results Of 2703 caregiver respondents, 47.4% (n = 1281) reported experiencing ≥1 bias(es) when receiving decision support for making cancer‐related decisions. Bias was more prevalent among younger caregivers, males, transwomen/men or gender non‐conforming caregivers, racial/ethnic minorities, and those providing care over a longer time period. The odds of having high anxiety (GAD‐2 scores ≥ 3) were 2.1 times higher for caregivers experiencing one type of bias (adjusted OR, 2.1; 95% CI, 1.6–2.8) and 4.2 times higher for caregivers experiencing ≥2 biases (adjusted OR, 4.2; 95% CI, 3.4–5.3) compared to none. Similar results were found for high depression scores (PHQ‐2 scores ≥ 3). Conclusions Nearly half of caregivers involved in their care recipients' cancer‐related decisions report bias in decision support received from the healthcare team. Experiencing bias was strongly associated with high psychological distress.

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes.

Partindo do princípio de que as práticas pedagógicas embasadas na experiência visual contribuem para um melhor aprendizado dos alunos surdos, este estudo investigou o uso do corpo como estratégia de mediação pedagógica durante a implementação do protocolo do Livro Digital Acessível (LDA) em duas turmas de surdos matriculados no 3º ano do Ensino Fundamental I em uma escola pública de Duque de Caxias/RJ que adota como proposta pedagógica o Bilinguismo. Pretende-se neste texto analisar as representações visuais sobre o corpo enquanto suporte visual no processo de ensino e aprendizagem. A metodologia desta pesquisa embasou-se na perspectiva histórico-cultural (FREITAS, 2002; SOUZA, 2001), com viés da pesquisa participante (TRIPP, 2005). Participaram do estudo três professoras da educação básica e quatro alunos surdos. Conclui-se que explorar o corpo enquanto recurso visual nas significações do mundo contribuiu para que os conteúdos fossem compreendidos pelos alunos; o corpo enquanto marca cultural carrega as impressões sociais e que a mediação pedagógica foi fundamental para que os assuntos abordados em aula fossem compreendidos.

This study identifies network management as a facilitator of effective policy transfer. We reconstruct the unconventional collaboration between Dutch private-sector experts and national governments of Vietnam and Bangladesh to develop multi-sectoral, long-term strategies (‘delta plans’). We identify the network management strategies used by the Dutch actors and use these to explain how problem perceptions of state and non-state actors were aligned in order to define solution pathways. Based on these cases, we argue that network analysis is a tool for policy transfer studies. This paper further concludes that the ‘soft’ nature of the transferred policy (in the form of principles, norms and ideas) increased its transferability, as being ambiguous and abstract left room for interpretation and translation to the local context.

O objetivo do artigo é discutir sobre a formação stricto sensu como um dos caminhos para uma formação continuada que contribua com o processo de emancipação humana. Reitera-se pensar a formação continuada como possibilidade de investigação, fundamentação, organização e análise por meio do estabelecimento de relações e construção da práxis possibilita que a formação stricto sensu faça parte desse escopo. Entende-se que nela existe a oportunidade de que, após a formação inicial, seja possível ir além da “capacitação”, do “aperfeiçoamento” ou do “treinamento”, visto que se refere a um processo que possibilita a construção da própria atividade e não se restringe apenas à aquisição de conhecimentos científicos e de sua aplicabilidade, pois leva em conta as dimensões políticas, éticas, estéticas e subjetivas. Considera-se que a formação no nível stricto sensu tem potencial de lócus de uma formação continuada de professores comprometida com um projeto de emancipação humana que compreenda que a educação escolar compõe um dos complexos sociais que podem atuar pela estruturação das condições objetivo-subjetivas em prol da emancipação humana a partir do tripé ensino, pesquisa e extensão.

Analisamos a aplicação de uma oficina pedagógica em um curso de Licenciatura em Pedagogia de uma universidade pública. A oficina propiciou, durante a formação inicial, discussão acerca da Educação Matemática e a experimentação de situações de inclusão de estudantes com deficiência física, visual e altas habilidades/superdotação. Foram utilizadas como ações pedagógicas o trabalho em grupo, atividades lúdicas e avaliação da oficina. Os resultados apontaram a importância do trabalho sobre o conhecimento matemático na formação inicial dos professores e as possibilidades da Educação Matemática Inclusiva na perspectiva dos Direitos Humanos. Por isso, a necessidade de se desenvolver e praticar estratégias e metodologias inovadoras que possibilitem a inclusão dos estudantes com deficiência em aulas de Matemática.

Abstract Background XMU-MP-1 is an inhibitor of the Hippo pathway kinases MST1/2 and has been shown to promote the downstream activation of the pro-proliferative, pro-regenerative and anti-apoptotic transcriptional regulator YAP1. We tested whether XMU-MP-1 can activate YAP1 in a model human mini-organ, namely the hair follicle, to determine whether it can be pharmacologically exploited to promote regeneration in the hair follicle as a novel strategy to treat pathological hair loss disorders. Results XMU-MP-1 treatment inhibited MOB1 phosphorylation but did not increase active YAP1 in the hair follicle. Rather than promote proliferation, XMU-MP-1 serendipitously decreased the number of Ki-67+, EdU+ and phospho histone H3+ hair matrix keratinocytes and antagonised the cytotoxic effects of paclitaxel. Conclusions XMU-MP-1 perturbs epithelial cell cycle progression in a model human mini-organ. This may arise as an off-target effect, especially when XMU-MP-1 has been described to strongly inhibit 21 additional kinases beyond MST1/2. Therefore, whilst these effects may be dependent on tissue context, researchers should exercise caution when interpreting the effects of XMU-MP-1, especially in tissues with actively proliferating cell populations.

A partir da díade migração e educação este artigo objetiva verificar os documentos curriculares da Educação Básica da Região Nordeste do Brasil a fim de compreender como tais documentos refletem o fenômeno migração. Com base na orientação pós-estruturalista investigou-se os documentos à busca de marcações e variações da presença do sujeito migrante, considerando diferentes tradições teóricas, exercendo a bricolagem de modo crítico. Como considerações têm-se que os documentos curriculares ainda não consideram o fenômeno migração internacional e sua complexidade de modo contundente por meio de dois movimentos, o primeiro da invisibilidade e o segundo da consideração fragmentada e não problematizadora.

O artigo tem como objetivo compreender como as ações governamentais têm materializado a articulação entre pós-graduação em educação Stricto Sensu e educação básica no que diz respeito à formação de professores através da discussão acerca da relação entre a formação stricto sensu e a formação continuada de professores que atuam na educação básica. As inquietações que levaram à escrita deste artigo foram as questões relativas ao papel da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); aos objetivos dos Programas de Pós-graduação em Educação (PPGE) em relação à formação dos seus discentes; à compreensão da diferença entre o mestrado profissional e acadêmico em termos de proposta para formação stricto sensu do professor da educação básica, em relação aos regimentos dos programas de pós-graduação stricto sensu em educação. Para possibilitar a investigação proposta fez-se uma pesquisa bibliográfica sobre a temática e análise de documentos do Ministério da Educação (MEC), da CAPES e dos programas de pós-graduação stricto sensu. Como considerações é possível inferir que existem ações que materializam possíveis articulações entre a pós-graduação stricto sensu e a educação básica, bem como instituições que já trazem em seus regimentos essa questão. Porém, ainda há um longo caminho a ser trilhado na aproximação entre universidade e escola.

Abstract Taxanes are a leading cause of severe and often permanent chemotherapy‐induced alopecia. As the underlying pathobiology of taxane chemotherapy‐induced alopecia remains poorly understood, we investigated how paclitaxel and docetaxel damage human scalp hair follicles in a clinically relevant ex vivo organ culture model. Paclitaxel and docetaxel induced massive mitotic defects and apoptosis in transit amplifying hair matrix keratinocytes and within epithelial stem/progenitor cell‐rich outer root sheath compartments, including within Keratin 15+ cell populations, thus implicating direct damage to stem/progenitor cells as an explanation for the severity and permanence of taxane chemotherapy‐induced alopecia. Moreover, by administering the CDK4/6 inhibitor palbociclib, we show that transit amplifying and stem/progenitor cells can be protected from paclitaxel cytotoxicity through G1 arrest, without premature catagen induction and additional hair follicle damage. Thus, the current study elucidates the pathobiology of taxane chemotherapy‐induced alopecia, highlights the paramount importance of epithelial stem/progenitor cell‐protective therapy in taxane‐based oncotherapy, and provides preclinical proof‐of‐principle in a healthy human (mini‐) organ that G1 arrest therapy can limit taxane‐induced tissue damage.

Objective To determine the value and perspectives of intensive care unit (ICU) healthcare professionals (HCPs) and families about the Glass Door (GD) decal team communication tool.Design Quality improvement methodology was used to design, test and implement the GD. Uptake was measured through audit. Impact was assessed through mixed methodology (survey of ICU HCPs (n=96) and semi-structured interviews of HCPs (n=10) and families (n=7)).Setting Eighteen bed, closed, mixed medical–surgical–cardiac ICU in a tertiary care, university-affiliated, paediatric hospital.Population Interdisciplinary ICU HCPs and families of children admitted to the ICU.Intervention A transparent template (the GD) applied to the outside of ICU patients’ doors with sections for HCPs names, physiological goals and planned tests and treatments for the day. Medical staff completed the GD in rounds (AM and PM) and any HCP caring for the patient updated it throughout the day.Measurements and main results After 3 months, 96% of 613 doors were employed of which 99% respected confidentiality. ICU HCPs reported improved understanding of the patient’s plan (84% today vs 59% pre-GD, p

Resumo O objetivo do trabalho foi avaliar os parâmetros físico-químicos, microbiológicos e a aceitabilidade de iogurtes funcionais, com e sem suplementação de frutooligossacarídeos, sabor cajá. Elaborou-se quatro formulações de iogurte, sendo elas: duas com leite integral com e sem suplementação de frutooligossacarídeos e duas com leite desnatado com e sem suplementação de frutooligossacarídeos. Foram analisados os valores de pH, acidez titulável, sólidos solúveis, padrões microbiológicos de qualidade, contagem de bactérias lácticas totais e análise sensorial, na qual foram realizadas perguntas sobre frequência de consumo, conhecimento dos benefícios relacionados ao consumo de produtos lácteos fermentados, intenção de compra e índice de aceitabilidade. Quanto ao pH, a formulação elaborada com leite integral e frutooligossacarídeos apresentou diferença significativa (p < 0,05) em relação às demais formulações. Não houve diferenças significativas (p > 0,05) quanto à acidez titulável e sólidos solúveis. A contagem de bactérias lácticas totais demonstrou valores elevados que atendem aos parâmetros da legislação. As formulações apresentaram qualidade higiênico-sanitária satisfatória e foram bem aceitas pelos consumidores para todos os atributos avaliados no teste sensorial. Assim, apresentaram-se viáveis em termos sensoriais, físico-químicos e microbiológicos, com potencial aproveitamento pela população por possuírem características simbióticas benéficas à saúde.

O artigo apresenta resultados de pesquisa sobre a [re]construção de identidades na contradição trabalho-capital, no contexto da Comunidade Quilombola Tambaí-Açu – Mocajuba/PA, Amazônia. Trata-se de investigação qualitativa, pautada no materialismo histórico-dialético. Conclui-se que o trabalho na comunidade é permeado por interesses antagônicos, dado a coexistência com modo de produção capitalista, configurado no monocultivo intensivo da pimenta-do-reino, e a negação a esta lógica, ao [re]criarem saberes do trabalho que compõem os mutirões quilombolas.

Objective: The aim of this study was to determine the prevalence of tuberculosis (TB) in adolescents in western Kenya. Methods: A cohort study of 5004 adolescents aged 12–18 years was conducted. Adolescents were screened for prevalent TB using clinical criteria, history of TB contact, and a Mantoux test. Cases of suspected TB were investigated through two sputum examinations (microscopy and liquid culture) and chest radiography. Results: Out of 5004 adolescents enrolled, 1960 (39.2%) were identified with suspected TB, including 1544 with a positive Mantoux (prevalence 1544/4808, 32.1%), 515 with symptoms suggestive of TB (10.3%), and 144 (2.9%) with household TB contact. Sixteen culture-confirmed (definite) and 18 probable pulmonary TB (PTB) cases were identified, reflecting a prevalence estimate of 3.2/1000 (definite) and 6.8/1000 all PTB, respectively. Only one smear-positive case was detected. The case notification rate among 12–18-year-old adolescents for all TB was 101/100 000, yielding a patient diagnostic rate of 0.13 (95% confidence interval 0.03–3.7) cases detected per person-year for all TB. Conclusion: The prevalence of PTB among adolescents is high, with the majority of cases not detected routinely. Innovative active case finding including the wider use of Xpert MTB/RIF is needed to detect smear-negative TB among adolescents.

Summary: WNT signaling promotes the reprogramming of somatic cells to an induced pluripotent state. We provide genetic evidence that WNT signaling is a requisite step during the induction of pluripotency. Fibroblasts from individuals with focal dermal hypoplasia (FDH), a rare genetic syndrome caused by mutations in the essential WNT processing enzyme PORCN, fail to reprogram with standard methods. This blockade in reprogramming is overcome by ectopic WNT signaling and PORCN overexpression, thus demonstrating that WNT signaling is essential for reprogramming. The rescue of reprogramming is critically dependent on the level of WNT signaling: steady baseline activation of the WNT pathway yields karyotypically normal iPSCs, whereas daily stimulation with Wnt3a produces FDH-iPSCs with severely abnormal karyotypes. Therefore, although WNT signaling is required for cellular reprogramming, inappropriate activation of WNT signaling induces chromosomal instability, highlighting the precarious nature of ectopic WNT activation and its tight relationship with oncogenic transformation. : WNT signaling is required for embryonic development, maintenance of stem cells in an undifferentiated state, and homeostasis of adult tissues. Here, Ross et al. provide genetic evidence that this signaling pathway is also essential to the process of reprogramming of somatic cells to an induced pluripotent state. These studies also reveal an unexpected link between aberrant WNT signaling and chromosomal instability.

A pós-graduação no país tem um papel fundamental na formação de pesquisadores e na geração de pesquisas e conhecimentos novos a respeito da temática metalinguística e alfabetização. Nesse sentido, o objetivo do presente artigo foi mapear a produção acadêmica brasileira sobre desenvolvimento metalinguístico e linguagem escrita, no período de 2005 a 2010, em dissertações e teses. Para este levantamento, foi consultado o banco de teses da CAPES. Os resultados foram organizados conforme o nível da pós-graduação, área de concentração, estado, universidade, termos-chave, características e número de sujeitos investigados, delineamento da pesquisa e ano de defesa. Constatou-se que a produção anual dobrou neste período, somando 187 estudos produzidos nestes cinco anos. Porém, o aumento quantitativo não foi acompanhado, em igual medida, pela diversificação no tipo de delineamento, faixa etária dos sujeitos e das habilidades metalinguísticas investigadas. Os resultados são discutidos em termos de avanços, limitações e tendências para novos estudos.

Sparta has long enjoyed the reputation of a polis that was hostile toward and incompetent in τὰ ναυτικά. Impediments, including its location and agrarian economic base, made it difficult for Sparta to challenge Athenian sea power before the last decade of the fifth century. Herodotus and Thucydides, moreover, repeatedly offer support for the Athenian-based stereotype of the Lacedaemonian “landlubber”. Both authors, however, provide accounts of Spartan naval activity that question the assumption that the Spartans were “at sea” when it came to naval matters.

During mammalian meiosis, double-strand breaks are deliberately made throughout the genome and then repaired, leading to the exchange of genetic material between copies of chromosomes. How the locations of breaks are specified was largely unknown until a fortuitous confluence of statistical genetics and molecular biology uncovered the role of PRDM9, a DNA binding protein. Many properties of this protein remain mysterious, however, including how it binds to DNA, how it contributes to male infertility-both in humans, and in hybrid mice-and why, in spite of its fundamental function in meiosis, its binding domain varies extensively among humans and across mammals. We present a brief summary of what has recently been learned about PRDM9 in different fields, focusing on the puzzles yet to be resolved.

Despite the fundamental role of crossing-over in the pairing and segregation of chromosomes during human meiosis, the rates and placements of events vary markedly among individuals. Characterizing this variation and identifying its determinants are essential steps in our understanding of the human recombination process and its evolution.Using three large sets of European-American pedigrees, we examined variation in five recombination phenotypes that capture distinct aspects of crossing-over patterns. We found that the mean recombination rate in males and females and the historical hotspot usage are significantly heritable and are uncorrelated with one another. We then conducted a genome-wide association study in order to identify loci that influence them. We replicated associations of RNF212 with the mean rate in males and in females as well as the association of Inversion 17q21.31 with the female mean rate. We also replicated the association of PRDM9 with historical hotspot usage, finding that it explains most of the genetic variance in this phenotype. In addition, we identified a set of new candidate regions for further validation.These findings suggest that variation at broad and fine scales is largely separable and that, beyond three known loci, there is no evidence for common variation with large effects on recombination phenotypes.

Each year increasing numbers of people participate in a wider variety of athletic endeavors. Unlike previous generations, many patients remain in these activities later into their lives, some well beyond retirement. As the population ages and their activities continue, they are subject to injury of various forms affecting all aspects of their bodies., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Primary bone tumors are infrequently encountered in a sports medicine practice. We describe a case in which a young athletic woman with a medical history significant for ulcerative colitis initially presented to our clinic with chronic hip pain. Her initial roentograms were negative for boney pathology and her history and examination were consistent with trochanteric bursitis. However, follow-up radiographs performed 9 months later showed a radiolucent mass that eventually, after open biopsy and histologic evaluation, was determined to be giant cell tumor. This case shows the importance of repeat radiographic studies in patients whose joint pain does not respond or responds slowly to conservative therapy, despite initial normal findings. It also establishes that radiographic findings do not always correlate with actual disease process, for this lesion was found to be giant cell carcinoma--a diagnosis contrary to the original diagnosis of clear cell chondrosarcoma that was suggested by radiology., (Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Scapular instability may be the result of a variety of casues of which the clinician should be made aware. Work-up should include an initial radiographic evaluation and may require more in-depth investigation. Treatment should be prescribed dependent on the underlying diagnosis. In most cases, instability about the scapula can be treated with a careful plan of exercises to strengthen the involved musculature. It may take upwards of 12 to 18 months to achieve adequate results. Nonoperative failures may need to be treated with surgical techniques including nerve dissection and reconstruction with muscle flaps.

Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain.

This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of knee and lower extremity injuries that commonly occur during athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.

This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of shoulder and upper extremity injuries commonly occurring from athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.